付丽萍　　张军港　　冯霞　　裘丹英

[摘要] 目的 研究腹部手術加速康复外科患者疼痛控制结局，为改进腹部手术患者疼痛控制结局提供参考。 方法 选取2018年1月至2019年5月采用便利抽样法对符合入选标准的228例腹部手术加速康复外科患者在术后24～48 h进行疼痛控制结局问卷调查，描述疼痛控制结局，比较使用与未使用非药物止痛措施患者的疼痛控制结局指标的差异，并分析影响疼痛控制满意度的因素。 结果 腹部手术加速康复外科患者术后24 h内：最高疼痛评分中位数为4.00（3.00）分，处于重度疼痛的百分比中位数为20.00（20.00）%，疼痛对下床活动的影响评分中位数为3.00（3.00）分，疼痛缓解程度中位数为70.00（20.00）%，疼痛控制满意度中位数为8.00（2.00）分;使用非药物止痛措施的患者“术后24 h最高疼痛评分”和“处于重度疼痛的百分比”低于未使用非药物止痛措施的患者，“疼痛控制满意度”高于未使用非药物止痛措施的患者，差异有统计学意义（P<0.05）;疼痛控制满意度与术后疼痛缓解程度（r=0.657）、参与疼痛治疗决策程度（r=0.673）、疼痛治疗方案信息的帮助程度（r=0.460）显著相关，差异有统计学意义（P<0.05）;与获得疼痛治疗方案信息（r=0.156）、使用非药物止痛措施（r=0.183）、医护人员鼓励非药物止痛措施频率（r=0.173）显著相关，差异有统计学意义（P<0.05）。 结论 腹部手术加速康复外科患者疼痛控制结局总体较好，仍需关注术后活动性疼痛的评估和治疗，重视使用非药物镇痛措施，以期改善患者的疼痛控制结局;患者对术后疼痛控制的总体评价满意，值得临床借鉴。

[关键词] 疼痛控制;加速康复外科;腹部手术;非药物镇痛措施

[中图分类号] R473.73;R493          [文献标识码] B          [文章编号] 1673-9701（2021）11-0170-06

Research on the outcome of pain control in patients undergoing accelerated rehabilitation after abdominal surgery

FU Liping1 ZHANG Jungang2 FENG Xia2 QIU Danying3

1.PACU， Zhejiang Provincial People′s Hospital， the People′s Hospital of Hangzhou Medical College， Hangzhou   310014，China; 2.Department of Hepatobiliary Pancreatic Surgery， Zhejiang Provincial People′s Hospital，the People′s Hospital of Hangzhou Medical College， Hangzhou   310014， China; 3.Department of Nursing， Zhejiang Provincial People′s Hospital，the People′s Hospital of Hangzhou Medical College， Hangzhou   310014，China

[Abstract] Objective To research the outcome of pain control in patients undergoing accelerated rehabilitation after abdominal surgery，and to provide reference for improving the outcome of pain control in patients undergoing abdominal surgery. Methods A questionnaire survey from January 2018 to May 2019 was conducted on the outcome of pain control in 228 patients who met the inclusion criteria of accelerated rehabilitation surgery during 24-48 hours after abdominal surgery according to the convenient sampling method. Meanwhile，the outcome of pain control was described，the difference of outcome of pain control between patients who used and did not use non-drug analgesic measures were compared and the factors impacting the satisfaction of pain control were analyzed. Results Within 24 hours after surgery，in the patients who underwent accelerated rehabilitation surgery after abdominal surgery， the median score of the highest pain was 4.00（3.00） points， the median percentage of severe pain was 20.00 （20.00）%， the median score of the impact of pain on getting out of bed was 3.00（3.00） points， the median degree of pain relief was 70.00（20.00）%， and the median satisfaction with pain control was 8.00（2.00）points. The “highest pain score” and “percentage of severe pain” of patients who took non-drug analgesic measures were lower than those who did not take non-drug analgesic measures，and the “pain control satisfaction” was higher than that of patients who did not take non-drug analgesic measures，and the differences were statistically significant（P<0.05）. Satisfaction with pain control was significantly correlated with postoperative pain relief degree（r=0.657），participation in pain treatment decision-making degree（r=0.673） and assistance degree of pain treatment plan information（r=0.460），and the differences were statistically significant（P<0.05）. It was significantly correlated with obtaining information of pain treatment plan（r=0.156），using non-drug analgesic measures （r=0.183），and the frequency of encouraging non-drug analgesic measures by medical staff （r=0.173）， and the differences were statistically significant （P<0.05）. Conclusion The outcome of pain control in patients undergoing accelerated rehabilitation surgery after abdominal surgery is generally good， and it is still necessary to pay attention to the evaluation and treatment of postoperative active pain and pay attention to the use of non-drug analgesia measures， so as to improve the outcome of pain control of patients. Patients are satisfied with the overall evaluation of postoperative pain control， which is worthy of clinical reference.

[Key words] Pain control; Accelerate rehabilitation surgery; Abdominal surgery; Non-drug analgesia measures

加速康复外科（Enhanced recovery after surgery，ERAS）是集麻醉、手术、护理及营养等多学科、多内容的综合性康复理念，其目的在于促使患者在最短的时间内达到最佳的康复效果[1]。疼痛治疗是ERAS非常重要的环节[2]，良好镇痛可提高患者生命质量，缓解紧张和焦虑，且提高早期进食、早期活动等依从性，加快机体机能恢复[3]。文献报道约75%的术后患者曾经历中重度疼痛，术后患者报告的疼痛得到充分缓解的不足50%[4-5]，而腹部手术术后疼痛是限制患者术后快速康复的重要因素[6]，因此术后疼痛的管理仍是临床的难题和挑战。……