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目的探讨患者自主疼痛评估在全膝关节置换术(total knee arthroplasty,TKA)围手术期疼痛管理中的应用。方法将2016年3月—2017年3月共收治的行TKA的140例患者随机分为对照组和试验组,两组患者均接受相同的疼痛相关知识教育,对照组由护士进行疼痛评估,试验组则由患者进行自主疼痛评估,根据两组相应的评估结果进行处理。观察记录两组疼痛评估需要的时间、临时解救药的类型及使用次数、疼痛评分、康复自我效能量表评分及膝关节活动度。结果纳入并完成最终观察的患者为132例,其中试验组67例,对照组65例。两组患者术后疼痛评估时间(t=–2.736,P=0.007)、术后临时解救药物使用(χ2=10.276,P<0.05)、术后疼痛评分总计(Z=–2.146,P=0.032)、术后住院天数(t=–2.468,P=0.015)、术后第7天康复自我效能感量表评分(F=2.390,P=0.018)、术后第14天康复自我效能感量表评分(F=3.427,P=0.001)、术后第7天的膝关节活动度(F=2.109,P=0.037)的比较,差异均有统计学意义;两组患者术后平均每日疼痛评分(Z=–1.779,P=0.077)、术后第3天康复自我效能感量表评分(F=1.010,P=0.314)、术后第1天膝关节活动度(F=1.319,P=0.189)、术后第14天膝关节活动度(F=1.603,P=0.111)的组间比较,差异均无统计学意义。结论患者自主的疼痛评估能调动膝关节置换患者主动参与疼痛管理,可更准确地反映患者的疼痛强度,在减少医护工作量的同时,有利于围手术期疼痛管理措施的优化,从而促进其快速康复。
Objective To explore the application of patient-independent pain assessment in the management of perioperative pain in total knee arthroplasty (TKA). Methods A total of 140 TKA patients who were admitted to our hospital from March 2016 to March 2017 were randomly divided into control group and experimental group. Both groups received the same knowledge of pain-related education. The control group was evaluated by nurses for pain evaluation. Patients were evaluated for spontaneous pain and were treated according to the two groups of assessment results. The time required for pain assessment, the type and number of temporary rescue drugs, the pain score, the Rehabilitation Self-Efficacy Scale score, and the knee joint activity were recorded and recorded. Results 132 patients were enrolled and completed the final observation, of which 67 were in the test group and 65 in the control group. Postoperative pain evaluation time (t = -2.736, P = 0.007) and postoperative temporary rescue medication (χ2 = 10.276, P <0.05) and postoperative pain score (Z = -2.146, P = 0.032) , Postoperative hospital stay (t = -2.468, P = 0.015), postoperative 7th day rehabilitation self-efficacy scale score (F = 2.390, P = 0.018), postoperative 14th day rehabilitation self-efficacy scale score (F = 3.427, P = 0.001). The knee joint activity (F = 2.109, P = 0.037) on the 7th day after operation was significantly different between the two groups. The mean daily pain score (F = 1.010, P = 0.314), knee mobility (F = 1.319, P = 0.189) on the first postoperative day after operation, , The knee joint mobility (F = 1.603, P = 0.111) on the 14th postoperative day was not significantly different between the two groups. CONCLUSIONS: Patients’ autonomous pain assessment can mobilize patients with knee joint replacement to actively participate in pain management, which can reflect the pain intensity of patients more accurately. It not only reduces the workload of medical care, but also optimizes the perioperative management of pain and thus promotes its rapid Rehabilitation.