经皮内镜下胃造口术后患者的疼痛和焦虑
背景：经皮内镜下胃造口术（PEG）后的腹痛被认为是并发症。然而，疼痛的发生率和严重程度并不十分清楚。我们对进行PEG后可语言交流和不可语言交流患者的腹痛和焦虑水平均进行了评估。
方法：我们利用11点李克特式量表（11-point Likert-type scales）的前瞻性调查问卷分别在PEG术前1h，术后1h，术后24h对患者的焦虑和腹痛进行了评估。同时随访患者直到疼痛消失。对手术过程的数据，止痛请求，以及并发症都要实时记录。将患者分为可交流组（可以自我评估的）和不可交流组（临床医生评估）来分析。
结果：共对70例患者进行了评估。其中49例自我评估患者中，11例（22%）为术后立即痛，32例（65%）在1h时痛（24例为轻度痛，5例为中度痛，3例为重度痛），以及40（82%）例为24h时痛。疼痛持续时间大多数在24-48h之间（25例）。在21例临床医生评估的患者中，仅1例被认为有疼痛，发生在24h时。4例（6%）因为疼痛而收住院。术前的焦虑评分和术后疼痛评分并无关联性。
讨论：PEG术后疼痛虽然常见，但是一般在48h即可缓解。在可交流患者中，与患者自我评分相比，临床医生对疼痛的评分较低。不可交流患者的疼痛可能未被识别。临床医生需要更好告知术后疼痛发生可能性，并对其进行常规评估来进行适当止痛治疗。
JPEN J Parenter Enteral Nutr. 2015;39(7):823-7.
Pain and Anxiety Experienced by Patients Following Placement of a Percutaneous Endoscopic Gastrostomy.
Oppong P, Pitts N, Chudleigh V, Latchford A, Roy A, Rocket M, Lewis S.
Derriford Hospital, Plymouth, UK.
St Marks Hospital, London, UK.
BACKGROUND: Abdominal pain following percutaneous endoscopic gastrostomy (PEG) placement is a recognized complication. However, the prevalence and degree of severity of pain are poorly characterized. We assessed abdominal pain and anxiety levels associated with PEG placement in communicative and noncommunicative patients.
METHODS: A prospective questionnaire assessed patients' anxiety and abdominal pain 1 hour before, 1 hour after, and 24 hours after PEG placement using 11-point Likert-type scales. Patients were followed up until pain had resolved. Procedural data, analgesia requirements, and complications were recorded. For analysis, patients were divided into 2 groups: communicative (able to self-assess) and noncommunicative (clinician assessed).
RESULTS: Seventy consecutive patients were assessed. Of the 49 self-assessed patients, 11 (22%) reported immediate pain, 32 (65%) reported pain at 1 hour (24 mild, 5 moderate, 3 severe), and 40 (82%) reported pain at 24 hours. Pain most commonly lasted between 24 and 48 hours (25 patients). Of the 21 clinician-assessed patients, only 1 was deemed to have pain, and this was at 24 hours. Four (6%) patients were admitted with pain. There was no relationship between preplacement anxiety scores and postplacement pain scores.
DISCUSSION: Abdominal pain after PEG placement pain is common but resolved by 48 hours in most patients. In patients able to communicate, clinicians scored pain lower compared with patients' scores. It is likely that pain is not identified in patients unable to communicate. Patients need to be better informed about the possibility of postprocedural pain and routinely offered access to appropriate analgesia.
KEYWORDS: abdominal pain; endoscopic gastrostomy; enteral nutrition
PMID: 25249027
DOI: 10.1177/0148607114551798