Subjective and Objective Assessment of the Therapeutic Effect of Activity-induced Pain after Thoracic Surgery

doi:10.12114/j.issn.1007-9572.2019.00.018

Abstract

Abstract: Background　At present，most of domestic studies about postoperative pain evaluate the pain in general without explaining whether it is rest pain or activity-induced pain.Studies about postoperative activity-induced pain in China are very limited.Recently，it has been widely pointed out in studies at home and abroad that the relief of activity-induced pain can ensure maximal postoperative recovery of physical function.In addition，most of the pain assessment methods used in some studies are only subjective self-evaluation from patients，which is not comprehensive enough.Objective　To subjectively and objectively evaluate the therapeutic effect of postoperative activity-induced pain in patients with thoracic surgery.Methods　We selected 15 patients who underwent video-assisted thoracoscopic surgery under general anesthesia in Department of Thoracic Surgery，the First Affiliated Hospital of Jinzhou Medical University during August to September，2018.All of them received an intraoperative frozen section diagnosis of lung cancer.We adopted four grade Functional Activity Score （FAS） to evaluate the patient's ability to cough effectively within 30 minutes before or after taking flurbiprofen axetil 4 times daily （namely at 10：00，11：30，
16：00，and 17：30） and used Numerical Rating Scale （NRS） to evaluate the intensity of pain during effective coughing，on the 1st day after surgery，the day of extubation，the 1st day after extubation，and the discharge day，respectively.Results　There were no significant differences between the average NRS scores of the patients at 10：00 and 11：30，and between the average NRS scores at 16：00 and 17：30 on the 1st day after surgery，the day of extubation，the 1st day after extubation，and the discharge day（P>0.05）．The average NRS scores of the patients at 10：00，11：30，16：00 and 17：30 were similar on the 1st day after surgery，and they were also similar on the 1st day after extubation，and the discharge day（P>0.05）．The average NRS score of the patients at 10：00，11：30，16：00 and 17：30 on the day of extubation varied notably（P<0.05）．The average NRS score of the patients at 10：00，11：30，16：00 and 17：30 differed significantly on the 1st day after surgery，the day of extubation，the 1st day after extubation，and the discharge day（P<0.05）．Conclusion　The activity-induced pain control for the patients is stable at present.However，the stimulation of the drainage tube is still an obvious factor causing pain for patients.

Key words: Pain, postoperative；Numerical rating scale；Functional activity score

摘要： 背景　目前，我国关于术后活动性疼痛的研究较少，多数研究并未说明是在静息状态还是活动状态下的疼痛，只是笼统评估患者术后疼痛；而且近年来国内外研究均指出，活动状态下疼痛减轻才能保证患者术后躯体功能最大程度恢复；此外，部分研究所用的疼痛评估方法仅是患者主观自评，不能全面评估患者的疼痛情况。目的　运用主客观结合评估法评估胸外科术后患者活动性疼痛治疗效果。方法　选取2018年8—9月锦州医科大学附属第一医院胸外科收治的全身麻醉胸腔镜下且术中冷冻切片显示为肺癌的肺叶切除术后患者15例，运用数字评定量表（NRS）和四等级功能活动评分法（FAS）评估患者术后第1天、拔管当天、拔管后第1天、预约出院日在氟比洛芬酯用药前后0.5 h（即10：00、11：30和16：00、17：30）有效咳嗽时疼痛程度和完成有效咳嗽的能力。结果　术后第1天、拔管当天、拔管后第1天、预约出院日患者10：00和11：30的NRS评分、16：00和17：30的NRS评分比较，差异均无统计学意义（P>0.05）。术后第1天、拔管后第1天、预约出院日患者4个不同时刻NRS评分比较，差异均无统计学意义（P>0.05）；拔管当天4个不同时刻NRS评分比较，差异有统计学意义（P<0.05）。术后第1天、拔管当天、拔管后第1天、预约出院日患者10：00的NRS评分、11：30的NRS评分、16：00的NRS评分、17：30的NRS评分比较，差异均有统计学意义（P<0.05）。结论　目前患者活动性疼痛控制情况较稳定；但引流管的刺激仍然是影响患者疼痛的明显因素。

关键词: 疼痛, 手术后；数字评定量表；功能活动评分法

ZHOU Lijuan,ZHANG Lan. Subjective and Objective Assessment of the Therapeutic Effect of Activity-induced Pain after Thoracic Surgery　[J]. Chinese General Practice, 2019, 22(8): 994-998. DOI: 10.12114/j.issn.1007-9572.2019.00.018.
周利娟,张岚. 运用主客观结合评估法评价胸外科术后患者活动性疼痛治疗效果研究[J]. 中国全科医学, 2019, 22(8): 994-998. DOI: 10.12114/j.issn.1007-9572.2019.00.018.

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