Coventry Linda L, Siffleet Jo M, Williams Anne M
Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Crit Care Resusc. 2006 Jun;8(2):135-40.
To investigate analgesic prescription patterns and administration in postoperative cardiac surgery patients in the ICU in a tertiary hospital.
The audit was registered with the institutional Quality Improvement Committee. A sample of 73 postcardiac surgery patients who were admitted to the ICU during a 12-month period in 2003-2004 were reviewed.
All patients received opioid analgesia in the ICU. On the first postoperative day, patients received a mean of 1.27 mg morphine equivalents per hour, while the 25 patients present in the ICU for a second day received a mean of 0.84 mg morphine equivalents per hour. No relationship was seen between Day 1 administration of analgesia and age, sex or use of an internal mammary artery (IMA) graft or Day 2 administration and sex or use of IMA. A slight negative relationship existed between morphine administered on Day 2 and age (r = ?0.38, P = 0.06). Paracetamol or paracetamol plus codeine (8 mg or 30 mg) was administered to 70 patients (96%), but was prescribed 6-hourly in 24 patients (33%) and actually administered 6- hourly in 32 (44%). No analgesia was administered in 23% of patients before removal of chest drains. The average time to extubation was 15.7 h (SD, 12.1 h). A moderate correlation between time to extubation and morphine equivalents per hour on Day 1 was demonstrated (r=0.43, P < 0.001). The average duration of ICU stay was 28.1 h. A routine pain assessment score was not charted for any the 73 patients.
We recommend introducing scoring of patient pain in the ICU, both at rest and with movement, and provision of a designated area on the ICU flow chart for these scores. Paracetamol or other simple analgesics could be prescribed regularly, and staff need education about premedication of patients before removal of chest drains.
调查一家三级医院重症监护病房（ICU）中心脏手术后患者的镇痛处方模式及用药情况。
该审核已在机构质量改进委员会备案。回顾了2003年至2004年期间12个月内入住ICU的73例心脏手术后患者的样本。
所有患者在ICU均接受了阿片类镇痛治疗。术后第一天，患者每小时平均接受1.27毫克吗啡当量，而在ICU停留第二天的25例患者每小时平均接受0.84毫克吗啡当量。第一天的镇痛用药与年龄、性别或使用乳内动脉（IMA）移植物之间未见关联，第二天的用药与性别或IMA的使用之间也无关联。第二天使用的吗啡与年龄之间存在轻微负相关（r = -0.38，P = 0.06）。70例患者（96%）使用了对乙酰氨基酚或对乙酰氨基酚加可待因（8毫克或30毫克），但24例患者（33%）的处方为每6小时一次，实际每6小时给药的有32例（44%）。23%的患者在拔除胸引管前未给予镇痛治疗。平均拔管时间为15.7小时（标准差，12.1小时）。拔管时间与第一天每小时吗啡当量之间存在中度相关性（r = 0.43，P < 0.001）。ICU平均住院时间为28.1小时。73例患者均未记录常规疼痛评估评分。
我们建议在ICU引入患者静息及活动时的疼痛评分，并在ICU流程图上为这些评分设置指定区域。可定期开具对乙酰氨基酚或其他简单镇痛药，工作人员需要接受关于患者拔除胸引管前预处理的教育。
