基于疼痛护理质量指标指引下的护理干预在骨科术后患者疼痛管理中的应用实践

The application practice of nursing intervention under the guidance of pain care quality in pain management of patients undergone orthopedic surgery

目的分析基于疼痛护理质量指引下的护理干预在骨科术后患者疼痛管理中的应用效果，为骨科术后患者的疼痛规范化管理提供参考。 方法选择2015年1月至2016年6月收治的骨科术后患者124例为研究对象，采用随机数字表法分为观察组和对照组各62例，对照组给予包括疼痛宣教、疼痛预防、疼痛对症处理等在内的骨科术后常规疼痛护理干预，观察组给予疼痛护理质量指标指导下的护理干预，比较2组疼痛相关指标、疼痛护理质量相关指标、疼痛相关并发症。 结果观察组术后0、1、3 d视觉模拟疼痛评分（VAS）分别为（2.82 ± 0.42）、（2.45 ± 0.40）、（1.85 ± 0.32）分，对照组分别为（4.14 ± 0.56）、（3.25 ± 0.52）、（2.21 ± 0.36）分，2组比较差异有统计学意义（t=14.848、9.601、5.885，P〈0.05或〈0.01）；观察组术后0、1、3 d睡眠时间分别为（5.16 ± 0.71）、（6.01 ± 0.82）、（6.84 ± 1.02）h，对照组分别为（4.12 ± 0.62）、（4.65 ± 0.72）、（6.01 ± 0.75）h，2组比较差异有统计学意义（t=8.689、9.613、5.162，P〈0.05或〈0.01）；观察组计划外麻醉用药次数为（2.32 ± 0.45）次，对照组为（3.45 ± 0.56）次，2组比较差异有统计学意义（t=12.385，P〈0.01）；观察组观察及时率、护理记录合格率、疼痛干预有效率、管理满意度分别为98.39%（61/62）、96.77%（60/62）、96.77%（60/62）、96.77%（60/62），对照组分别为88.71%（55/62）、87.10%（54/62）、85.48%（53/62）、87.10%（54/62），2组比较差异有统计学意义（χ2=3.916~4.888，均P〈0.05）；观察组切口延迟愈合、失眠、便秘发生率分别为0、9.68%（6/62）、1.61%（1/62），对照组分别为6.45%（4/62）、24.19%（15/62）、11.29%（7/62），2组比较差异有统计学意义（χ2=4.133、4.644、4.810，均P〈0.05）。 结论基于疼痛护理质量指标指引下的护理干预有助于缓解骨科术后患者疼痛程度，改善睡眠质量，减少术后并发症，提高疼痛护理管理水平。

ObjectiveTo analyze the application effect of nursing intervention under the guidance of pain care quality in pain management of patients undergone orthopedic surgery, and to provide reference for the standardized management of pain in patients undergone orthopedic surgery. MethodsA total of 124 cases of patients who were to undergo orthopedic surgery and admitted to hospital from January 2015 to June 2016 were selected as the research objects, and divided into the observation group and the control group using the random number table method, with 62 cases in each group. Patients in the control group were performed routine pain nursing intervention after orthopedic surgery, including pain propaganda and education, pain prevention and pain symptomatic treatment. Patients in the observation group were performed nursing intervention under the guidance of pain nursing quality indexes. The pain related indicators, pain nursing quality related indexes and pain related complications of patients in the two groups were compared. ResultsThe scores of visual analogue scale （VAS） 0 d, 1 d and 3 d after the operation in the observation group were respectively 2.82±0.42, 2.45±0.40 and 1.85±0.32, the corresponding scores in the control group were respectively 4.14±0.56, 3.25±0.52 and 2.21±0.36, and the difference between the two groups was statistically significant （t=14.848, 9.601, 5.885, P〈0.05 or 0.01）. The sleep hours 0d, 1d and 3d after the operation in the observation group were respectively （5.16±0.71）h, （6.01±0.82）h and （6.84±1.02） h, the corresponding sleep hours in the control group were respectively （4.12±0.62） h, （4.65±0.72）h and （6.01±0.75）h, and the difference between the two groups was statistically significant （t=8.689, 9.613, 5.162, P〈0.05 or 0.01）. The unplanned anesthetic medication times in the observation group and the control group were respectively （2.32±0.45） times and （3.45±0.56） times, and the difference between the two groups was statistically significant （t=12.385, P〈0.01）. The observation timeliness rate, nursing record pass percent, pain intervention effective rate and management satisfaction degree in the observation group were respectively 98.39%（61/62）, 96.77%（60/62）, 96.77%（60/62） and 96.77%（60/62）, the corresponding values in the control group were respectively 88.71% （55/62） , 87.10% （54/62） , 85.48% （53/62） and 87.10% （54/62） . The difference between the two groups was statistically significant （χ2=4.810, 3.916, 4.888, 3.916, all P〈0.05）. The incidence rates of delayed incision healing, insomnia and constipation in the observation group were respectively 0, 9.68% （6/62） and 1.61% （1/62） , the corresponding incidence rates in the control group were respectively 6.45% （4/62） , 24.19% （15/62） and 11.29% （7/62） , and the difference between the two groups was statistically significant（χ2=4.133, 4.644, 4.810, all P〈0.05）. ConclusionsNursing intervention under the guidance of pain care quality can help alleviate the pain degree of patients undergone orthopedic surgery, improve the sleep quality, reduce postoperative complications and enhance the management level of pain nursing.