| Objectives:By describing the longitudinal change trend of perioperative pain of TKA patients and care-giving competence of primary caregiver during perioperative period,it discusses influence of care-giving competence of primary caregiver on perioperative pain of TKA patients,providing basis for post-operative EBN(evidence-based nursing).Methods:From September 2015 to September 2016,there are a total of 89 groups of TKA patients and primary caregivers for convenience of sampling investigation and conforming to admission standards.Field investigation is adopted during hospitalization,telephone follow-up adopted after discharge and the contents for evaluation include:1.Evaluate the basic information via self-compiled questionnaires at admission;2.Evaluate social support via SSRS(social support rating scale)one day before operation;3.Screen patients’ pre-operative anxiety and depression via HAD(hospital anxiety and depression scale)one day before operation;4.Investigate patients’ self-evaluated degree of activity pain and rest pain one day before operation,current day of operation to three days after operation,one month after operation and three month after operation via"Changhai Pain Rating Scale".The evaluation contents of primary caregiver include:1.Evaluate the basic information via self-compiled questionnaires at admission;2.Investigate the care-giving competence of caregivers of patients accepting major surgical operation one day before operation,one day before discharge,one month after operation and three month after operation.The care-giving competence in different periods is divided into three groups scoring low,medium and high.In longitudinal study.use multiple logistic regression to analyze influencing factors of patients’ perioperative pain.Use GEE(generalized estimating equations)to analyze influence of care-giving competence of primary caregiver on perioperative pain of TKA patients.Results:1.The proportions of severe activity pain before operation,one day to three days after operation,one month and three months after operation are:71.9%,18.0%,36.0%,64.0%,32.6%and 6.7%,the proportions of medium activity pain before operation,one day to three days after operation,one month and three months after operation are:27.0%,36.0%,48.3%,29.2%,60.7%and 65.2%.The proportions of severe rest pain in current day of operation,one day,two days and three days after operation are:64.0%,25.8%,6.7%and 0%,those of medium rest pain are:21.3%,53.9%,40.4%and 25.8%.The extent of peri-operative pain of patients minimizes with the change of time.The comparative difference of pain scoring at different times has statistical significance.2.TKA patients high up to 77.5%have anxiety and depression symptoms.The score range of social support is from 24 to 48,the median is 37.to be in the medium range.3.The comparison of scoring of various dimensions at different times has statistical difference:the care knowledge is improved obviously three months after operation compared with pre-operation and scores the highest one month after operation,The operation techniques are reduced obviously three months after operation compared with pre-operation and score the highest before discharge.The behavioral attitude is reduced obviously three months after operation compared with pre-operation and scores the highest before discharge.The decision-making and self-efficacy score the highest one month after operation.4.The single factor generalized estimating equation showed that the preoperative and postoperative pain degrees of patients in the care ability high score group was higher than those of the medium and low score groups.The activity pain was lower in the postoperative 1 day and 1 month;The rest pain was higher in the postoperative 3 months.5.The multiple logistic regression results showed that the patients’ age.religious belief,anesthesia method,injection drug,social support,caregivers’ age,gender,religious belief,education background,Changhai Pain Rating Scale,family’s month-earning,relationship between caregivers and patients were the influence factors of perioperative activity pain of patients;The caregivers’ age and injection drug were the influence factors of perioperative rest pain of patients.6.The multiple generalized estimating equation:after adjustment for potential confounding factor,the perioperative activity pain of patients in the care ability low score group was lower than that of high score group before the operation(χ2=11.416,P<0.01);The perioperative activity pain of patients in the care ability medium score group was higher than that of high score group before being discharged(χ2=5.047,P<0.01).The perioperative rest pain of patients in the care ability low score group was lower than that of high score group before the operation(χ2=9.612,P<0.01);The perioperative rest pain of patients in the care ability medium score group was lower than that of high score group in the postoperative 1 month(χ2=10.585,P<0.01),The perioperative rest pain of patients in the care ability low score group was lower than that of high score group in the postoperative 3 months(χ2=15.678,P<0.01).Conclusion:1.1 The extent of post-operative pain of TKA patients is high and the peri-operative paincontrol is not ideal.1.2 The scores of care-giving competence of primary caregiver are in the medium level,and patients of TKA are under dynamic change in peri-operative period.1.3 The patients,age,religious belief,anesthesia method,injection drug,social support,caregivers’ age,gender,religious belief,education background,Changhai Pain Rating Scale,family’s month-earning,relationship with patients were the influence factors of perioperative activity pain of patients;The caregivers’ age and injection drug were the influence factors of perioperative rest pain of patients.1.4The extent of peri-operative pain of patients cared by those scoring high in care-giving competence in different time periods is higher.Medical staffs shall emphasize propaganda and education on post-operative pain,not only not to ignore but also not to focus on it excessively.They shall also integrate correct knowledge and techniques of pain care and medication decision-making guidance of pain killers into peri-operative pain management guidance. |
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