NBAS-ASP服务在肺癌术后急性疼痛管理中应用

NBAS-ASP Service in Postoperative Acute Pain Management of Lung Cancer

目的探讨以护士为主体、临床医师及麻醉医师协作的的服务模式(Nurse-based Acute Pain Service,NBASAPS)对肺癌术后急性疼痛控制的干预效果。方法选取2014年11月—2015年12月在该院手术的肺癌患者152例,随机分为干预组(77例)和对照组(75例)。干预组运行NBAS-APS规范化的疼痛干预,对照组实施常规疼痛干预。观察两组患者术前1d—术后72 hVAS分值、胸腔引流管置管时间、术后首次下床活动时间、术后5 d肺部并发症发生率及镇痛满意度。结果干预组患者:术后12 hVAS(3.91±1.89)分、术后24 h(3.01±1.88)分、术后48 h(2.55±1.78)分、VASmax(4.94±1.67)分、VASmean(2.76±1.51)分、PVAS>3(12.79±2.86)h,均明显低于对照组(P<0.01);胸腔引流管置管时间(57.1±3.97)h较对照组明显缩短(P<0.01),首次下床活动时间(29.57±3.54)h较对照组提前(P<0.01);肺炎发生率3.90%、肺不张发生率1.30%,均明显低于对照组(P<0.05);术后5 d镇痛满意度较对照组提高33.89%(χ~2=249.72,P<0.01)。结论 NBAS-APS疼痛规范化干预充分发挥了护士在疼痛管理中的优势,有效降低了患者急性疼痛强度,缩短了首次下床活动及胸腔引流管带管时间,减轻了肺部并发症的发生率,患者镇痛满意度大幅度提高。

Objective This paper tries to evaluate the clinical effect of NBAS-APS in standardized pain management in the controlling acute pain of postoperative patients with lung cancer.Methods 152 patients with lung cancer received the surgical treatment in this hospital from November 2014 to December 2015 were selected and were randomly divided into intervention group(77 patients)and control group(75 patients).The intervention group adopted NBAS-APS standardized pain intervention and the control group performed routine pain intervention.The VAS scores of 1 d before surgery and 72 h after operation,chest drainage tube catheterization time,time to first bed after ambulation,incidence of pulmonary complications 5 d after operation and analgesia satisfaction of the two groups were observed.Results Compared with that in the control group in the postoperative period,the pain VAS scores at postoperative 12 h was(3.91±1.89)poins,the pain VAS scores at postoperative 24 h was(3.01±1.88)points,the pain VAS scores at postoperative 48 h was(2.55±1.78)points,the maximum of pain VAS scores was(4.94±1.67)points,the mean of pain VAS scores was(2.76±1.51)points,the length of pain VAS scores PVAS>3(12.79±2.86)h,lower than control group(P<0.01).The time with a chest tube in the intervention group was(57.1±3.9)in 7 h and the first time out of bed after operation was(29.57±3.54)h,shorter than the control group(P<0.01).The incidence of pneumonia and atelectasis was 3.90%and 1.30%,significantly lower than the control group(P<0.05).The analgesic satisfaction in the intervention group was 33.89%,higher than the control group(χ2=249.72,P<0.01).Conclusion NBAS-APS in standardized pain management in the controlling acute pain of postoperative patients with lung cancer can significantly reduce acute pain intensity and shorten the first time out of bed after operation and the time with a chest tube and reduce the incidence of pulmonary complications.And it also greatly improves the analgesic satisfaction of patients.