华西医学

华西医学

加速康复外科模式的大肠癌患者术后急性疼痛控制现状及影响因素评价

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目的 描述加速康复外科模式的大肠癌患者术后疼痛控制的现状,探讨影响疼痛控制现状的因素。 方法 2017 年 3 月—12 月选取四川大学华西医院胃肠外科中心实施加速康复外科模式的大肠癌术后患者,对符合入选标准的 74 例术后第 3 天住院疼痛患者进行问卷调查,问卷由一般资料核查表、休斯顿疼痛情况调查表、焦虑自评量表及社会支持评定量表组成。采用均数±标准差和百分比描述疼痛经历总分情况,单因素分析采用t 检验、方差分析、Spearman 相关分析,多因素分析采用多重线性回归。 结果 术后疼痛经历得分为(15.1±3.8)分。单因素结果显示:疼痛对日常生活的影响(rs=0.270,P=0.020)、对控制疼痛教育的满意度(rs=–0.283,P=0.015)、主观支持(rs=–0.326,P=0.005)、社会支持利用度(rs=–0.253,P=0.029)与疼痛经历总分存在相关关系。多因素分析结果显示:对控制疼痛教育的满意度(P<0.001)、主观支持(P=0.005)是术后疼痛经历总分的负性影响因素,重度焦虑(P=0.001)、术后疼痛期望值(P=0.016)是术后疼痛经历总分的正性影响因素。 结论 患者总体疼痛控制情况较好,良好的疼痛教育和较高的主观支持有助于缓解患者的疼痛,医护人员应重视重度焦虑患者,帮助患者建立术后合理的疼痛期望值。

Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.

关键词: 加速康复外科; 大肠癌; 术后疼痛; 疼痛控制

Key words: Enhanced recovery after surgery; Colorectal cancer; Postoperative pain; Pain management

引用本文: 黄明君, 汪晓东, 李卡. 加速康复外科模式的大肠癌患者术后急性疼痛控制现状及影响因素评价. 华西医学, 2018, 33(12): 1486-1490. doi: 10.7507/1002-0179.201811063 复制

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