崔立敏　胡丽霞　张英　耿文真

【摘要】 目的：探讨“医护麻药”四位一体规范化疼痛干预在肛周疾病围术期患者中的镇痛效果。方法：干预组95例肛周疾病围术期患者实施“医护麻药”四位一体规范化疼痛干预，对照组97例实施常规疼痛管理方法，对比两组患者疼痛评分、术后康复指标及镇痛满意度。结果：干预组术后排便、换药NRSmax、围术期NRSmean及PNRS>3均低于对照组（P<0.01）；首次排便时间、首次下床活动时间、创面愈合天数、术后住院天数均较对照组缩短（P<0.01）；患者镇痛满意度为95.79%，高出对照组34.14%（P<0.01），总体满意度较对照组提高7.17%（P<0.01）。结论：肛周疾病围术期患者中实施“医护麻药”四位一体规范化疼痛干预，有效降低患者疼痛强度，患者首次排便及下床活动时间提前，促进创面愈合及缩短住院时间，患者对疼痛管理及住院总体满意度均明显提高。

【关键词】 多团队合作； 规范镇痛； 肛周疾病； 围术期

Effectiveness Analysis of Standardize Pain Management of More Teamwork with Nurse，Anesthesiologist，Physicians and Clinical Pharmacists for Patients Undergoing Perianal Operation/CUI Li-min，HU Li-xia，ZHANG Ying，et al.//Medical Innovation of China，2017，14（16）：141-144

【Abstract】 Objective：To evaluate the effect of standardize pain management of more teamwork with nurse，anesthesiologist，physicians and clinical pharmacists for patients undergoing perianal operation.Method：The intervention group of 95 patients were given standardized pain interventions of more teamwork with nurse，anesthesiologist，physicians and clinical pharmacists.The control group of 97 patients were given routine methods of pain management.The pain intensity，indicators of postoperative rehabilitation and analgesic satisfaction of two groups were observed.Result：Compared with that in the control group，the NRSmax of the first defecation and ambulation，the perioperative NRSmean and PNRS>3 in intervention group were lower（P<0.01）.The first time of defecation and ambulation，the length of wound healing and hospital stay in intervention group were less than those of the control group（P<0.01）.The analgesic satisfaction in the intervention group was 95.79%， which was 34.14% higher than the control group（P<0.01）.The overall satisfaction was improved 7.17% compared with the control group（P<0.01）.Conclusion：Standardize pain management provided by more teamwork with nurse，anesthesiologist，physicians and clinical pharmacists for patients undergoing perianal operation，can significantly reduce acute pain intensity and shorten the first time of defecation and ambulation，the length of wound healing and hospital stay.The analgesic satisfaction and the overall satisfaction are significantly improved.

【Key words】 More teamwork； Standardize pain management； Perianal disease； Perioperative

First-authors address：The Peoples Hospital of Binzhou，Binzhou 256600，China

doi：10.3969/j.issn.1674-4985.2017.16.041

肛周疾病為临床常见疾病，目前最理想的治疗手段为手术治疗，但由于肛周肌肉神经丰富、感觉敏锐，最棘手的问题就是术后疼痛，有调查显示术后疼痛发生率可高达95%以上[1-4]。GOLIGHER描述肛周患者术后排便时就像“排出碎玻璃”一样疼痛，疼痛不仅给患者带来巨大的身心痛苦，更重要的是作为不良刺激影响着创面的愈合及患者康复，甚至有的患者因为惧怕疼痛对手术望而止步[5-6]。2015年以来，笔者尝试成立“医护麻药”多团队合作的疼痛管理小组，在肛周疾病围术期患者中实施规范化疼痛干预，取得了较满意的效果，现报告如下。

1 资料与方法

1.1 一般资料 选择本院普外科一病区2015年9月-2016年4月入住的肛周疾病围术期患者为研究对象，该研究已经医院伦理委员会批准，且本人签署知情同意书。（1）纳入标准：①无非甾体抗炎药过敏史；②言语表达清楚；③无心血管、糖尿病、消化道溃疡、肝肾疾患及严重感染性疾病。（2）排除标准：①其他严重躯体性疾病；②智力或认知功能障碍患者；③文盲患者。符……