摘要
目的减轻老年消化道肿瘤患者术后疼痛程度及疼痛所致的不良影响。方法将择期行消化道肿瘤根治术的150例老年患者随机分为对照组(73例)和观察组(77例)。两组均予静脉自控镇痛,对照组行常规护理,观察组实施全程无痛干预,包括对可能产生疼痛的诊疗项目进行无痛化处理、加强术后镇痛管理、围术期对患者进行疼痛知识教育及心理行为干预。结果两组除长记忆、动物名及临摹外,老年认知功能量表(SECF)总分及其他8个维度得分比较,差异有统计学意义(P<0.05,P<0.01);两组SECF总分及回忆1低于划界分病例数比较,差异有统计学意义(均P<0.01);两组术后6 h、12 h2、4 h、48 h VAS评分比较,差异有统计学意义(P<0.05,P<0.01);两组患者首次下床活动时间、术后芬太尼用量、住院时间比较,差异有统计学意义(均P<0.01)。结论围术期全程无痛干预能减少老年消化道肿瘤患者术后认知功能障碍的发生率,减轻患者术后疼痛,减少术后镇痛药物的用量,有利于患者术后恢复。
Objective To reduce degree of pain and pain-related adverse effects in older patients with gastrointestinal tumor receiving surgical treatment.Methods One hundred and fifty older patients receiving radical resection of gastrointestinal carcinoma were randomized into a control group（n=73） and an observation group（n=77）.Both groups received patient controlled intravenous analgesia,and patients in the control group were given routine nursing care,while participants in the observation group were subjected to pain reduction interventions,including making diagnostic procedures painless,strengthening postoperative pain management,and conducting pain-related knowledge education and psychological behavioral interventions.Results Except subscales of long-term anamnesis,animal names and imitating,the total score of the Scale of Elderly Cognitive Function（SECF） and the scores of the other 8 subscales showed significant differences between the two groups（P0.05,P0.01）;the proportion of patients with the total score of SECF and the score of instant memory lower than the demarcation scores in the two groups had significant differences（P0.01 for both）.The scores of the Visual Analogue Scale had statistical differences between the two groups at postoperative 6 h,12 h,24 h,48 h（P0.05,P0.01）.Significant differences were found in the time for carrying out out-of-bed exercises,the dose of fentanyl,and the length of hospital stays between the two groups（P0.01 for all）.Conclusion Interventions for pain reduction could reduce postoperative cognitive dysfunction in older patients with gastrointestinal tumor,relieve their postoperative pain,reduce the dose of anesthetics,and improve their recovery.
关键词
老年人
消化道肿瘤
手术
认知功能障碍
抑郁
全程无痛干预
the elderly
gastrointestinal tumor
operation
cognitive dysfunction
depression
interventions for pain reduction
作者简介
敖琴英：女，硕士，讲师／主管护师；通信作者
