Application of pain control in postoperative patients with hemorrhoids
I. Summary
Patients in hemorrhoids surgery are very common, and postoperative pain is the most common problem. Good postoperative analgesia can not only provide patients with better medical quality service subjectively, but also promote their postoperative recovery and reduce complications.
Second, the preface
Hemorrhoids are common anal diseases. As the saying goes, "ten men and nine hemorrhoids" shows its universality. But in fact, the incidence of male and female is equal, and because of the location, it is difficult to say, so patients often diagnose themselves and use folk remedies. Female pregnancy is more serious (Bran, Rao, Zhao, Wu, 1999). Patients undergoing hemorrhoidectomy in surgical wards are very common, and postoperative pain is the most common problem (Li, Lai, Chen, Liu, 2001; Lin, Lin, Yao, 200 1), but it is often found that patients are afraid to use analgesics after operation, probably because they are afraid of addiction or hinder wound healing. On the other hand, nurses often give analgesics when the patients are in great pain, but they don't take the initiative to correctly evaluate the patients' pain, so that the patients' postoperative pain can't be effectively controlled (Li et al., 200 1). If the pain control is not done well, not only will the patients lose their confidence in treatment, but the treatment effect can't be fully exerted. Therefore, I hope this report can provide reference for clinical nurses to take care of such patients in the future.
Third, document verification.
Hemorrhoid refers to the static varicose veins in the anus and rectum. Because of the increase of intra-abdominal pressure and the obstruction of venous return, hemorrhoid has permanent varicose veins, so long-term constipation, severe diarrhea, pregnancy, prostatic hypertrophy and other factors that will increase intra-abdominal pressure will promote the formation of hemorrhoids (Wang, 2000; Lin, 2000; Bran, etc., 1999).
The normal anal canal of human body has a structure called "sawtooth line" about 2 cm above the outer edge of anus. Hemorrhoids above this line are called internal hemorrhoids, and those below this line are called external hemorrhoids. If they are all, they are called mixed hemorrhoids. Because the anal canal innervation below the "sawtooth line" is similar to the body surface, it is very sensitive and acute to the stimulation of pain, so the main symptom of external hemorrhoids is pain, especially when blood clots accumulate or the so-called "hemorrhoid nucleus" is formed due to hemorrhoid bleeding. The innervation above the "sawtooth line" is similar to visceral innervation, that is, it is insensitive to pain, so the main symptom of internal hemorrhoids is bleeding or uncomfortable burning sensation in rectum (Xu, 2005). The severity of hemorrhoids can be divided into four grades; The first level is not obvious; The second stage is that although hemorrhoids are prominent, they will automatically retract; The third level is that prominent hemorrhoids must be pushed back by hand; The fourth level is hemorrhoids that cannot be postponed. Its clinical manifestations are bleeding, pain, swelling and incarceration during defecation (Wang, 2000; Bran, etc., 1999).
Clinically, due to the aggravation of pain, patients may have hemorrhoids prolapse. In addition, they can go to the hospital for medical treatment through anoscope or sigmoidoscopy, and clinically, they can make diagnosis through palpation, anoscope or sigmoidoscopy. In addition, fecal occult blood reaction and whole blood cell count can be used to evaluate bleeding or anemia caused by chronic blood loss (Lin, 2000; Bran, etc., 1999).
Clinically, the treatment methods of hemorrhoids are local treatment: using ice compress, hot compress or bupivacaine, rectal application and other analgesic ointments; Take laxatives; Use sitz bath to relieve pain. Other treatments include rubber band ligation, infrared therapy and surgery. Among them, surgery is the most effective treatment for external hemorrhoids, but postoperative complications often include: wound pain, bleeding, urinary retention and so on. (Wang, 2000; Lin, 2000; Bran, etc., 1999).
Wound pain is the most common nursing problem for patients undergoing hemorrhoidectomy. The report of Musgrave (1990) pointed out that postoperative pain was caused by the direct cutting injury of pain nerve endings in internal tissues and skin surface, which led to the secretion of endogenous pain substances in the injured tissues. Neurotransmitters such as 5- hydroxytryptamine, bradykinin and post-ligand stimulate and increase chemical hormones produced by muscle metabolism, and then transmit them to the brain through the spinal cord, resulting in pain (Li et al., 200 1).
Pain is a defense mechanism for the body to avoid invasive stimuli, but postoperative pain has almost no useful purpose. But it will affect breathing, circulation, digestion and muscle function. Postoperative complications, such as not being able to take a deep breath because of pain, may lead to atelectasis. Pain limits activities, and may also lead to venous congestion to form embolism and thrombosis. In addition, pain will release catecholamine and some stress hormones, leading to vasospasm and hypertension, which will lead to stroke, myocardial infarction, bleeding and other problems. Therefore, the prevention of postoperative pain is more important than the treatment of pain itself, and effective pain control can improve the prognosis of surgery.
Clinical pain can be divided into drug therapy and non-drug therapy (Chen, 2000; Lin et al; Lin et al? 2004 )。 Drug pain management, such as non-narcotic analgesics-non-steroidal anti-inflammatory drugs, such as aspirin and scanol, is usually used for mild to moderate postoperative pain management (Lin et al., 2001; Chen, 2000). Weak anesthetic analgesics such as codeine and morphine are used for moderate to severe postoperative pain management (Lin et al., 2001; Chen, 2000). There are three ways to administer narcotic analgesics: (1) intramuscular injection (2) intravenous injection (3) epidural injection. Coping? The bed needs to develop new derivatives from traditional morphine, which has analgesic effect and reduces its side effects, including respiratory depression, slow heartbeat, intestinal peristalsis and addiction. Morphine sulfate: traditional morphine can cause histamine release, cause hypotension, and be excreted by liver and kidney. What about kidney? Good patient? Accumulate in the body? Must be reduced? Use. Fentanyl citrate: effective? Better than morphine 100 times. It is very fat-soluble and has a very quick and short-lived effect. what's up Stimulate histamine release and cause hypotension. When the patient's blood circulation system is stable, he can switch to this medicine. Hydromorphine: Effective? Five times stronger than morphine. what's up Stimulates histamine release and causes hypotension, which is mainly used as a substitute for fentanyl. Pethidine (Demerol): Is it effective? Morphine about110 belongs to short-acting morphine because it has an exciting center? The side effects of menstruation and the rapid heartbeat are the only addictive painkillers with vagal effect at present. Non-drug therapy such as relaxation techniques refers to the application of techniques to reduce muscle tension, thereby relieving anxiety and releasing the body or mind from tension and stress situations, thus achieving the purpose of relieving pain (Lin et al., 2001; Chen, 2000). The application of cold and hot therapy can relieve muscle spasm and increase the pain threshold, but it can relieve pain (Lin et al., 2001; Chen, 2000). Good postoperative analgesia can not only provide better medical quality service for patients subjectively, but also promote their postoperative recovery and reduce the occurrence of complications. For example, patients will not be afraid to breathe because of pain, thus reducing the incidence of pulmonary complications; Patients can get out of bed early, which can reduce the occurrence of venous embolism and advance the time of gastrointestinal exhaust. In addition, the incidence of cardiovascular complications in patients decreased, the time of indwelling in intensive care center was shortened, and the length of hospitalization was shortened, which were obvious benefits after the implementation of postoperative analgesia.
The occurrence of hemorrhoids has a great relationship with daily life habits, so we should pay attention to daily life habits: we should develop the habit of regular defecation. Avoid reading books and newspapers when defecating, so as not to prolong the defecation time. Drink plenty of water, take in 2000~3000cc of water every day, and eat more fruits and vegetables rich in fiber, so as to make the stool soft, defecate smoothly and prevent constipation. Eat less irritating food, such as coffee, wine and spicy food. Live a normal life, avoid staying up late and overworking, exercise moderately every day and avoid constipation. Warm water sitz bath (multiple times a day, each time 10 minute) is used to promote blood circulation around anus, reduce swelling and relieve pain.
Fourth, clinical discussion
Despite the continuous improvement of medical technology, improper pain management still exists. Literature reports show that 65,438+0/4 patients did not receive good pain management after operation. There are many reasons. Doctors and nurses often underestimate the pain of patients, so they give insufficient pain treatment. The lack of pain treatment education has left many mysteries about pain. Other postoperative patients refused to use appropriate narcotic painkillers for fear of the risk of addiction, and the delay between the patient's request for pain treatment and the nurse's actual medication was also one of the reasons. Because nurses are front-line workers facing patients' postoperative pain, nurses' views on pain and pain treatment can affect the time and even dosage of painkillers, so nurses' understanding of pain treatment can directly or indirectly affect the effect of postoperative pain control.
In the use of postoperative painkillers, most nurses think that Demerol is superior to morphine and is the first choice for postoperative analgesia. Pethidine is usually the most commonly used analgesic after operation, not morphine, because of its low toxicity, low respiratory inhibition and little influence on blood pressure. In fact, the inhibitory effect of pethidine on respiration is equivalent to that of morphine, and the action time of pethidine is about 2-4 hours, which is shorter than that of morphine, so the persistent pain after operation needs a short injection interval to take effect. However, when general nurses use pethidine for analgesia, the injection interval is more than four hours, so its analgesic effect is often insufficient. Nurses also believe that the dosage of painkillers mainly depends on the patient's weight, height, etc., while ignoring the degree of pain of patients is the main index to determine the dosage. Therefore, for patients with severe pain, the dosage used is often insufficient, so the pain is often not effectively relieved.
Verb (abbreviation of verb) conclusion and experience
Traditional postoperative analgesia only uses a fixed dose of analgesics when the patient requests it. However, due to the different pain levels of patients, patients' demand for painkillers varies greatly, or they are afraid to use painkillers for fear of side effects, and the postoperative analgesic effect is poor, which makes patients miserable. Clinical nurses have the most contact with inpatients, and their pain knowledge, attitudes and beliefs have a considerable impact on the pain care they provide to patients (Al-hassah, Aldhalil,&; Maaitah,1999; Le Bowitz, Florence and. Bathina， 1997)； Health policy and research agency; AHCPR, 1994) pointed out that the incorrect pain beliefs of medical staff often affect the effective use of pain treatment by professionals and patients. Therefore, in addition to improving the pain education of nurses (Xu, Zhang, Chen, Lai, 2001; Collins, 1999), nursing leaders should also support new pain management policies and revise nursing standards as the basis for clinical nurses to implement nursing measures (Wei, 2002; Collins, 1999).
The recurrence rate of hemorrhoids is quite high. Nurses should strengthen the health education of patients after discharge, such as keeping defecation unobstructed, eating more foods containing fiber such as vegetables and fruits, drinking more water every day to prevent constipation from causing difficulty in defecation, and not reading newspapers and magazines when defecating, so as to avoid local congestion in anus and aggravate hemorrhoids. Avoid squatting for a long time to avoid loosening the suspension system. Pay attention to local hygiene after defecation, and finally wash the anus with warm water to reduce the occurrence of friction and infection, and at the same time use the water temperature to promote the improvement of local circulation. Avoid alcohol, peppers and other irritating foods, reduce constipation and stimulate the anus. Avoid standing for a long time or sitting for a long time, reduce local congestion in anus, do proper exercise regularly, promote blood circulation, and use laxatives according to the doctor's advice when necessary (Lin, 2000).
As the saying goes, "ten men and nine hemorrhoids" shows the universality of hemorrhoids. However, due to the location, it is difficult to say, so patients often diagnose themselves and use folk remedies (Bran, Rao, Zhao, Wu, 1999). Although hemorrhoid is an unremarkable disease, it is often ignored by ordinary people and brings troubles to life and work. Some people even ask for remedial measures and lead to serious complications. In severe cases, colostomy and shunt surgery will even be performed, and the responsibility cannot be ignored. In addition, patients often treat all stool bleeding as hemorrhoid bleeding, which delays medical treatment and suddenly excludes the possibility of other diseases, including rectal cancer. Therefore, hemorrhoids are a variety of options in treatment, simple and convenient, and the treatment rate is also good. Don't treat him as a hidden disease and delay medical treatment or seek remedies, which is not worth the loss. "Prevention is better than cure" is an old saying, but it is the most practical. Don't be afraid to see a doctor. Early diagnosis and treatment is the right way.
Reference of intransitive verbs
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