Coutaux Anne, Salomon Laurence, Rosenheim Michel, Baccard Anne-Sophie, Quiertant Catherine, Papy Emmanuelle, Blanchon Thierry, Collin Elisabeth, Cesselin François, Binhas Michèle, Bourgeois Pierre
Unit of Pain Assessment and Treatment, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie - Paris VI, Paris 75005, France.
Eur J Pain. 2008 Jan;12(1):3-8. doi: 10.1016/j.ejpain.2007.05.002. Epub 2007 Jul 2.
Care-related pain includes pain occurring during transportation, movement, diagnostic imaging, physical examination, or treatment. Its prevalence has never been assessed in a large adult inpatient population.
To identify the procedures likely to induce or increase pain in hospital patients, attempting to separate the most painful from those reported as most frequently inducing pain.
A single-day cross-sectional survey conducted in two large French teaching hospitals, including all hospitalized patients, free of communication problems. One third was randomly selected and interviewed about the painful episodes that had occurred or were associated with the procedures performed during the previous two weeks. Patients were interviewed using a structured questionnaire.
Six-hundred-eighty-four patients were randomly selected. Six-hundred-seventy-one painful events were reported in 55% of the patients, with an average of 1.8 events/patient. Fifty-two percent of the painful events were associated with procedures performed by non-medical staff; 38% of the painful episodes occurred during procedures involving vascular puncture and 24% during patients' mobilization. In 57% of painful procedures, pain was rated as severe or extremely severe. The most painful procedures were invasive procedures, other than vascular and non vascular punctures (74% of severe and extremely severe painful episodes). Maximum pain intensity was rated higher for procedures that were repeated than for those experienced only once (62% versus 53%, p=0.02).
This survey gives new insight into our daily practice. Proper management of care-related pain should be a major concern of all hospital staff to improve the quality of our health care.
与护理相关的疼痛包括在转运、移动、诊断成像、体格检查或治疗过程中出现的疼痛。其在大量成年住院患者中的患病率从未得到评估。
确定可能在医院患者中诱发或加重疼痛的操作，试图将最疼痛的操作与那些被报告为最常诱发疼痛的操作区分开来。
在两家大型法国教学医院进行了为期一天的横断面调查，纳入所有住院患者，且无沟通问题。随机抽取三分之一的患者，询问他们在前两周内发生的或与所进行操作相关的疼痛事件。使用结构化问卷对患者进行访谈。
随机选取了684名患者。55%的患者报告了671起疼痛事件，平均每位患者1.8起。52%的疼痛事件与非医务人员进行的操作有关；38%的疼痛发作发生在涉及血管穿刺的操作过程中，24%发生在患者移动期间。在57%的疼痛操作中，疼痛被评为重度或极重度。最疼痛的操作是除血管和非血管穿刺以外的侵入性操作（74%的重度和极重度疼痛发作）。重复进行的操作的最大疼痛强度评分高于仅经历一次的操作（62%对53%，p = 0.02）。
这项调查为我们的日常实践提供了新的见解。对与护理相关疼痛的妥善管理应成为所有医院工作人员的主要关注点，以提高我们的医疗保健质量。
