戴旻晖　李春燕　林欢　钟敏红　熊静

〔摘要〕 目的 探讨基于CDIO的案例与病例融合结合护理团队管理翼狀胬肉患者术后疼痛的效果。方法 选取2016年12月至2018年6月在湖南省某综合性三甲医院眼科诊治的原发性翼状胬肉患者80例80眼为研究对象，按随机数字表法分为观察组和对照组，各40例。观察组采取基于CDIO的案例与病例融合团队全程管理，对照组采取常规管理。对两组患者：术后当天、1 d及2 d采用疼痛量表（NRS）评分，术前、术后当天及1 d采用焦虑自评量表（SAS）评分，术后当天及1 d采用自制不适耐受度表评分，观察并比较两组患者的NRS、SAS评分、术后不适耐受度情况。结果 观察组各时间点疼痛评分均低于对照组，差异有统计学意义（P<0.05）;观察组术后当天及1 d 的焦虑评分均低于对照组，差异有统计学意义（P<0.05）;观察组术后不适耐受度高于对照组，差异有统计学意义（P<0.05）。结论 对翼状胬肉患者采取基于CDIO的案例与病例融合团队全程管理，能有效缓解患者疼痛，减轻焦虑，提高不适耐受程度。

〔关键词〕 CDIO;护理团队;翼状胬肉切除术;疼痛

〔中图分类号〕R473       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.02.027

〔Abstract〕 Objective To explore the effect of case and case fusion based on CDIO combined with nursing team in the management of postoperative pain in patients with pterygium. Methods A total of 80 cases and 80 eyes of primary pterygium patients treated in the ophthalmology department of a comprehensive Grade A hospital in Hunan province from December 2016 to June 2018 were selected as the research subjects. Patients were assigned randomly into the observation group and the control group， with 40 per group. The observation group received case and case fusion based on CDIO combined with nursing team in the management， while the control group received ordinary management. The scale of pain （NRS） was measured on the day of operation， and in 1 and 2 days postoperative， and self rating anxiety scale （SAS） was carried at preoperative， same-day and 1 day after operation. The self-made discomfort tolerance scale was assessed on the same day and 1 day after operation. NRS scores， SAS scores and postoperative discomfort tolerance were observed and compared of two groups. Results The scale of pain at each time point of the observation group was lower than the control group， and the difference was statistically significant （P<0.05）; the anxiety scores of the same-day and 1 day after operation in the observation group was lower than the control group， and the difference was statistically significant （P<0.05）; the postoperative discomfort tolerance in the observation group was higher than the control group， and the difference was statistically significant （P<0.05）. Conclusion For pterygium patients， the whole process management of case and case fusion team based on CDIO can effectively relieve pain， anxiety and improve the degree of discomfort tolerance.

〔Keywords〕 CDIO; nursing team; pterygium excision; pain

翼状胬肉是一种常见的临床眼表疾病[1]，它的主要治疗方式是手术，但手术会损伤角膜，术后患者眼部出现疼痛、异物感、睁眼困难等不适症状，疼痛易使患者产生焦虑、抗拒等负性情绪[2]，负性情绪则会使人焦虑、恐惧等[3]，而焦虑可以增加疼痛的风险和发生率[4]。为缓解疼痛及不适，业界进行了多方探索，现大多采取心理干预及应用镇痛药物行疼痛管理，这些方法存在一定的弊端，单纯心理干预对患者行疼痛管理效果不太显著。使用镇痛药物，患者有可能产生医源性毒瘾。中医穴位刺激控制疼痛基本无成瘾性，且不良反应小[5]。已往研究证实了穴位刺激在缓解癌性疼痛[6]，降低翼状胬肉术后疼痛程度效果显著[7]。……