无线远程镇痛泵监控系统用于术后患者镇痛管理的可行性及有效性研究﹡

FEASIBILITY AND EFFICACY OF THE WIRELESS REMOTE PATIENT-CONTROLLED INTRAVENOUS ANALGESIA MONITORING SYSTEM FOR POSTOPERATIVE ANALGESIA MANAGEMENT AFTER THORACOSCOPY PULMONARY LOBOTOMY

目的：探讨无线远程镇痛泵监控系统用于胸腔镜肺叶切除患者术后镇痛管理的可行性及有效性.方法：将82例静吸复合全身麻醉下行胸腔镜肺叶切除的患者随机分为远程管理组39例,传统管理组43例;远程管理组采用无线远程镇痛泵监控系统进行术后PCIA （patient-controlled intravenousanalgesia,PCIA）镇痛管理,传统管理组采用传统PCIA镇痛管理;两组镇痛药物配方均为舒芬太尼（1μg/ml）;传统管理组术后常规每日床旁随访患者,患者出现疼痛强度评分≥4分时,由护士通知麻醉科会诊,再由研究者补救镇痛;远程管理组在常规随访基础上,远程监控PCIA泵按压次数及疼痛评分,研究者根据监控结果主动到床旁评估患者疼痛强度并补救镇痛.结果：无线远程镇痛泵监控系统与PCIA泵的数据记录一致性较好,Kappa值为0.966～1;与传统管理组相比,远程管理组患者术后第二日24 h平均疼痛评分较低（2.4±0.7 vs 3.0±1.0,P＜0.01）,术后第一日3 PM和术后第二日9AM活动时疼痛评分较低（3.0±1.5 vs 3.8±1.7,P＜0.05; 3.0±1.0 vs 3.7±1.7,P＜0.05）;远程管理组患者和医务人员对镇痛效果的满意度高于传统管理组.结论：无线远程镇痛泵监控系统用于术后镇痛管理,安全可行,能改善镇痛效果,有助于为患者实施个体化镇痛管理,提高患者及医务人员对镇痛效果的满意度.

Objective： To evaluate the feasibility and efficacy of the wireless remote patient-controlled intravenous analgesia monitoring system for postoperative analgesia management after thoracoscopy pulmonary lobotomy. Methods： 82 patients, receiving thoracoscopy pulmonary lobotomy underwent intravenous-inhalation combined anesthesia were randomly allocated into two groups. In the remote management group patients （n = 39） received analgesia management through the wireless remote patientcontrolled intravenous analgesia （PCIA） monitoring system, whereas in the traditional management group patients （n = 43） received analgesia management through traditional PCIA. Both of them were infused with sulfentanil 1 μg/ml. Patients in traditional management group received routine bedside follow-up and remedy analgesia from investigators after the nurses informed the anesthetist that the patient is suffering from moderate pain （ numerical rating scale, NRS ≥ 4 ） . In the wireless remote PCIA monitoring system, the system would automatically monitor the performance of the PCIA, and the researcher will provide bedside service when the patient is suffering moderate pain （NRS≥ 4）. Results： There was highly consistencybetween the wireless remote PCIA monitoring system and the recorded data of PCIA pump, and the kappa statistic was 0.966 - 1. Patients in remote management group reported lower scores than in traditional management group when compared the average pain score of the 24 h on the second day （ 2.4±0.7 vs 3.0±1.0, P 〈 0.01 ） , the activity pain at 3 PM on the first day and at 9 AM on the second day after operation （ 3.0±1.5 vs 3.8± 1.7, P〈 0.05; 3.0±1.0 vs 3.7± 1.7, P〈 0.05 ） . Patients and medical staffs were both more satisfied with Analgesia management in remote management group than in traditional management group. Conclusion： The Wireless Remote Patient-Controlled Intravenous Analgesia Monitoring System used in postoperative analgesia management could improve analgesic effect, provide personalized analgesic and enhance the satisfaction of the patients and medical staffs with preferable feasibility and efficacy.