无痛病房管理模式在肝癌患者围术期的应用

Application of Painless Ward Management Model for Patients with Liver Cancer during Perioperative Period

目的探讨无痛病房管理模式对肝癌患者围术期疼痛控制及术后恢复的影响。方法选取2013年在我科住院行手术切除的原发性肝癌患者182例,将其随机分为对照组(85例)和观察组(97例)。对照组患者给予传统的疼痛管理模式,观察组患者给予无痛病房管理模式。比较两组患者术后下床活动时间、肠道通气时间、夜间睡眠时长、住院时间、并发症发生率及疼痛控制满意度间的差异。结果观察组术后下床活动时间、肠道通气时间、住院时间分别为(1.82±0.41)、(1.83±0.52)、(9.74±1.42)d,均低于对照组的(3.01±0.62)、(2.72±0.81)、(12.83±2.92)d(P<0.05),而夜间睡眠时长则较对照组延长〔(7.4±0.8)h与(5.7±0.7)h,P<0.05〕。术后观察组并发症发生率为12.4%(12/97),与对照组的17.6%(15/85)比较无差异(P>0.05)。观察组对疼痛控制不满意6例(6.2%),满意61例(62.9%),非常满意30例(30.9%);对照组对疼痛控制不满意42例(49.4%),满意38例(44.7%),非常满意5例(5.9%),观察组疼痛控制满意度优于对照组(P<0.05)。结论无痛病房管理模式在肝癌围术期的应用不仅缩短了患者术后下床活动时间、肠道通气时间及住院时间,延长了术后夜间睡眠时长,还提高了患者对住院期间疼痛控制的满意度,有效改善了患者围术期的生活质量,促进了患者早日康复。

Objective To investigate the effects of painless ward management model on pain control and postoperative recovery of patients with hepatocellular carcinoma（ HCC） during perioperative period.Methods 182 patients with HCC who underwent hepatectomy in our department were randomly divided into control group（ 85 cases） and observation group（ 97 cases）.The patients in observation group underwent painless ward management model and those in control group underwent traditional pain management model.Time for get out of bed after surgery,postoperative intestinal exhaust time,duration of night sleep,duration of hospital stays,incidence of postoperative complication and satisfaction degree for pain- control were compared between two groups of patients.Results The time for get out of bed after surgery,postoperative intestinal exhaust time and duration of hospital stays in observation group were（ 1.82 ± 0.41） d,（ 1.83 ± 0.52） d and（ 9.74 ± 1.42） d,respectively,which were significantly shorter than those in control group 〔（ 3.01 ± 0.62） d,（ 2.72 ± 0.81） d,（ 12.83 ± 2.92） d,respectively,P 〈0.05〕; Duration of night sleep in observation group was（ 7.4 ± 0.8） h,which was significantly longer than that（ 5.7 ± 0.7）h in control group（ P 〈0.05）.There was no significant difference in incidence of postoperative complication between observation group 〔12.4%（ 12 /97） 〕and control group 〔17.6%（ 15 /85） 〕（ P 〉0.05）.Satisfaction degree for pain- control in observation group： 6（ 6.2%） were not satisfied,61（ 62.9%） were satisfied,30（ 30.9%） were very satisfied; satisfaction degree for pain- control in control group： 42（ 49.4%） were not satisfied,38（ 44.7%） were satisfied,5（ 5.9%） were very satisfied.Satisfaction degree in observation group was significantly better than that in control group（ P 〈0.05）.Conclusion Application of painless ward management model for patients with HCC during perioperative period can shorten time for get out of bed after surgery,postoperative intestinal exhaust time and duration of hospital stays,prolong duration of night sleep,improve satisfaction degree for pain- control during hospitalization,effectively improve the quality of life of patients during perioperative period,and promote a soon recovery.