老年骨科术后患者进行早期规律性疼痛干预对降低基础疾病发生率效果的研究

发布时间：2018-06-15 04:00

本文选题：老年 + 下肢骨折术后　；参考：《内蒙古大学》2017年硕士论文

【摘要】：中国已进入老龄化社会,各种多发疾病的高频出现使得更多老年人必须接受手术治疗。对于患有基础疾病的老年人来说,因手术引起的疼痛是另一种危害健康和影响生活质量的潜在不利因素。有目的的对术后老年患者进行早期规律性的疼痛干预,既可以缓解痛苦,又可以降低基础疾病的诱发。因而,对老年患者的围手术期进行疼痛干预,显得尤为重要。而在疼痛强度评估中,骨科疼痛的级别较高。但医护人员及患者家属,对病人的疼痛感重视程度均不够。尤其严重的是,对于老年患者,手术后引发的中重度疼痛可能会成为自身基础疾病的诱发因素。为此,本论文选取临床病例进行老年患者术后的早期疼痛干预,以便探索这种干预对基础疾病诱发的抑制效果。临床病人选择标准如下:住院期限:2015至2016年度;年龄及性别:60至75岁男性;病因:下肢骨折手术;疼痛级别:中度疼痛。样本数总计为200例,包括合并高血压的患者100例(其中50例作为对照组,进行被动不规律的疼痛干预;另外50例作为实验组,进行早期规律的疼痛干预);合并冠心病的患者100例(其中50例作为对照组,进行被动不规律的疼痛干预;另外50例作为实验组,进行早期规律的疼痛干预)。早期规律疼痛干预的方法为:术后留置镇痛泵+口服药物,镇痛泵内药物:布比卡因注射液(Bupivacaineinjection)150mg持续泵入;3日后改为:氨酚双氢可待因片(paracetamol and dihydrocodeine tartrate tables)500mg,每6小时口服一次。被动不规律的疼痛干预方法为:患者自述疼痛时,对症止痛治疗。给于氨酚双氢可待因片500mg 口服。通过每日对患者血压、心率、主诉的测量及调查,分析两种不同干预方式对基础疾病的影响。并得到如下实验结果:1、骨折合并高血压患者样本病例中,早期规律疼痛干预病例与被动不规律疼痛干预病例比较,血压值异常例数少,正常例数多,异常率低。2、骨折合并冠心病患者样本病例中,早期规律疼痛干预病例与被动不规律疼痛干预病例比较,出现自主症状及心律失常的例数少,正常例数多,异常率低。由上述结果得出如下结论:早期规律的对老年骨科术后患者进行疼痛干预,不仅会提高患者的舒适度,减轻痛苦,而且对降低基础疾病的诱发率也有一定的抑制作用。
[Abstract]:China has entered an aging society, and the high frequency of various diseases makes more elderly people have to undergo surgical treatment. Surgical pain is another potential health hazard and quality of life hazard for older people with underlying diseases. The early regular pain intervention can not only relieve the pain but also reduce the induction of underlying diseases. Therefore, it is particularly important to intervene in the perioperative period of the elderly patients. In pain intensity assessment, orthopaedic pain is higher. However, medical staff and patients' families do not pay enough attention to patients' pain. In particular, in elderly patients, moderate and severe postoperative pain may be a predisposing factor for underlying diseases. In order to explore the inhibitory effect of the intervention on underlying diseases, this paper selected clinical cases to carry out early postoperative pain intervention in elderly patients. Clinical patient selection criteria are as follows: hospitalization duration: 2015-2016; age and sex: male: 60 to 75; etiology: lower limb fracture surgery; pain grade: moderate pain. The total number of samples was 200, including 100 patients with hypertension (50 as control group for passive and irregular pain intervention, and 50 as experimental group). There were 100 patients with coronary heart disease (50 cases as control group) and 50 cases as experimental group with early regular pain intervention. The methods of early regular pain intervention were as follows: after operation, intrapump administration of bupivacaine injection Bupivacaineinjection 150mg and paracetamol and dihydrocodeine tartrate tablesserine 500mg every 6 hours. Passive and irregular pain intervention methods are as follows: when patients report pain, they should be treated with symptomatic pain relief. 500mg was administered orally to aminophenol dihydrocodeine tablets. The effects of two different intervention methods on the underlying diseases were analyzed by measuring and investigating the blood pressure, heart rate and complaint of the patients daily. And obtained the following experimental results: 1. In the sample cases of fracture and hypertension, the early regular pain intervention cases compared with the passive irregular pain intervention cases had fewer abnormal blood pressure values and more normal cases. The abnormal rate was low. In the sample of patients with fracture and coronary heart disease, the cases of early regular pain intervention and passive irregular pain intervention had fewer cases of spontaneous symptoms and arrhythmias, more normal cases and lower abnormal rate. The conclusions are as follows: early regular pain intervention in the elderly orthopedic patients will not only improve the comfort of the patients, alleviate the pain, but also reduce the induced rate of basic diseases has a certain inhibitory effect.
【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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