术后机械通气患者吸痰操作疼痛现状及影响因素研究

摘要

Objective To describe the status of endotracheal suctioning related pain in mechanically ventilated patients and its change in their first 24 hours staying in ICU after surgery,and to explore the influencing factors.Methods A total of 101 patients were enrolled in this study.Patients' endotracheal suctioning related pain was assessed with Chinese version of Behavioral Pain Scale(C-BPS) and Richmond Agitation-Sedation Scale(RASS).Each patient was assessed 6 times:5 min before suctioning,during suctioning,5 min,10 min,15 min,20 min after suctioning.Results The practice of endotracheal suctioning could obviously increase patients' pain intensity.The medium score of pain intensity during endotracheal suctioning was 8.The highest score of pain intensity was 12.There were 100 patients(99.0％) with pain.There were 94 patients(93.1％) with significant pain.At 5 min after endotracheal suctioning,the pain intensity score returned to the level of that in 5 min before endotracheal suctioning.Multiple regression demonstrated that patients with lower levels of sedation,more drainage tubes,history of previous surgery,had lower pain scores.Conclusion Endotracheal suctioning can significantly increase patients' pain intensity.RASS score,the number of drainage tubes and the history of previous surgery can affect patients' pain intensity score.%目的 描述ICU患者术后24 h内机械通气吸痰操作疼痛现状、疼痛变化趋势及影响因素.方法 便利选取ICU术后机械通气患者101例,使用中文版行为疼痛评估量表、Richmond躁动-镇静评分量表评估机械通气患者术后24 h内第1次吸痰操作的操作前5 min,操作中,操作后5 min、10 min、15 min、20 min 6个时间点的疼痛强度和镇静状态.结果 吸痰操作明显增加了患者的疼痛强度,吸痰时疼痛评分中位数为8分,最高为12分;有疼痛感受者100例(99.0％);有明显疼痛感受者94例(93.1％);在操作后5 min,疼痛强度恢复到操作前5 min水平.单因素分析和多因素分析结果显示,患者的镇静水平越低、引流管数量越多、有既往手术史,其疼痛评分越低.结论 吸痰操作会明显增加ICU机械通气患者术后24 h内的疼痛强度.Richmond躁动-镇静评分、引流管数量、既往手术史会影响患者的疼痛强度.