医院环境中的镇痛药物使用与疼痛

Analgesic use and pain in the hospital settings.

作者信息

Vallano A, Malouf J, Payrulet P, Baños J E

机构信息

Fundació Institut Català de Farmacología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

出版信息

Eur J Clin Pharmacol. 2007 Jun;63(6):619-26. doi: 10.1007/s00228-007-0303-7. Epub 2007 Apr 20.

DOI:10.1007/s00228-007-0303-7

PMID:17447056

Abstract

AIM

The aim of this study was to assess the analgesic treatment and the prevalence of pain in patients treated with analgesics in hospitals.

METHODS

Adult patients treated with analgesics were selected from a sample of 1,675 patients in a cross-sectional study carried out in 15 Catalonian hospitals (Spain). Patient characteristics, type of analgesics, treatment schedules, patients' pain intensity and clinical ward and hospital characteristics were assessed. Adherence to analgesic use guidelines was established according to the principles and recommendations of internationally recognised guidelines for pain management. Pain was determined by asking patients about pain intensity by means of a visual analogue scale (VAS).

RESULTS

Analgesics were prescribed for 1,173 patients (70%; 95% CI: 67.4-72.6), in whom 57% (95% CI: 54.2-59.8) had pain and in whom 30.5% (95% CI: 27.9-33.1) pain intensity was greater than 30 mm. Adherence to analgesic treatment guidelines was judged appropriate in only 26.9% (95% CI: 24.4-29.4%) of all patients. The administered analgesic dose was in the recommended dose range in 42% (95% CI: 54-58) of all analgesics and in 28% (95% CI: 24-32) of opioid analgesics. A minority of patients was treated with a rescue schedule or patient-controlled analgesia (2%; 95% CI: 1.4-2.6). Pain prevalence was higher in those with analgesic treatment that did not adhere to guidelines (63.6%; 95% CI: 60.4-66.8) than in those considered as having appropriate adherence to guidelines (39.3%; 95% CI: 33.8-44.6) (p < 0.001). Adherence to analgesic treatment guidelines was higher in the large hospitals (21%; 95% CI: 18-24) than in medium and small hospitals (13%; 95% CI: 9-16) (p < 0.001).

CONCLUSIONS

Although analgesic use is high in the hospital settings, adherence to the principles and recommendations of pain guidelines is low, and pain is usually common in patients treated with analgesics. These results once again emphasise the need to improve analgesic use and pain management in hospitals.

摘要

目的

本研究旨在评估医院中接受镇痛药治疗患者的镇痛治疗情况及疼痛发生率。

方法

在西班牙加泰罗尼亚地区15家医院开展的一项横断面研究中，从1675例患者样本中选取接受镇痛药治疗的成年患者。评估患者特征、镇痛药类型、治疗方案、患者疼痛强度以及临床科室和医院特征。根据国际认可的疼痛管理指南的原则和建议确定镇痛药使用的依从性。通过视觉模拟量表（VAS）询问患者疼痛强度来确定疼痛情况。

结果

1173例患者（70%；95%置信区间：67.4 - 72.6）接受了镇痛药处方，其中57%（95%置信区间：54.2 - 59.8）有疼痛，30.5%（95%置信区间：27.9 - 33.1）的疼痛强度大于30mm。在所有患者中，仅26.9%（95%置信区间：24.4 - 29.4%）的镇痛药治疗依从性被判定为恰当。所有镇痛药中42%（95%置信区间：54 - 58）以及阿片类镇痛药中28%（95%置信区间：24 - 32）的给药剂量在推荐剂量范围内。少数患者采用了补救方案或患者自控镇痛（2%；95%置信区间：1.4 - 2.6）。未遵循指南的镇痛药治疗患者的疼痛发生率（63.6%；95%置信区间：60.4 - 66.8）高于被认为依从性恰当的患者（39.3%；95%置信区间：33.8 - 44.6）（p < 0.001）。大型医院的镇痛药治疗依从性（21%；95%置信区间：18 - 24）高于中小型医院（13%；95%置信区间：9 - 16）（p < 0.001）。