【作者】 利民；

【导师】 周彩峰；

【作者基本信息】 郑州大学 ， 护理学， 2013， 硕士

【摘要】 对于脊髓拴系综合征的患儿来说,手术是目前治疗此病的唯一途径,但手术较复杂、切口长,术后疼痛明显。疼痛会对小儿产生负面影响,因此探寻术后有效的疼痛干预模式对于患儿是十分重要的。目的对接受脊髓拴系手术的患儿实施以家庭为中心护理和多种非药物干预相结合的疼痛干预模式,探索这种干预模式对患儿术后疼痛、焦虑、及患儿家长术后焦虑、护理服务满意度的干预效果。并通过质性研究了解护理人员在小儿疼痛管理中的真实感受,为以后疼痛管理服务提供依据。方法1研究对象采用非同期对照和方便抽样的方法,抽取郑州大学第三附属医院3岁到12岁接受脊髓拴系手术患儿及家长各40例,以2011年10月至2012年3月期间接受脊髓拴系手术患儿及家长各20例为对照组;2012年3月至2012年11月的接受脊髓拴系手术患儿及家长各20例为干预组,质性研究采用立意采样法,有目的地选取儿科护士,共8名护士参与访谈。2方法对照组采用目前小儿外科病房的普通护理模式,家长接受常规健康教育及术后护理。干预组采用以家庭为中心护理和多种非药物干预相结合的疼痛干预模式。分别用Wong—Banker面部表情量表(Faces Pain Scale, FPS)、改良耶鲁围手术期焦虑量表(The modified Yale Preoperative Anxiety Scale,YPAS)、状态焦虑问卷(State Anxiety Inventory, SAI)、纽卡斯尔护理服务满意度量表(Newcastle satisfaction with nursing scales, NSNS)来评价干预后两组患儿术后疼痛、术后焦虑、患儿家长术后焦虑、护理服务满意度。采用质性研究对8名儿科护士进行深度访谈。3统计方法使用SPSS17.0统计软件包处理所有数据,计量资料如年龄等采用均数、标准差描述,计数资料如性别等采用频数描述；采用两独立样本Mann-Whitney U检验、两独立样本t检验比较两组患儿一般资料中计量资料之间的差异有无统计学意义,采用Fisher确切概率法比较两组患儿一般资料中计数资料之间的差异有无统计学意义。干预前采用两独立样本t检验比较两组患儿家长焦虑状况有无差异,干预后采用Mann-WhitneyU非参数秩和检验、两独立样本t检验分析对照组和干预组患儿疼痛评分、患儿术后焦虑、患儿家长术后焦虑状况、护理满意度有无差异。检验水准α=0.05。结果1两组患儿一般资料比较本研究中对对照组和干预组的年龄、年龄构成、性别、居住地、兄弟姐妹等一般资料进行比较,差异均无统计学意义(P>0.05)。2两组患儿术后疼痛和术后焦虑得分比较干预后术后1小时、术后24小时两组患儿疼痛评分差异无统计学意义(P>0.05)；术后8小时、术后16小时干预组疼痛评分低于对照组且疼痛评分差异有统计学意义(P<0.05)。干预后两组患儿术后焦虑进行比较,干预组比对照组患儿术后焦虑得分低,差异有统计学意义(P<0.05)。3两组家长干预前焦虑得分和干预后焦虑得分、护理满意度比较干预前对照组和干预组家长焦虑得分差异无统计学意义(P>0.05)。干预后干预组家长术后焦虑得分比对照组家长术后焦虑得分低,差异有统计学意义(P<0.05)。干预后干预组家长护理服务满意度比对照组高,差异有统计学意义(P<0.05)。4质性研究提炼出4个主题质性研究提炼出护士普遍经历过患儿的疼痛、缺乏疼痛评估量表的使用、护士缺乏疼痛治疗和非药物干预的相关知识、疼痛管理面临多重挑战4个主题。结论以家庭为中心护理和多种非药物干预相结合的疼痛干预模式,可以降低患儿术后疼痛、焦虑程度及患儿家长的焦虑程度,提高护理服务满意度。更多还原

【Abstract】 Operation is the only way for Children with Tethered Cord Syndrome. Because the operation is complicated and need long incisions,the patients have significant postoperative pain. It’s so important for patients to build postoperative pain intervention model。ObjectiveTo explore the effects of the integrative pain intervention models of family-centered care and multimodal nonpharmacological interventions on postoperative pain and anxiety in infants with tethered cord syndrome, and anxiety, satisfaction with nursing in parents of children with tethered cord syndrome. According to the actual perception of nursing personnel in the management of pediatric pain, to provide effective reference for further development of pain management services.Methods1ObjectsA quasi-experiment controlled design was employed.20cases of3-12years old children with tethered cord syndrome and their parents in The Third Affiliated Hospital of Zhengzhou University from October,2011to March,2012were selected as control group through convenience sampling.20cases of3-12years old children with tethered cord syndrome and their parents were selected as intervention group from March,2012to December,2012.2MethodsThe control group children used the common clinical care model, and their parents acquired convention health and postoperative nursing care education. The intervention group used integrative pain intervention models of family-centered care and multimodal nonpharmacological interventions.The Faces Pain Scale(FPS), The modified Yale Preoperative Anxiety Scale(YPAS), State Anxiety Inventory(SAI), Newcastle Satisfaction with Nursing Scale (NSNS) were used to assess the two groups after the intervention. In-depth interview was conducted on8pediatric nurses adopting qualitative research.3Statistics analysisSPSS17.0was used to analysis all data. Mean and Std deviation were used to describe the measurement data such as age. Frequency was used to describe the count data such as gender. Significant difference of the measurement data between two groups of children were compared by two independent-sample Mann-Whitney U test and T test. Difference between the count data of the two groups of children were compared by Fisher exact test. Two independent-sample T test were used to compare the difference of anxiety in two sets of parents before the intervention. After intervention, the two groups’ scores of FPS, YPAS, SAI and NSNS were analyzed by two independent-sample T test and Mann-Whitney U test. The significant level was a=0.05.Results1The comparison of indicators between intervention group and control groupThe data of age, age structure, gender, residence and operation time did not differ significantly between the two groups (P>0.05).2The comparison of postoperative pain and anxiety in children between intervention group and control group1hour and24hour after intervention, pain scores measured in this study were not significantly different (P>0.05).8-16hour after the surgery, the scores of FPS and YPAS were significantly decreased in the intervention group compared with the control group (P<0.05).3The comparison of the scores of anxiety and satisfaction with nursing of parents of children with tethered cord syndrome between before and after interventionThere is no significant difference of the scores of anxiety and of parents between intervention group and control group before intervention (P>0.05).After intervention, the scores of anxiety of parents were decreased in the intervention group compared with the control group (P<0.05). The scores of NSNS were significantly increased in the intervention group compared with the control group (P<0.05).4Through this qualitative research,4themes were extractedThrough this qualitative research,4themes were extracted:common experiences of pain in children, limited knowledge of pain assessment scale, lack of pain treatment knowledge and non-pharmaceutical intervention knowledge, multiple challenges on pain management.ConclusionsThe integrative pain intervention models of family-centered care and multimodal non-pharmacological interventions can relief children’s postoperative pain and anxiety, alleviate parents’ anxiety, improve satisfaction with nursing during their children with tethered cord syndrome were in the hospital.更多还原