干预措施对骨科术后患者自控硬膜外镇痛认知程度的影响

Influence of Interventions on the Cognition of Patient Controlled Epidural Analgesia after Orthopedic Surgery

目的探讨干预措施对骨科术后患者自控硬膜外镇痛（PCEA）认知程度的影响。方法选择2011年4月至2014年4月长江航运总医院收治的178例骨科术后患者为研究对象,采用自行设计调查问卷调查所有患者对疼痛和PCEA的认知程度,并比较不同年龄和文化程度组干预前后的变化。结果骨科术后患者对疼痛的认知程度处在较低水平,73.6%（131/178）的患者认为术后疼痛是必然的,认为疼痛会对生理、心理造成影响的患者分别为42.2%（75/178）和61.2%（109/178）,认为疼痛会影响切口愈合的仅有26.4%（47/178）;骨科术后患者对PCEA的认知程度非常低,仅有6.7%~15.2%对6项内容完全了解,绝大部分表示为不了解,干预后患者对6项内容的了解程度较干预前均显著增加（P〈0.05）;骨科术后患者采取各种干预措施后,不同文化程度和不同年龄的患者对PCEA的认知程度均明显改善（P〈0.05）,且文化程度越高组和年龄较轻组改善更为显著（P〈0.05）。结论骨科术后患者对疼痛和PCEA的认知状况较低,应提高患者对疼痛的认知,加强PCEA的知识宣教,使骨科患者术后镇痛在临床上得到广泛应用。

Objective To investigate the influence of interventions on the cognition of patient controlled epidural analgesia（ PCEA） after orthopedic surgery. Methods A total of 178 orthopedic patients hospitalized in Yangtze River Shipping General Hospital from Apr. 2011 to Apr. 2014 were included in the study,and the awareness of pain and PCEA of all patients were investigated by self-designed questionnaire,and the changes after the intervention in patients with different ages and education backgrounds were compared.Results The pain awareness of patients after orthopedic surgery was on a low level,73. 6%（ 131 /178） of the patients believed the postoperative pain was inevitable,patients who believed the pain would impact on physiological,psychological accounted for 42. 2%（ 75 /178） and 61. 2%（ 109 /178）,only 26. 4%（ 47 /178）patients believed that pain would affect wound healing; awareness of PCEA of orthopedic patients was very low,only 6. 7%-15. 2% patients understood the full content of the six items,most expressed they didn＇ t understand. The percentage of patients understanding the content of the six items after the intervention increased significantly than before（ P〈0. 05）. After various interventions,the awareness of PCEA in patients with different education backgrounds and ages were significantly improved（ P〈0. 05）,and the higher education group and the younger age group improved more significantly（ P〈0. 05）. Conclusion The cognitive status of pain and PCEA of orthopedic postoperative patients is low,the patient＇s knowledge of pain should be improved,and the education on PCEA should be strengthened,and the postoperative analgesia should be widely applied on the orthopedic patients in clinical.