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一本关于疼痛管理的教育手册干预对心脏手术后疼痛控制的影响。

The impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery.

作者信息

Bjørnnes Ann Kristin, Parry Monica, Lie Irene, Fagerland Morten Wang, Watt-Watson Judy, Rustøen Tone, Stubhaug Audun, Leegaard Marit

机构信息

1 Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.

2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.

出版信息

Eur J Cardiovasc Nurs. 2017 Jan;16(1):18-27. doi: 10.1177/1474515116631680. Epub 2016 Jul 7.

Abstract

BACKGROUND

Relevant discharge information about the use of analgesic medication and other strategies may help patients to manage their pain more effectively and prevent postoperative persistent pain.

AIMS

To examine patients' pain characteristics, analgesic intake and the impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Concerns about pain and pain medication prior to surgery will also be described.

METHODS

From March 2012 to September 2013, 416 participants (23% women) were consecutively enrolled in a randomized controlled trial. The intervention group received usual care plus an educational booklet at discharge with supportive telephone follow-up on postoperative day 10, and the control group received only usual care. The primary outcome was worst pain intensity (The Brief Pain Inventory - Short Form). Data about pain characteristics and analgesic use were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery. General linear mixed models were used to determine between-group differences over time.

RESULTS

Twenty-nine percent of participants reported surgically related pain at rest and 9% reported moderate to severe pain at 12 months post-surgery. Many participants had concerns about pain and pain medication, and analgesic intake was insufficient post-discharge. No statistically significant differences between the groups were observed in terms of the outcome measures following surgery.

CONCLUSION

Postoperative pain and inadequate analgesic use were problems for many participants regardless of group allocation, and the current intervention did not reduce worst pain intensity compared with control. Further examination of supportive follow-up monitoring and/or self-management strategies post-discharge is required.

摘要

背景

有关止痛药物使用及其他策略的相关出院信息,可能有助于患者更有效地管理疼痛,并预防术后持续性疼痛。

目的

研究心脏手术后患者的疼痛特征、止痛药物摄入情况,以及一份疼痛管理教育手册干预措施对术后疼痛控制的影响。同时,还将描述患者术前对疼痛及止痛药物的担忧。

方法

2012年3月至2013年9月,416名参与者(23%为女性)连续纳入一项随机对照试验。干预组在出院时接受常规护理加一本教育手册,并在术后第10天接受支持性电话随访,对照组仅接受常规护理。主要结局指标为最严重疼痛强度(简明疼痛问卷简表)。在术后2周、1个月、3个月、6个月和12个月收集疼痛特征及止痛药物使用的数据。采用广义线性混合模型确定组间随时间的差异。

结果

29%的参与者报告术后静息时有手术相关疼痛,9%的参与者在术后12个月报告有中度至重度疼痛。许多参与者对疼痛及止痛药物存在担忧,出院后止痛药物摄入不足。术后两组在结局指标方面未观察到统计学上的显著差异。

结论

无论分组如何,术后疼痛和止痛药物使用不足对许多参与者来说都是问题,与对照组相比,当前的干预措施并未降低最严重疼痛强度。需要进一步研究出院后的支持性随访监测和/或自我管理策略。

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