小儿围术期镇痛管理现状及效果研究

Current situation and effect study of peri-operative analgesia management in children patients

目的调查小儿围术期急性疼痛管理现状及其家属满意度,为完善小儿术后疼痛管理循证转化策略提供依据。方法采用便利抽样的方法对我院2018年4-6月术后预计出现中重度疼痛的100例患儿及其家属进行问卷调查。结果患儿术中采用区域阻滞技术镇痛者占42%,术后均使用镇痛泵,其中静脉镇痛泵占96%,术后镇痛药物中仅使用盐酸氢吗啡酮的占88%;患儿出苏醒室总的疼痛评分最低(1.63±1.41)分,术后24h和48h的疼痛评分最高,分别为(4.03±1.39)分和(4.21±1.14)分,术后72h下降为(3.50±0.81)分,术后12~72h中重度疼痛的发生率之和均大于50%;术后出现恶心呕吐者69例次。家属对护士日常的疼痛评估满意度最高,对术后疼痛缓解程度满意度最低,总体满意度仅70.25%。结论患儿围术期疼痛管理仍存在很多问题,希望加快制定出更加安全有效的疼痛策略和管理模式,以减轻患儿术后疼痛,提高家属满意度。

Objective To investigate the status of peri-operative acute pain management and the satisfaction of family members in children,and to provide evidence for improving the evidence-based transformation strategy of post-operative pain management in children.Methods A questionnaire survey was conducted on 100 children and their families who were expected to have moderate to severe pain after surgery from April to June 2018 in our hospital.Results Regional block technique was used for analgesia in 42%of children,and analgesia pump was used after operation,in which intravenous analgesia pump accounted for 96%,and hydro morphine hydrochloride alone accounted for 88%of postoperative analgesia drugs.The total pain score when leaving the post anesthesia care unit(PACU)was the lowest,which was(1.63±1.41)points.The highest pain scores were(4.03±1.39)and(4.21±1.14)at 24h and 48h after surgery,and decreased to(3.50±0.81)at 72h after surgery.The proportion of moderate to severe pain was more than 50%at 12 to 72 hours after the operation.Postoperative nausea and vomiting occurred in 69 person-time.The family members were most satisfied with the daily pain assessment of nurses,and the least satisfied was the postoperative pain relief,with the overall satisfaction was accounting for only 70.25%.Conclusions There are still many problems in peri-operative pain management.It is necessary to speed up the development of safer and more effective pain strategies and management models to reduce postoperative pain and improve family satisfaction.