目的 探討“醫護一體化”疼痛管理模式在骶骨腫瘤患者圍手術期的應用效果。 方法 以2011年1月－10月選取的23例骶骨腫瘤患者作為研究對象，根據科室疼痛管理的規范化流程，在“醫護一體化”工作模式下由護士進行疼痛評估、醫生護士共同制定疼痛管理方案，護士落實個體化疼痛護理措施、規范用藥指導、綜合心理護理和鎮痛效果反饋等。 結果 經“醫護一體化”疼痛管理，患者疼痛情況大為改觀，20例患者疼痛評分＜3分，占總例數的87.0%，由入院初期的中、重度疼痛患者居多轉變為輕度疼痛患者占主導。 結論 運用醫護一體化多模式疼痛管理可以有效減輕患者疼痛，提高護理服務質量。
ObjectiveTo review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery.MethodsRegular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years.ResultsAs for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently.ConclusionHeretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.
Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.
Objective To investigate the effect of intravenous analgesia with a wireless or traditional analgesia pump system in thoracoscopic lung resection.MethodsPatients who used the patient-controlled intravenous analgesia after thoracoscopic lung resection between June 2016 and June 2021 were enrolled in the study. They were allocated into a wireless pump group (a ZigBee-based wireless analgesia pump system collecting data automatically) and a traditional analgesia pump group. Perioperative analgesia management followed the routine standard operation protocol of Shanghai Chest Hospital. The patients’ numeric rating scale (NRS) for pain and postoperative nausea and vomiting (PONV) scores were collected for analysis from the Anesthesia Information Record System. The incidence of postoperative analgesia insufficiency (defined as NRS≥4 points) within 48 h, the incidence of PONV within 24 h, and the 48 h completion rate of analgesia pump infusion were compared. ResultsA total of 59431 patients were collected, including 24855 males and 34576 females, 17209 patients in the wireless pump group, and 42222 patients in the traditional analgesia pump group. The incidence of analgesia insufficiency within 48 h after operation (3.75% vs. 4.98%, P=0.007), the incidence of PONV within 24 h after operation (13.60% vs. 16.70%, P=0.030) in the wireless pump group were lower than those in the traditional analgesia pump group. The 48 h completion rate of analgesia pump infusion in the wireless pump group was higher than that in the traditional analgesia pump group (83.40% vs. 71.90%, P<0.001). The wireless pump group could monitor the pressing times and use of the analgesia pump, while the traditional analgesia pump group could not record the relevant data. ConclusionCompared with the traditional analgesia pump, the wireless analgesia management system may be convenient for timely, accurate and individualized management, and has good analgesic effect and low incidence of adverse reactions, and may be more suitable for perioperative analgesia management.
目的 了解住院患者疼痛控制結局的現狀及對疼痛控制的滿意度，為疼痛管理提供依據。 方法 2012年5月運用便利抽樣法選取206例住院患者為研究對象，采用調查問卷的方式了解患者疼痛管理現狀和滿意度。調查工具為自行設計的患者基本信息調查表、美國疼痛協會結局問卷修訂量表。 結果 調查對象當前、過去24 h內最劇烈的疼痛程度及疼痛平均水平以輕度為主，分別占43.2%、42.2%、40.3%；疼痛對一般活動、情緒和其他康復活動的影響程度以中度為主，分別占52.4%、58.3%、53.4%；對疼痛處理結果的滿意度以一般為主，占40.8%；78.6%的患者在入院時未被告知疼痛治療的重要性；66.5%～84.5%的患者對疼痛和止痛藥的認知均較差。 結論 二級醫院住院患者的疼痛程度較輕，其對生活影響程度尚不嚴重，但患者對疼痛控制的滿意度欠佳，對疼痛相關知識的認知也較差，急需醫護人員采取相應的措施提高疼痛控制的效果和質量，從而提高患者在住院期間的滿意度。
Objective To explore the application effect of day surgery nursing based on finite time theory in patients undergoing gastroesophageal reflux surgery. Methods A total of 108 patients undergoing gastroesophageal reflux surgery in Day Surgery Center of the First Affiliated Hospital of Air Force Medical University were enrolled and divided into control group (n=54, routine nursing) and study group (n=54, finite time theory intervention on basis of control group) according to random number table method between May 2023 and May 2025. The scores of Visual Analogue Scale (VAS) for pain before and after surgery, postoperative recovery indexes, total incidence of postoperative complications, scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before surgery and discharge, and patients satisfaction in the two groups were compared. Results After surgery, the VAS score in the study group was lower than that in the control group (2.86±0.31 vs. 3.58±0.39, P<0.05). The first leaving bed time, the first time for liquid intake, and the postoperative anal exhaust time in the study group [(6.23±0.68), (4.22±0.53), and (16.78±2.03) h, respectively] were shorter than those in control group [(8.24±1.34), (6.68±0.86), (19.14±2.21) h, respectively; P<0.05]. Before discharge, the scores of SAS and SDS in the study group (49.14±5.11 and 41.26±4.31, respectively) were lower than those in the control group (53.79±5.58 and 49.85±5.06, respectively; P<0.05). The scores of patients satisfaction with daytime medical treatment process, doctor-nurse-patient communication, service attitude of medical staff and health education methods in the study group (91.56±3.58, 93.27±3.24, 92.07±5.37, and 92.68±4.22, respectively) were higher than those in the control group (82.35±4.11, 83.51±5.20, 84.11±4.33, and 81.70±5.41, respectively; P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (9.25% vs. 16.67%, P>0.05). Conclusion The day surgery nursing based on finite time theory can effectively alleviate postoperative pain, accelerate postoperative recovery, improve psychological state and nursing satisfaction in patients undergoing gastroesophageal reflux surgery.
Pain education based on biomedical models is currently a common approach to patient pain management. However, due to its inability to accurately explain pain, patients may develop incorrect beliefs and understandings about pain, leading to anxiety and fear of movement. Pain neuroscience education is based on a biological psychological social educational model, aiming to redefine the concept of pain. It has a positive effect on pain, catastrophizing, anxiety, and fear of movement, and is a reliable new method for pain rehabilitation therapy and management. This article provides a review of the concept, implementation principles, implementation methods, dosage factors, combination therapy, and clinical application of pain neuroscience education, in order to provide ideas for the rehabilitation therapy of pain.