本文選題：肺癌 + 疼痛管理�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]肺癌患者術(shù)后疼痛一直是困擾胸外科醫(yī)生的難題之一,術(shù)后疼痛不僅導(dǎo)致患者生活質(zhì)量大大下降,而且可以導(dǎo)致并發(fā)癥發(fā)生率的增加及住院時(shí)間的延長,故肺癌患者術(shù)后有效的鎮(zhèn)痛顯得十分重要。近年來規(guī)范化的疼痛管理在臨床逐漸看展研究,本文以此為背景,在昆明醫(yī)科大學(xué)第一附屬醫(yī)院胸外科針對(duì)肺癌患者在圍手術(shù)期開展了臨床規(guī)范化疼痛管理的探索,探討我科采用規(guī)范化疼痛管理后的臨床意義。[方法]收集昆明醫(yī)科大學(xué)第一附屬醫(yī)院胸外科自2016年3月實(shí)施無痛病房疼痛管理開始至2016年12月收治的肺癌手術(shù)患者病例資料,根據(jù)入組條件篩選出共212例患者,其中將采用我科圍手術(shù)期規(guī)范化疼痛管理的112例患者設(shè)計(jì)成觀察組,將采用傳統(tǒng)疼痛管理的100例患者設(shè)計(jì)為對(duì)照組。用疼痛視覺模擬評(píng)分法對(duì)術(shù)后疼痛進(jìn)行評(píng)分,作為判斷患者術(shù)后疼痛的標(biāo)準(zhǔn)。對(duì)觀察組和對(duì)照組術(shù)后疼痛程度、發(fā)生肺部感染等并發(fā)癥的概率及住院時(shí)間進(jìn)行對(duì)比研究,以此來探討肺癌患者圍手術(shù)期的規(guī)范化疼痛管理的臨床應(yīng)用價(jià)值。[結(jié)果]1.同一手術(shù)方式下觀察組和對(duì)照組在年齡,性別上均無統(tǒng)計(jì)學(xué)意義,(P0.05)。2.早期的拔管減輕了患者術(shù)后疼痛,在采用我科規(guī)范化綜合管理情況下提前拔管并未出現(xiàn)并發(fā)癥的增加。3.相同手術(shù)方式下觀察組較對(duì)照組在入院時(shí)疼痛評(píng)分無統(tǒng)計(jì)學(xué)意義(P0.05);觀察組在麻醉清醒時(shí),術(shù)后第一天、第二天、第三天及出院時(shí)對(duì)比對(duì)照組疼痛程度上有明顯減輕(P0.05)。4.全組患者均手術(shù)成功,術(shù)后無死亡病例。觀察組發(fā)生肺部感染2例、肺不張2例、房顫2例、壓瘡1例;對(duì)照組發(fā)生肺部感染5例、肺不張4例、房顫2例、壓瘡3例,觀察組并發(fā)癥概率較對(duì)照組顯著減少(P0.05)。5.相同手術(shù)方式下的觀察組住院時(shí)間較對(duì)照組有明顯縮短(P0.05)。[結(jié)論]經(jīng)過我科開展的規(guī)范化疼痛管理能夠使肺癌圍手術(shù)期患者減輕術(shù)后疼痛,提高了患者術(shù)后的生活質(zhì)量,降低了術(shù)后并發(fā)癥的概率,縮短了住院時(shí)間,在我科臨床療效顯著,值得在今后臨床進(jìn)一步深入實(shí)踐和研究以及在臨床各科室大力推廣。
[Abstract]:[objective] postoperative pain in patients with lung cancer has been one of the difficult problems for thoracic surgeons. Postoperative pain not only leads to a great decline in the quality of life of patients, but also increases the incidence of complications and prolongs the length of stay in hospital. Therefore, effective postoperative analgesia in patients with lung cancer is very important. In recent years, standardized pain management has been studied gradually in clinic. Based on this background, the chest surgery of the first affiliated Hospital of Kunming Medical University carried out the exploration of clinical standardized pain management for lung cancer patients during perioperative period. To explore the clinical significance of standardized pain management in our department. [methods] A total of 212 patients with lung cancer were collected from chest surgery department of the first affiliated Hospital of Kunming Medical University from the beginning of painless ward pain management in March 2016 to December 2016. 212 patients were selected according to the condition of admission. 112 patients with standardized pain management during perioperative period in our department were designed as observation group and 100 patients with traditional pain management as control group. Visual analogue score was used to evaluate postoperative pain. The clinical value of standardized pain management in patients with lung cancer during perioperative period was studied by comparing the degree of postoperative pain, the probability of pulmonary infection and the length of hospitalization in the observation group and the control group. [result] 1. There was no significant difference in age and sex between the observation group and the control group under the same operation mode. The early extubation alleviated the postoperative pain of the patients, and there was no increase of complications in the early extubation under the condition of standardized comprehensive management in our department. There was no significant difference in pain score between the observation group and the control group at admission under the same operation mode (P 0.05), and the pain degree of the observation group on the first day, the second day, the third day after operation and at the time of discharge was significantly reduced compared with the control group at the first day, the second day, the third day and the time of discharge. All patients were successfully operated and there were no death cases after operation. There were 2 cases of pulmonary infection, 2 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of pressure sore in the observation group, 5 cases of pulmonary infection, 4 cases of atelectasis, 2 cases of atrial fibrillation and 3 cases of pressure sore in the control group. The probability of complications in the observation group was significantly lower than that in the control group. The hospitalization time of the observation group under the same operation mode was significantly shorter than that of the control group (P 0.05). [conclusion] the standardized pain management carried out by our department can relieve postoperative pain, improve the quality of life, reduce the probability of postoperative complications and shorten the hospitalization time in patients with lung cancer during perioperative period. It is worthy of further practice and research in clinical practice and popularization in clinical departments.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

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