急性疼痛服务组织全程干预对患者术后静脉自控镇痛效果的影响

Effects of whole intervention by acute pain service on the quality of patient controlled analgesia

目的评估急性疼痛服务组织（acutepainservice，APS）术后当日查房联合术前、术后疼痛查房全程干预对患者静脉自控镇痛（patientcontrolledintravenousanalgesia，PCIA）效果和满意度的影响。方法采用回顾性分析方法，纳入2013年1月-2013年6月实施PCIA的胸腹部手术患者393例，将术前、术后当日、术后次日接受APS全程干预的PCIA患者204例作为实验组，将接受常规术前、术后查房干预，未能进行术后当日查房干预的189例患者作为对照组，通过术后镇痛数据库和Docare手术麻醉系统提取患者的一般情况、手术麻醉、术后镇痛、患者满意度等相关资料，进行统计分析。结果两组患者术后24h内静息数字评分法（numericalratingscale，NRS）评分比较，实验组[（1．3±1．2）分]低于对照组[（1．8±1．4）分]，差异有统计学意义（P〈0．01）；活动痛NRS评分比较，实验组[（2．8±1．0）分]低于对照组[（3．3±1．1）分]，差异有统计学意义（P〈0．01）：术后48h舒芬太尼累计用量组间比较，实验组[（123±25）μg]低于对照组[（145±24）μg]，差异有统计学意义（P〈0．01）；患者镇痛不全的发生率干预组为7．4％、对照组为13．8％，差异有统计学意义（P〈0．05）；满意度评分实验组[（4．5±0．1）分]高于对照组[（4．0±0．1）分]，差异有统计学意义（P〈0．01）。结论APS小组对PCIA患者实施全程干预不仅可以降低镇痛不全发生率，减轻PCIA患者术后24h内的疼痛，提高患者的舒适度和满意度，而且可以减少镇痛药物的使用量。

Objective To evaluate postoperative patient satisfaction and analgesic effect with patient controlled intravenous analgesia（PCIA） by acute pain service（APS） rounds missionaries to postoperative patients by whole intervention. Methods Three hundred ninety-three patients undergoing thoracic or abdomen surgery were retrospectively analyzed. All patients received postoperative PCIA after surgery 4 h. The patients in the experimental group received postoperative intervention on the operation day except preoperative education and pain around in the next day. The patients in the control group were not given postoperative intervention on the operation day. All patients were anesthetized using a unified program and analgesic programs, recording the patient＇s analgesic rounds assess the degree of control, pain score, sufentanil dosage, and postoperative complications. Results The rest numerical rating scale （NRS） of patients in the experimental group during the postoperative 24 h were（1.3±1.2）, which was lower than that of the controlled group （1.8±1.4）（P〈0.001 ）. The movement NRS of patients in the experimental group during postoperative 24 h were（2.8±1.0）, which was lower than that of the controlled group （3.3±1.1）（P〈0.001 ）. The total dose sulfentanyl used in postoperative 48 h, was （123±25）μg in the experimental group and （145±24） μg in the control group, respectively （P〈 0.001 ）. The incidence of inadequate postoperative analgesia was 7.4% in the intervention group and 13.8% in the control group, respectively, with a significantly statistical significant （P〈0.05）. The mean satisfaction score of patients was （4.5 ±0.1 ） in the intervention group and （4.0±0.1） in the control group, respectively （P〈0.001）. Conclusions The whole intervention by APS team gives can not only improve the quality of postoperative pain management by reducing inadequate postoperative analgesia and pain score of the patients undergoing PCIA, improving patient comfort and satisfaction, but also reduce the total dosages of analgesic medication.