| BackgroundWith the development of society and the continuous improvement of medical treatment level,people pay more and more attention to the problem of health and pain in the past 20 years.Since 1988,Ready,LB reported the first hospital for acute pain service center(APS,Acute Pain Service),the corresponding analgesic methods and analgesic drugs,and the multidisciplinary team's continuous application of pain therapy(PMDT),We have made some progress in the control of postoperative pain.The IASP(International association for the study of pain)has designated October 11 th each year as "global conquest of pain" from 2004,at the same time,adjust the pain definition to “tissue damage or potential tissue damage unpleasant physical subjective feelings and emotional experience,but also associated with metabolic,endocrine,respiratory,circulatory function and physiology and other multi-system changes”.In 1995,James Campbell,president of the American Society of Pains,suggested that pain as a fifth vital sign,along with blood pressure,body temperature,breathing,and pulse,was an important indicator of vital signs.American Joint Commission on Accreditation of healthcare organizations(JCAHO)and the Veterans Health Administration(VHA)were formally adopted to formally assess pain as a fifth vital sign and to develop criteria for all patients to develop pain assessment and management.In 2000,the 106 th Congress of the United States set 2000 to 2010 as "a decade of pain control and researc h".The 2001 Asia-Pacific Pain Forum called "Elimination of pain is the fundamental right of patients".The pain that does not alleviate,bring physical and mental anguish to the patient,is not conducive to early postoperative patients out of bed activities,may affect the body recovery process,increase the hospitalization days and expenses,or even seriously affect the life quality of patients at the same time,it is also an important factor of postoperative complications and mortality increased.Pain stimulation can make the patient appear insomnia and anxiety and even a helpless feeling,this psychological factor will undoubtedly delay the patient after the rehabilitation process.Therefore,the pain is a lot of people complain after surgery.ObjectiveTo investigate the analgesic status and comprehensive satisfaction of the 12 hospitals in Guangdong Province and the Genenral Hospital of PLA Guangzhou Military Area affiliated to Southern Medical University(intelligent management system),Xiaolan hospital Affiliated Hospital of Southern Medical University,to find out the problems and improve the postoperative pain control quality,in order to recommend a good way to postoperative analgesia,for clinical application to provide a reference.MethodThe First Affiliated Hospital of Sun Yat-sen University,Guangzhou Medical University Affiliated C ity People's Hospital,Sun Yat-sen Sun Yat-sen Memorial Hospital,Guangdong Provincial People's Hospital,Sun Yat-sen University Affiliated Foshan Hospital,Southern Medical University Southern Hospital,the Second Affiliated Hospital of Guangzhou Medical University,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,the Second People's Hospital of Guangdong Province,the First Affiliated Hospital of Jinan University,Zhongshan People's Hospital,And invited by intelligent PCA management system of a city hospital(Genenral Hospital of PLA Guangzhou Military Area affiliated to Southern Medical University: B group)and a grassroots hospital(Xiaolan hospital Affiliated Hospital of Southern Medical University C group).Unified investigation time is scheduled for In April 11,2016,0:00~2016,April 22 nd 23:59:59 all patients admitted into the operation room.The follow-up time starts at 0:00 on April 12,2016 and ends on April 24 th at 23:59:59.Recorded and followed up for the completion of the 12 + 2 hospitals coordinated after the unified printed postoperative analgesia questionnaire.Result1.A total of 4370 postoperative questionnaires were collected in 12 + 2 Grade A of Level ? hospitals,shedding rate of 3.14%.Including 1854 cases of male,female 2516 cases,aged 44.9 ± 18.0 years old.More than 70 years old accounted for 8.0%.ASA grade I,II,III-IV cases were 1229,2574,567 cases.In 2016 14 hospitals by the competent department of Anesthesiology of postoperative analgesia accounted for about 32.6% of the cases(the proportion of analgesia was 31.6% in the anesthesia department of 12 hospitals).There were 2(16.7%)hospitals with more than 50% postoperative analgesia in the anesthesiology department,6(50.0%)in less than 25%,4(33.3%)in 26% to 50%.Two invited hospitals anesthesia analgesic situation: intelligent system management hospital 51.4%,the grassroots hospital 32.7%.There were 1028 patients(23.5%)with PCIA analgesia,252 patients(5.8%)with PCEA analgesia,and 227 patients(5.2%)without analgesia.According to the different types of analgesic pumps,of which electronic analgesic pump accounted for 27.0%,mechanical analgesic pump accounted for 63.2%,the Internet intelligent analgesic pump system accounted for 9.8%.In patients undergoing anesthesia,Patient-Controlled Intravenous analgesia(PCIA)and patient-controlled epidural analgesia(PC EA)were 72.2% and 17.7%,respectively.2.4370 follow-up questionnaire,1167 cases(26.7%)patients had preoperative pain,463 cases(39.7%)before surgery under moderate to severe pain(VAS score ? 4 points).1167 patients with preoperative pain,the first day after the surgery,a proportion of 15% had an insufficient analgesia at rest.When active,more than 40% had moderate to severe pain.All the operations,about 3138 cases(71.8%)patients for general anesthesia,913 cases(20.9%)for spinal anesthesia(including combined spinal epidural anesthesia and epidural anesthesia,subarachnoid anesthesia),148 cases(3.4%)for peripheral nerve block anesthesia.3.In the survey of 12 hospitals(group A),2016(50.4%)were minor surgery,1202 were moderate(30.0%),784(19.6%)were major operation.Different operation time has obvious impact on the occurrence of the phenomenon of incomplete analgesia after operation.Surgery time ? 2 hours of surgery compared with the operation time> 2 hours,after 24 hours of rest and activity,the proportion of the patients with incomplete analgesia was respectively 8.8% and 26.5%.The difference was statistically significant(P < 0.05).Minimally invasive surgery and open surgery,24 hours after the operation,the rest and the activities of the proportion of incomplete analgesia were8.5%,27%;12.4%,34.4%,respectively,the difference was statistically significant(P < 0.05).Major surgery,moderate surgery and minor surgery,24 hours after the operation,the rest and the activities of the percentage of postoperative incomplete analgesia was 17.1%,48.0%,12.2%,34.4%,7.6% and 9.1%,respectively,and the difference was statistically significant(p <0.05).4.The proportion of patients with moderate to severe pain(VAS score ? 4 points)was different in 12 +2 hospitals after operation.At rest,the average number of moderate to severe pain was 10.6%(2.8% ~ 23.7%)on the first day after operation,and 3.8%(3.2% ~ 8.6%)on the second day after operation;during the event,the average of the first day after surgery was 33.6%(17.1% ~ 53.4%)with moderate to severe pain,the average after the second day of surgery was 16.3%(3.3% ~ 34.4%).5.The main adverse reactions of 12+2 hospital were nausea and vomiting.The incidence of nausea was 16% on the first day after operation,and the incidence of vomiting was about 10.4%.There were more than 40% and 23.5% of patients with indwelling catheter on the first day and the second day after operation.The satisfaction of the first day and the second day after operation were 66.5% and 78.6%,respectively.O n the first night after surgery,more than 45% of the patients had poor sleep quality,and on the night of the second day,there was still a 1/4 of the patients who had a bad sleep in private prosecution.6.The VAS score ? 4 points were 10.9%,7.3%,9.3% respectively,after 24 hours of operation at 12 hospitals(Group A),Southern Medical University,Guangzhou Military Region,Guangzhou General Hospital(Group B),Southern Medical University,Xiaolan Hospital(Group C),the difference was not statistically significant(P > 0.05).During the event,the VAS score ?4 was 13.6%,8.3% and 10.0%,respectively.The VAS score ?4 was 13.9%,8.3% and 10.0%,respectively,when at the daytime.The VAS score ?4 was 39.1%,52.3% and 70.7%,respectively,at night.The most severe time VAS score ? 4 were 39.8%,52.3%,70.7% respectively.The difference was statistically significant(p <0.05)).The VAS score ? 4 points was significantly lower in the second day after operation.Conclusion1.In 2016,the rate of postoperative analgesia was 32.6% in the Department of Anesthesiology,the Grade A of Level ? hospitals of Guangdong Province,C hina.Compared with the results of the investigation of the postoperative analgesia in the year of 2010,the analgesic rate of the anesthesiologist was reduced by 5.1%.2.The first day after surgery and two days in patients with activities of moderate to severe pain(VAS score ?4)incidence rates were 33.6% and 16.3%,the incidence rates were 41.4% and 18.8% of the most violent,compared with the 2010 survey results of 12 hospitals,patients after surgery in severe pain(VAS score ?4)proportion did not improve.3.In 2016,the proportion of epidural analgesia after surgery decreased,the proportion of intravenous analgesia increased.Postoperative analgesic drugs are mainly opioids.Postoperative nausea,vomiting is still the main adverse reaction after postoperative analgesia,but the incidence of adverse reactions is low.4.Recommended intelligent analgesic pump system for postoperative analgesia,improve the multi-mode and the whole individual joint analgesic model,improve patient comfort and promote rehabilitation. |
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