CAJ | 학술논문

目的：采用自制疼痛评估表（ NRS）记录并分析上肢骨折患者的疼痛影响因素与术后疼痛管理效果。方法选择2012年2月—2013年2月行切开复位钢板内固定术治疗的164例上肢骨折患者，所有患者术后均采用静脉自控镇痛（ PCIA）联合静脉滴注氟比洛酚酯镇痛。对影响患者疼痛程度的各因素进行Logistic回归分析。并于伤后24 h、48 h记录患者疼痛NRS评分的最大值，同时计算并比较术后24 h、48 h、72 h静息状态时疼痛缓解程度。结果不同性别、年龄、受伤时间、骨折部位、骨折AO分型的患者其疼痛程度差异有统计学意义（ P＜0．05）。性别（女）、年龄（≤60岁）、骨折部位（肱骨近端骨折）、骨折分型（C型）是上肢骨折后重度疼痛发生的影响因素（P＜0．05）。伤后24 h、48 h时不同部位的骨折（肱骨近端骨折、肱骨远端骨折、尺／桡骨骨折）疼痛程度NRS评分之间差异均有统计学意义（ F值分别为81．756，84．288；P＜0．05）；不同部位的骨折在伤后24 h疼痛程度NRS评分均高于伤后48 h，差异有统计学意义（t值分别为4．720，5．703，5．888；P＜0．05）。术后24 h、48 h、72 h在疼痛干预下，术后24 h女性患者疼痛缓解程度较男性高，差异有统计学意义（t＝2．857，P＜0．05）。术后72 h患者对术后疼痛控制情况为：非常满意92例，较满意59例，不满意13例。结论上肢骨折患者疼痛程度因性别、年龄、骨折部位、骨折分型而异，医务人员应对骨折患者予以合理的疼痛管理，才能提高患者满意度。
목적：채용자제동통평고표（ NRS）기록병분석상지골절환자적동통영향인소여술후동통관리효과。방법선택2012년2월—2013년2월행절개복위강판내고정술치료적164례상지골절환자，소유환자술후균채용정맥자공진통（ PCIA）연합정맥적주불비락분지진통。대영향환자동통정도적각인소진행Logistic회귀분석。병우상후24 h、48 h기록환자동통NRS평분적최대치，동시계산병비교술후24 h、48 h、72 h정식상태시동통완해정도。결과불동성별、년령、수상시간、골절부위、골절AO분형적환자기동통정도차이유통계학의의（ P＜0．05）。성별（녀）、년령（≤60세）、골절부위（굉골근단골절）、골절분형（C형）시상지골절후중도동통발생적영향인소（P＜0．05）。상후24 h、48 h시불동부위적골절（굉골근단골절、굉골원단골절、척／뇨골골절）동통정도NRS평분지간차이균유통계학의의（ F치분별위81．756，84．288；P＜0．05）；불동부위적골절재상후24 h동통정도NRS평분균고우상후48 h，차이유통계학의의（t치분별위4．720，5．703，5．888；P＜0．05）。술후24 h、48 h、72 h재동통간예하，술후24 h녀성환자동통완해정도교남성고，차이유통계학의의（t＝2．857，P＜0．05）。술후72 h환자대술후동통공제정황위：비상만의92례，교만의59례，불만의13례。결론상지골절환자동통정도인성별、년령、골절부위、골절분형이이，의무인원응대골절환자여이합리적동통관리，재능제고환자만의도。
Objective To select NRS to record and analyze influencing factors and management effects of pain for patients with upper limp fracture.Methods Totals of 164 patients with upper limp fracture had been chosen from February 2012 to February 2013, and all of them received PCIA combining with transfused flurbiprofen to relieve pain.We analyzed influencing factors of pain by Logistic regression analysis and recorded the maximum of pain score assessed by NRS at 24 h and 48 h after trauma and compared the pain score during break at 24 h, 48 h and 72 h after operation.Results The gender, age, length of fracture, position of fracture and fracture of AO type brought out different level of pain and those of pain had statistical difference ( P <0.05).The gender (female), age (beyond 60 years old), position of fracture (proximal humerus fracture) and fracture of C type were severe risks to cause pain (P <0.05).The pain scores of proximal humerus fracture, distal end of humerusfracture, radial fracture and ulnar fracture,which assessed by NRS, had statistical difference at 24 h and 48 h after fracture (F=81.756,84.288, respectively;P<0.05), while different position of fracture had high pain score at 24 h than 48 h (t=4.720,5.703,5.888, respectively;P<0.05).Under analgesia after operation at 24 h,48 h and 72 h, female patients had more effective pain control result than males (t=2.857,P<0.05).After 72hrs operation, there were ninety two cases satisfaction, fifty nine cases certain satisfaction and thirteen cases dissatisfaction for the result of pain control.Conclusions Because different gender, age, position of fracture and fracture type result in different level of pain, medical staff should provide reasonable pain management for fracture patient in order to enhance patient’ s satisfactory.