Carroll K C, Atkins P J, Herold G R, Mlcek C A, Shively M, Clopton P, Glaser D N
Veterans Affairs Healthcare System, San Diego, Calif., USA.
Am J Crit Care. 1999 Mar;8(2):105-17.
Pain in critically ill patients is undertreated.
To examine patients' perceptions of pain and acute pain management practices in a large metropolitan area to provide direction for improvements in pain relief.
In a descriptive, correlational study, data were collected from 213 patients in 13 hospitals. Interviews with patients, chart reviews, and interviews with nurse leaders were used to examine institutional and individual approaches to pain management.
Twenty-eight percent of patients did not recall an explanation of a pain management plan, and 64% were often in moderate to severe pain while in the intensive care unit. High pain intensity correlated with wait for an analgesic (P < .001), expectations of less pain (P < .001), and longer stay in the intensive care unit (P < .001). Low satisfaction correlated with expectations of less pain (P < .001), often being in moderate to severe pain (P < .001), and long wait for an analgesic (P < .001). In the first 24 hours postoperatively, only 54% of patients had a numerical pain rating documented; 91% had a pain description. The amount of opioid given on postoperative day 1 was influenced by pain intensity (P < .001), the patient's age (P = .03), type of surgery (P = .002), and route of analgesic (P < .001). Only 33% of patients had nonpharmacological pain interventions documented.
Despite moderate to severe pain, patients are generally satisfied with their pain relief. Measuring patients' satisfaction alone is not a reliable outcome for determining the effectiveness of pain management. Realistic expectations of patients about their pain may enhance coping, increase satisfaction, and decrease pain intensity after surgery.
重症患者的疼痛未得到充分治疗。
调查大城市地区患者对疼痛的认知以及急性疼痛管理措施，为改善疼痛缓解提供指导。
在一项描述性、相关性研究中，收集了13家医院213名患者的数据。通过对患者的访谈、病历审查以及对护士主管的访谈，来研究机构和个人的疼痛管理方法。
28%的患者不记得曾被告知疼痛管理计划，64%的患者在重症监护病房时经常处于中度至重度疼痛中。高疼痛强度与等待镇痛药的时间相关（P <.001）、对疼痛减轻的期望相关（P <.001）以及在重症监护病房的住院时间延长相关（P <.001）。低满意度与对疼痛减轻的期望相关（P <.001）、经常处于中度至重度疼痛中（P <.001）以及等待镇痛药的时间长相关（P <.001）。术后头24小时内，只有54%的患者有数字疼痛评分记录；91%有疼痛描述。术后第1天给予的阿片类药物剂量受疼痛强度（P <.001）、患者年龄（P =.03）、手术类型（P =.002）和镇痛途径（P <.001）影响。只有33%的患者有非药物性疼痛干预记录。
尽管存在中度至重度疼痛，但患者总体上对疼痛缓解感到满意。仅衡量患者满意度并非确定疼痛管理有效性的可靠结果。患者对自身疼痛的现实期望可能会增强应对能力、提高满意度并降低术后疼痛强度。
