基于移动互联网的虚拟无痛病房对开颅手术后患者疼痛管理的效果

doi:10.3969/j.issn.1006-9771.2021.02.017

摘要/Abstract

摘要： 目的

评价基于移动互联网的虚拟无痛病房管理对开颅手术后患者疼痛管理的效果。

方法

采用历史对照的研究设计，选取2019年5月至10月本院神经外科肿瘤六病区实施虚拟无痛病房管理后住院行开颅手术的117例患者为无痛病房组；选取2018年11月至2019年4月在同一科室住院行开颅手术、未行无痛病房管理的117例患者作为对照组。建立回归方程对两组患者术后疼痛数字评分量表(NRS)评分、护理满意度和焦虑发生率进行比较，并将年龄等作为自变量进入回归方程。计算调整后无痛病房管理相对未行无痛病房管理的偏回归系数(B)、比值比(OR)及其95%可信区间(confidence interval, CI)。

结果

多因素回归分析显示，无痛病房管理后4 d内NRS评分显著降低(B = -2.700, 95%CI -3.167~-2.232, P < 0.001)，护理满意度显著升高(B = 0.542, 95%CI 0.289~0.795, P < 0.001)，焦虑发生率显著下降(B = -2.119, OR = 0.120, 95%CI0.053~0.271, P < 0.001)，但无痛病房管理对焦虑状态的改善可能不完全依赖疼痛评分的降低(B = -0.112, OR = 0.894, 95%CI 0.727~1.100, P > 0.05)。

结论

基于移动互联网的虚拟无痛病房管理可提高开颅手术后患者镇痛的管理水平。

关键词: 虚拟无痛病房, 开颅手术, 疼痛, 护理满意度, 焦虑

Abstract: Objective

To evaluate the effect of virtual painless ward management based on mobile internet on pain management of patients after craniotomy.

Methods

From May to October, 2019, 117 patients who accepted virtual painless ward management based on mobile Internet after craniotomy were selected as painless ward group. From December, 2018 to April, 2019, 117 patients previously hospitalized in the same department after craniotomy were selected as control group. The regression equation was established to compare the Numerical Rating Scale (NRS), nursing satisfaction and anxiety rate between two groups, and the general data, such as age, were taken as independent variables into the regression equation. Partial regression coefficient (B), odds ratio (OR) and 95% confidence interval (CI) of the painless ward management after adjustment compared with that of the non-painless ward management were calculated.

Results

Multivariate regression analysis showed that, compared with the control group, the score of NRS within four days significantly decreased (B = -2.700, 95%CI -3.167 to -2.232, P < 0.001), the nursing satisfaction significantly increased (B = 0.542, 95%CI 0.289 to 0.795, P < 0.001), and the anxiety rate significantly decreased (B = -2.119, OR = 0.120, 95%CI0.053 to 0.271, P < 0.001) in the painless ward group. However, the improvement of the anxiety rate might not completely depend on the decrease of NRS score (B = -0.112, OR = 0.894, 95%CI 0.727 to 1.100, P > 0.05).

Conclusion

The procedure of virtual painless ward based on mobile internet could obviously improve the management level of analgesia for patients after craniotomy.

Key words: virtual painless ward, craniotomy, pain, nursing satisfaction, anxiety

中图分类号:

R614

黄娜,张慧鑫,任浩,郭昱琪. 基于移动互联网的虚拟无痛病房对开颅手术后患者疼痛管理的效果[J]. 《中国康复理论与实践》, 2021, 27(2): 222-229.

Na HUANG,Hui-xin ZHANG,Hao REN,Yu-qi GUO. Effect of Virtual Painless Ward Based on Mobile Internet on Pain Management for Patients after Craniotomy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 222-229.

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项目	对照组(n = 117)	无痛病房组(n = 117)	t/χ²值	P值
年龄(岁)	54.6±8.3	55.8±10.2	-1.059	0.291
女性(n)	61	68	0.847	0.358
BMI (kg/m²)	24.4±2.6	22.8±3.6	4.055	< 0.001
受教育程度(n)			6.633	0.025
小学	8	8
中学	66	47
大专及以上	43	62
既往开颅手术史(n)	11	10	0.052	0.819
慢性头痛病史(n)	29	16	4.650	0.031
颈椎病病史(n)	23	18	0.739	0.390
慢性并发症(n)
高血压	21	27	0.944	0.331
冠心病	9	13	0.803	0.370
糖尿病	6	12	2.167	0.141
脑血管病	3	8	2.385	0.123
手术切口部位(n)			4.709	0.185
额部	17	30
颞部	61	55
顶部	36	29
枕部	3	3
恶性肿瘤(n)	55	51	0.276	0.599
阿片类药物用量(μg)	54.1±18.3	40.3±16.7	5.990	< 0.001

自变量及赋值	B	95% CI		P值
是否接受无痛病房管理(0 =否，1 =是)	-2.700	-3.167	-2.232	< 0.001
年龄	0.011	-0.013	0.036	0.367
性别(1=女，2=男)	0.018	-0.411	0.447	0.935
BMI	0.010	-0.057	0.078	0.765
文化程度(1 =小学，2 =中学，3=大专及以上)	-0.088	-0.435	0.258	0.616
以往进行过开颅手术(0 =否，1 =是)	0.200	-0.530	0.929	0.590
慢性头痛病史(0 =否，1 =是)	0.230	-0.301	0.761	0.394
颈椎病病史(0 =否，1 =是)	-0.064	-0.606	0.479	0.817
高血压(0 =否，1 =是)	-0.416	-0.947	0.115	0.124
冠心病(0=否；1=是)	-0.551	-1.278	0.176	0.137
糖尿病(0 =否，1 =是)	0.021	-0.777	0.819	0.959
脑血管病(0 =否，1 =是)	0.065	-0.951	1.081	0.900
手术切口部位(1 =额部，2 =颞部，3 =顶部，4 =枕部)	-0.140	-0.420	0.140	0.324
肿瘤性质(1 =良性，2 =恶性)	0.023	-0.398	0.444	0.913
镇痛泵药物使用量	0.033	0.021	0.045	< 0.001
常数	3.975	1.182	6.768	0.005

自变量及赋值	B	95% CI		P值
是否接受无痛病房管理(0 =否，1 =是)	0.542	0.289	0.795	< 0.001
年龄	0.006	-0.007	0.020	0.341
性别(1=女，2=男)	-0.086	-0.318	0.146	0.468
BMI	-0.001	-0.037	0.036	0.962
文化程度(1 =小学，2 =中学，3=大专及以上)	-0.080	-0.268	0.108	0.402
以往进行过开颅手术(0 =否，1 =是)	-0.007	-0.402	0.388	0.971
慢性头痛病史(0 =否，1 =是)	0.073	-0.214	0.361	0.616
颈椎病病史(0 =否，1 =是)	0.206	-0.088	0.499	0.169
高血压(0 =否，1 =是)	0.102	-0.186	0.390	0.485
冠心病(0=否；1=是)	-0.087	-0.480	0.307	0.665
糖尿病(0 =否，1 =是)	-0.089	-0.521	0.343	0.684
脑血管病(0 =否，1 =是)	-0.166	-0.716	0.384	0.553
手术切口部位(1 =额部，2 =颞部，3 =顶部，4 =枕部)	0.022	-0.129	0.174	0.771
肿瘤性质(1 =良性，2 =恶性)	-0.184	-0.412	0.044	0.113
镇痛泵药物使用量	-0.002	-0.009	0.004	0.487
常数	4.132	2.620	5.644	< 0.001

自变量及赋值	B	OR值	OR值的95% CI		P值
是否接受无痛病房管理(0 =否，1 =是)	-2.119	0.120	0.053	0.271	< 0.001
年龄	0.002	0.942	0.483	1.838	0.914
性别(1 =女，2 =男)	-0.060	0.950	0.849	1.063	0.861
BMI	-0.051	1.275	0.731	2.224	0.370
文化程度(1 =小学，2 =中学，3 =大专及以上)	0.243	0.487	0.141	1.675	0.392
以往进行过开颅手术(0 =否，1 =是)	-0.720	1.488	0.693	3.198	0.254
慢性头痛病史(0 =否，1 =是)	0.398	0.732	0.309	1.734	0.308
颈椎病病史(0 =否，1 =是)	-0.312	1.374	0.606	3.117	0.478
高血压(0 =否，1 =是)	0.318	0.902	0.275	2.960	0.447
冠心病(0 =否，1 =是)	-0.103	0.745	0.189	2.930	0.865
糖尿病(0 =否，1 =是)	-0.295	0.876	0.150	5.109	0.673
脑血管病(0 =否，1 =是)	-0.132	1.210	0.778	1.880	0.883
手术切口部位(1 =额部，2 =颞部，3 =顶部，4 =枕部)	0.190	1.347	0.694	2.617	0.397
肿瘤性质(1 =良性，2 =恶性)	0.298	0.998	0.980	1.017	0.379
镇痛泵药物使用量	-0.002	0.706	0.965	1.041	0.853
常数	-0.347	1.002			0.879

自变量及赋值	B	OR值	OR的95% CI		P值
是否接受无痛病房管理(0 =否，1 =是)	-2.417	0.089	0.033	0.241	< 0.001
年龄	0.004	1.004	0.966	1.044	0.826
性别(1 =女，2 =男)	-0.074	0.929	0.475	1.817	0.829
BMI	-0.049	0.952	0.850	1.066	0.392
文化程度(1 =小学，2 =中学，3 =大专及以上)	0.233	1.263	0.722	2.207	0.413
以往进行过开颅手术(0 =否，1 =是)	-0.692	0.500	0.145	1.722	0.272
慢性头痛病史(0 =否，1 =是)	0.447	1.563	0.724	3.374	0.255
颈椎病病史(0 =否，1 =是)	-0.330	0.719	0.301	1.716	0.457
高血压(0 =否，1 =是)	0.265	1.304	0.570	2.983	0.530
冠心病(0 =否，1 =是)	-0.194	0.824	0.246	2.763	0.754
糖尿病(0 =否，1 =是)	-0.254	0.775	0.197	3.046	0.715
脑血管病(0 =否，1 =是)	-0.139	0.870	0.148	5.097	0.877
手术切口部位(1 =额部，2 =颞部，3 =顶部，4 =枕部)	0.162	1.176	0.753	1.836	0.476
肿瘤性质(1 =良性，2 =恶性)	0.284	1.328	0.684	2.581	0.402
镇痛泵药物使用量	0.003	1.003	0.983	1.023	0.790
NRS评分	-0.112	0.894	0.727	1.100	0.290
常数	0.059	1.060			0.980