3种术前教育方法对开胸手术患者术后自控镇痛的作用

Effect of three different preoperative education methods on patients applied patient-controlled analgesia after anatomize chest surgery

目的探讨3种术前教育方法对开胸手术患者术后自控镇痛(PCA)的作用。方法类实验性研究。以单纯随机抽样法选择开胸术后使用PCA泵的患者90例,分为对照组,实验组Ⅰ和实验组Ⅱ,每组30例。对照组术前1天由麻醉医师进行术前教育,介绍PCA泵使用方法;实验组Ⅰ术前2天阅读"自控镇痛术前教育手册",并进行面对面系统化口头教育,术前1天再进行1次,时间共60 min;实验组Ⅱ术前2天观看自控镇痛视听教材后进行面对面个别指导,用示教用PCA泵教会患者使用方法。评价3组术后6、24、36、48 h的疼痛强度。结果术后6、24、36、48 h,对照组疼痛评分明显高于实验组Ⅰ、Ⅱ;术后6、24、36 h,实验组Ⅰ疼痛评分明显高于实验组Ⅱ;术后48 h实验组Ⅰ疼痛评分与实验组Ⅱ比较,差异无显著性意义。结论系统化口头教育、发放教育手册及观看教育录像配合PCA泵练习能有效降低开胸术后患者的疼痛,术后36 h内,观看教育录像配合PCA泵练习比系统化口头教育及发放教育手册能更有效地降低术后疼痛。

Objective To explore the effect of three different preoperative education methods on patients applied patient-controlled analgesia （PCA） after anatomize chest surgery. Meth- ods Quasi-experimental study. 90 patients applied intravenous PCA after anatomize chest surgery were divided into three groups： control group, experimental group Ⅰ and experimental group Ⅱ （n=30 in each group）. One day before operation, anesthetists introduced how to use PCA to control group; two days before operation, group I read preoperative education hand- book of patient-controlled analgesia and were given face-to-face systematic preoperative oral ed- ucation which will be also done in the next day for 60 min; while two days before operation, after watching video course of patient-controlled analgesia, group Ⅱ were given face-to-face personal guidance which helped them to use PCA. VAS pain scores at 6, 24, 36 and 48 hours after operation were evaluated. Results The pain scores in experimental group I and II were lower than those of control group at 6, 24, 36 and 48 hours after operation. 6, 24 and 36 hours the pain scores in experimental group Ⅱ were obviously lower than those of group Ⅰ. There were no significant difference between experimental group Ⅰ and Ⅱ at 48 hours. Conclusion Systematic preoperative oral education preoperative education handbook and practising PCA af- ter watching video course can effectively decrease the patients pain after anatomize chest sur- gery. Within the early postoperative 36 hours, practising PCA after watching video course was more effective than systematic preoperative oral education and giving preoperative education handbook.