Desbiens N A, Wu A W, Broste S K, Wenger N S, Connors A F, Lynn J, Yasui Y, Phillips R S, Fulkerson W
Marshfield Clinic, Johns Hopkins University, WI, USA.
Crit Care Med. 1996 Dec;24(12):1953-61. doi: 10.1097/00003246-199612000-00005.
To evaluate the pain experience of seriously ill hospitalized patients and their satisfaction with control of pain during hospitalization. To understand the relationship of level of pain and dissatisfaction with pain control to demographic, psychological, and illness-related variables.
Prospective, cohort study.
Five teaching hospitals.
Patients for whom interviews were available about pain (n = 5,176) from a total of 9,105 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).
None.
Patients were interviewed after study enrollment about their experiences with pain. When patients could not be interviewed due to illness, we used surrogate (usually a family member) responses calibrated to patient responses (from the subset of interviews with both patient and surrogate responses). Ordinal logistic regression was used to study the association of variables with level of pain and satisfaction with its control. Nearly 50% of patients reported pain. Nearly 15% reported extremely severe pain or moderately severe pain occurring at least half of the time, and nearly 15% of those patients with pain were dissatisfied with its control. After adjustment for confounding variables, older and sicker patients reported less pain, while patients with more dependencies in activities of daily living, more comorbid conditions, more depression, more anxiety, and poor quality of life reported more pain. Patients with colon cancer reported more pain than patients in other disease categories. Levels of reported pain varied among the five hospitals and also by physician specialty. After adjustment for confounding variables, dissatisfaction with pain control was more likely among patients with more severe pain, greater anxiety, depression, and alteration of mental status, and lower reported income; dissatisfaction with pain control also varied among study hospitals and by physician specialty.
Pain is common among severely ill hospitalized patients. The most important variables associated with pain and satisfaction with pain control were patient demographics and those variables that reflected the acute illness. Pain and satisfaction with pain control varied significantly among study sites, even after adjustment for many potential confounders. Better pain management strategies are needed for patients with the serious and common illnesses studied in SUPPORT.
评估重症住院患者的疼痛体验及其对住院期间疼痛控制的满意度。了解疼痛程度和对疼痛控制的不满与人口统计学、心理及疾病相关变量之间的关系。
前瞻性队列研究。
五所教学医院。
在“了解治疗结果和风险的预后及偏好研究”（SUPPORT）中，共有9105名患者，其中有5176名患者接受了关于疼痛的访谈。
无。
患者在研究入组后接受关于疼痛体验的访谈。若患者因病情无法接受访谈，则采用代理人（通常为家庭成员）的回答，并根据患者的回答进行校准（来自患者和代理人都有回答的子集中）。采用有序逻辑回归研究变量与疼痛程度及对疼痛控制满意度之间的关联。近50%的患者报告有疼痛。近15%的患者报告至少一半时间出现极其严重或中度严重的疼痛，且近15%有疼痛的患者对疼痛控制不满意。在对混杂变量进行调整后，年龄较大和病情较重的患者报告的疼痛较少，而在日常生活活动中有更多依赖、合并症更多、抑郁更严重、焦虑更严重及生活质量较差的患者报告的疼痛更多。结肠癌患者报告的疼痛比其他疾病类别的患者更多。五所医院报告的疼痛程度各不相同，且因医生专业不同也有所差异。在对混杂变量进行调整后，疼痛更严重、焦虑更严重、抑郁更严重、精神状态改变及报告收入较低的患者对疼痛控制不满意的可能性更大；对疼痛控制的不满在研究医院之间及因医生专业不同也有所差异。
疼痛在重症住院患者中很常见。与疼痛及对疼痛控制满意度相关的最重要变量是患者人口统计学特征及那些反映急性疾病的变量。即使在对许多潜在混杂因素进行调整后，研究地点之间疼痛及对疼痛控制的满意度仍存在显著差异。对于SUPPORT研究中的严重且常见疾病患者，需要更好的疼痛管理策略。
