重庆地区部分医院住院患者手术后疼痛现状的 横断面调查与分析

Cross-sectional survey on postoperative pain of inpatients in hospitals in Chongqing，China

摘要:

目的：了解重庆地区住院患者术后急性疼痛的发生和治疗情况。方法：调查重庆地区18家医院在2015年3月18日0：00至3月21日0：00期间曾接受手术、且年龄≥9岁的住院患者术后疼痛的发生和治疗情况，调查在手术结束后48 h内完成。结果：实际调查患者1 147例，实查率为98.12%。术后疼痛发生率约96.6%。调查当时各级医院总体中重度静息痛发生率18.3%，中重度运动痛发生率49.9%；术后曾经历的最剧烈静息痛和运动痛达到中重度的比例分别为42.0%和84.2%。其中，三级教学医院、三级非教学医院和二级医院手术患者术后最剧烈静息痛达中重度的比例分别为30.7%、42.5%和54.7%（P<0.01），最剧烈运动痛达中重度的比例分别为78.5%、80.7%和93.4%（P<0.01）。各级医院镇痛药物平均使用率77.8%，三级教学医院（81.6%）使用率高于三级非教学医院（74.4%）。三级教学医院多选择阿片类药物和非甾体消炎药联合镇痛，三级非教学医院和二级医院则以阿片类药物单一镇痛为主。各级医院镇痛方式均主要为患者自控镇痛，给药途径以静脉注射为主。结论：重庆地区住院患者术后疼痛发生率较高，其中三级教学医院术后中重度疼痛发生率相对较低，以多种镇痛药物联合应用为主；而三级非教学医院和二级医院术后中重度疼痛较为普遍，以阿片类药物单一镇痛为主。

Abstract:

Objective：To survey the characteristics and treatments of postoperative pain in Chongqing hospitals of China. Methods：A questionnaire survey was conducted in all inpatients aged over 9 and undergone surgery between 0：00 on March 18th and 24：00 on March 20th，2015 in 18 hospitals in Chongqing city. All patients were interviewed within postoperative 48 hours. The presence and intensity of postoperative pain at the time of the survey，as well as the intensity of the most severe pain that patient had ever experienced after surgery were assessed. Pain was measured by numerical rating scale（NRS）. Moreover，information about treatment of postoperative pain was also recorded. And relevant medical-surgical data were retrieved from the patients’ hospital records. Results：A total of 1 147 patients were investigated，and the investigation rate was 98.12%. The overall prevalence of postoperative was 96.6%. At the specific time of the survey，210（18.3%） patients reported moderate to severe pain at rest，and 572（49.9%） patients reported moderate to severe pain on movement. Meanwhile，482（42.0%） patients complained they had experienced moderate to severe pain at rest after surgery，and 966（84.2%） patients had ever suffered moderate to severe pain on movement following surgery. In tertiary non-teaching hospitals，tertiary non-teaching hospitals and secondary hospitals，incidence of moderate to severe pain at rest in patients of were 30.7%，42.5%，and 54.7%，respectively（P<0.01），and moderate to severe pain on movement were 78.5%，80.7%，93.4%，respectively（P<0.01）. There were 892（77.8%） patients received analgesics to treat postoperative pain. More patients（81.6%） in tertiary teaching hospitals received analgesics than patients in tertiary non-teaching hospitals（74.4%）. A combination of opioids and non-steroidal anti-inflammatory drugs was the most commonly used analgesic regimen after surgery in tertiary teaching hospitals，whereas other grades hospitals preferred to use opioids alone to control postoperative pain. In hospitals of Chongqing，patient controlled analgesia was the most popular analgesic technique，and analgesics were most commonly administered by intravenous injection. Conclusion：The incidence of postoperative pain of inpatients is rather high in hospitals of Chongqing. Moderate to severe pain occurs relatively less frequently in tertiary teaching hospitals than in tertiary non-teaching hospitals and secondary hospitals. Analgesics combination is commonly used in tertiary teaching hospitals，while single opioid administration is popular in tertiary non-teaching hospitals and secondary hospitals.