本文選題：無痛病房　切入點：膽總管取石術(shù)　出處：《山東大學(xué)》2014年碩士論文

【摘要】：目的：探討開展無痛病房對經(jīng)ERCP膽總管取石術(shù)患者術(shù)后疼痛強度及疼痛護理滿意度的影響。 方法：本研究采用問卷調(diào)查法的方法,以方便抽樣的方式,選取2012年5-12月在山東省某三甲醫(yī)院住院的膽總管結(jié)石并且行經(jīng)ERCP取石術(shù)的患者84例為對照,選取2013年5-12月在山東省某三甲醫(yī)院消化科住院的膽總管結(jié)石并且行經(jīng)ERCP取石術(shù)的患者84例為研究對象。研究工具為患者一般資料調(diào)查表、簡明疼痛量表(BPI)、疼痛護理滿意度量表、數(shù)字疼痛分級法(NRS)。一般資料調(diào)查表由研究人員參閱國內(nèi)外文獻后,結(jié)合本研究的情況自行設(shè)計,用以統(tǒng)計病人的一般資料。簡明疼痛量表和疼痛護理滿意度量表廣泛應(yīng)用在國內(nèi)外,具有良好的信度和效度。具體方法為選取2012年5-12月在山東省某三甲醫(yī)院消化科住院的膽總管結(jié)石并且行經(jīng)ERCP取石術(shù)的患者,術(shù)前30分鐘用數(shù)字疼痛分級法(NRS)評估患者的疼痛,術(shù)后24小時對患者發(fā)放一般資料調(diào)查表及簡明疼痛量表,出院時對患者發(fā)放疼痛護理滿意度量表。2013年1-4月,在科室內(nèi)開展疼痛知識培訓(xùn),健全無痛病房各項規(guī)章制度,完善各項硬件措施,制定無痛病房工作程序,創(chuàng)建無痛理念,全面開展無痛病房。選取2013年5-12月在山東省某三甲醫(yī)院消化科住院的膽總管結(jié)石并且行經(jīng)ERCP取石術(shù)的患者,對其進行無痛病房管理,同樣,術(shù)前30分鐘用數(shù)字疼痛分級法(NRS)評估患者的疼痛,術(shù)后24小時為患者發(fā)放一般資料調(diào)查表及簡明疼痛量表,出院時為患者發(fā)放疼痛護理滿意度量表。比較兩組患者術(shù)后疼痛強度及疼痛護理滿意度的差別。數(shù)據(jù)處理上,應(yīng)用SPSS16.0軟件包進行數(shù)據(jù)錄入與分析,以P0.05表示有顯著統(tǒng)計學(xué)差異。以描述性統(tǒng)計(均數(shù)、標準差)、t檢驗、卡方檢驗、Fisher準確概率法等統(tǒng)計分析方法,分析兩組患者術(shù)后疼痛強度及疼痛護理滿意度的差別。 結(jié)果：共168名患者參與本次研究,其中無痛病房開展前84例,無痛病房開展后84例,兩組患者在年齡、性別、文化程度、民族、婚姻狀態(tài)、付費方式、居住地等方面比較,差異均無統(tǒng)計學(xué)意義(P0.05)。具體結(jié)果如下： 1兩組患者術(shù)前30分鐘評估的疼痛得分：開展無痛病房前組為(1.18-0.88),開展無痛病房后組為(1.19±0.86),經(jīng)t檢驗,顯示統(tǒng)計學(xué)無差異(PO.05)。 2兩組患者術(shù)后24小時評估的疼痛得分：24小時疼痛最劇烈的程度,開展無痛病房前組為(3.70-1.95),開展無痛病房后組為(2.92±1.50),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。24小時疼痛最輕微的程度,開展無痛病房前組為(1.23±1.10),開展無痛病房后組為(0.76±0.41),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。24小時疼痛平均程度,開展無痛病房前組為(2.21±1.19),開展無痛病房后組為(1.77±0.99),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)�；颊吣壳暗奶弁闯潭�,開展無痛病房前組為(1.25±1.07),開展無痛病房后組為(0.86±0.49),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。 3兩組患者疼痛護理滿意度比較：整體護理滿意度比較,開展無痛病房前組得分(70.30±10.21),,開展無痛病房后組得分(76.89±10.08),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。從量表的3個維度分別比較：信任關(guān)系：開展無痛病房前組得分(34.83±5.49),開展無痛病房后組得分(37.51±7.66),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。專業(yè)技術(shù)能力：開展無痛病房前組得分(17.71±4.64),開展無痛病房后組得分(19.70±3.39),·經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。教育關(guān)系：開展無痛病房前組得分(17.76±4.90),開展無痛病房后組得分(19.68±3.570),經(jīng)t檢驗,顯示統(tǒng)計學(xué)有差異(PO.05)。 4開展無痛病房前,84例患者,有4例發(fā)生術(shù)后急性胰腺炎,其中2例轉(zhuǎn)外科手術(shù)治療,2例內(nèi)科保守治療治愈；有8例患者術(shù)后應(yīng)用了鎮(zhèn)痛藥物；開展無痛病房后,84例患者,有2例發(fā)生術(shù)后急性胰腺炎,均內(nèi)科保守治療治愈；有4例患者術(shù)后應(yīng)用了鎮(zhèn)痛藥物。 結(jié)論：開展無痛病房能顯著降低膽總管結(jié)石行ERCP取石術(shù)患者的術(shù)后疼痛強度；開展無痛病房能顯著提高膽總管結(jié)石行ERCP取石術(shù)患者的疼痛護理滿意度；開展無痛病房能降低膽總管取石術(shù)患者術(shù)后并發(fā)癥的發(fā)生率,降低患者術(shù)后鎮(zhèn)痛藥物的使用比例。
[Abstract]:Objective : To investigate the effect of painless ward on the postoperative pain intensity and pain nursing satisfaction of patients undergoing endoscopic retrograde cholangiography .

Methods : 84 cases of common bile duct stone who were hospitalized in a 3A hospital in Shandong Province from May to December 2012 were selected and 84 cases of patients who had been hospitalized in the digestive department of a 3A hospital in Shandong Province from May to December of 2013 were selected by the method of questionnaire investigation .

Results : A total of 168 patients were involved in the study , of which 84 cases were performed in painless wards and 84 in painless wards . There was no significant difference in age , sex , culture , nationality , marital status , payment mode and place of residence ( P0.05 ) . The results were as follows :

Pain scores of the two groups were evaluated 30 minutes prior to operation : ( 1.18 - 0.88 ) in the anterior group of painless ward and ( 1.19 鹵 0.86 ) in the non - painful ward , and no difference was found between the two groups ( P . 05 ) .

The pain scores of the two groups were ( 2.92 鹵 1.50 ) and ( 2.92 鹵 1.50 ) after 24 - hour post - operative pain , and ( 2.92 鹵 1.50 ) in the patients with painless ward .

The scores of pain nursing satisfaction were compared between the two groups : the score of the former group of painless ward was ( 76.89 鹵 10.21 ) , the score of the group after painless ward was ( 76.89 鹵 10.08 ) , the score of the post - painless ward group was ( 19.70 鹵 3.39 ) , the score of the post - painless ward group ( 19.68 鹵 3.570 ) was performed , and the difference was statistically significant ( PO.05 ) .

4 of 84 patients had acute pancreatitis after operation without pain ward , 2 of them were treated with surgical treatment and 2 cases were treated with conservative treatment .
There were 8 patients who had postoperative analgesia .
After the painless ward , 84 patients , 2 patients with post - operative acute pancreatitis , were treated with conservative treatment .
Four patients had postoperative analgesia .

Conclusion : Carrying out painless ward can significantly reduce the postoperative pain intensity in patients with bile duct stone .
Carrying out painless ward can significantly improve the patient ' s pain nursing satisfaction in patients with bile duct stone .
To carry out painless ward can reduce the incidence of postoperative complications and reduce the use proportion of postoperative analgesia drugs in patients .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473.6

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