急性疼痛服务团队早期干预对患者术后自控镇痛效果的影响

Effects of early pain intervention provided by an patient-controlled analgesia

目的评价急性疼痛服务（APS）团队早期干预对术后自控镇痛效果的影响。方法选择2011年11～12月，在本院手术并要求术后镇痛的患者1467例，按手术月份分为对照组和干预组，其中11月份患者为对照组（n=725），12月份患者为干预组（n=742）。术后均采用舒芬太尼PCIA。对照组由负责麻醉的医生和责任护士常规术前宣教，介绍PCA使用的意义、操作要点、注意事项，嘱咐患者疼痛时，按压电子镇痛泵，如10min后无缓解，由APS医生调整镇痛泵参数或加用其他镇痛药物；干预组由麻醉科APS医生、复苏室专职疼痛护士和病房疼痛护士给予系统的疼痛控制教育，包括PCA使用的意义、操作要点、镇痛药物的介绍和注意事项、疼痛评估方法及超前镇痛的必要性，在手术前和出复苏室前给予2次疼痛教育，嘱咐患者在活动前或轻度疼痛时（VAS≤3分）按压自控镇痛泵，疼痛剧烈时由APS医生调整镇痛泵参数或加用其他镇痛药物。记录镇痛不全、不良反应的发生情况及患者满意度。结果与对照组比较，干预组镇痛不全发生率降低，患者满意度升高（P〈0．05），不良反应发生率差异无统计学意义（P〉0．05）。结论APS团队早期干预可增强术后自控镇痛效果，提高患者的满意度。

Objective To evaluate the clinical effects of early pain intervention provided by an acute pain service team on the efficacy of postoperative patient-controlled analgesia （PCA）. Methods One thousand four hundred and sixty-seven patients receiving postoperative PCA in November and December 2011 were enrolled in this study. Patients were excluded from the study if they were 〈 12 yr, unconscious or uncoorperative. The patients were divided into control group （group C, n = 725） and intervention group （group I, n =742）. Group I received preoperative systematic pain education on the significance and correct use of PCA including pharmacology of anal- gesic （sufentanil 100 μg in normal saline 100 ml） by an acute pain service team made up of anesthesiologists and nurses specializing in pain management. The education was repeated immediately before operation and when the patients were discharged from recovery room. While in group C the correct use of PCA was explained routinely before operation by anesthesiologists and nurses taking care of the patients. The incidence of incomplete analgesia and adverse reactions and patient＇ s satisfaction were rated. Results The incidence of incomplete analgesia was significandy lower and the patient＇s satisfaction higher in group I than in control group. There was no significant difference in adverse reactions between the two groups. Conclusion Early pain intervention provided by an acute pain service team is effective in improving the efficacy of postoperative PCA and patient＇ s satisfaction.