腰椎融合术后残余神经痛患者疼痛护理效果的临床回顾性分析

A Clinical Retrospective Analysis of the Efficacy of Pain Management in Patients with Residual Neuropathic Pain after Lumbar Spinal Fusion Surgery

摘要: 目的：探讨疼痛护理干预对腰椎融合术后残余神经痛患者疼痛程度、腰椎功能、生活质量及并发症发生情况的临床效果，明确疼痛护理在围手术期康复中的应用价值，为优化腰椎融合术后残余神经痛患者的临床护理方案、改善患者预后提供可靠的临床依据。方法：回顾性分析2021年1月~2024年12月在我院疼痛科接受腰椎融合术治疗，且术后出现残余神经痛的120例患者的完整临床资料。根据术后护理方案的不同，将所有患者分为观察组(n = 60)与对照组(n = 60)，其中对照组采用骨科常规护理模式，主要包括生命体征监测、基础体位指导、常规药物镇痛及简单康复告知等基础护理措施；观察组在对照组常规护理的基础上，实施针对性、系统化的疼痛护理干预，涵盖多模式镇痛管理、个体化体位与康复护理、心理干预及健康教育、并发症预防等综合措施。比较两组患者术后1周、1个月、3个月的视觉模拟评分法(VAS)疼痛评分、Oswestry功能障碍指数(ODI)，评估患者疼痛缓解情况与腰椎功能恢复效果；采用SF-36生活质量量表评估两组患者术后3个月的生活质量，同时统计两组患者术后并发症(下肢深静脉血栓、肺部感染、切口感染等)发生率、住院时间，并采用我院自制护理满意度量表评估患者对护理服务的满意度，比较两组上述指标的差异。结果：术后各观察时间点(1周、1个月、3个月)，观察组患者的VAS疼痛评分、ODI功能障碍指数均显著低于对照组，差异具有统计学意义(P < 0.05)，且随着时间推移，观察组两项指标的下降幅度明显大于对照组，提示疼痛护理可有效缓解残余神经痛，促进腰椎功能恢复；术后3个月，观察组SF-36量表各维度(生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康)评分均显著高于对照组，差异具有统计学意义(P < 0.05)，表明疼痛护理可显著提升患者生活质量；观察组术后并发症发生率为6.67% (4/60)，显著低于对照组的20.00% (12/60)，住院时间显著短于对照组，患者护理满意度为96.67% (58/60)，显著高于对照组的83.33% (50/60)，上述差异均具有统计学意义(P < 0.05)。结论：对腰椎融合术后残余神经痛患者实施系统化、针对性的疼痛护理干预，可有效缓解患者残余神经痛症状，改善腰椎功能，提升患者生活质量，降低术后并发症发生风险，缩短住院时间，提高患者护理满意度，具有较高的临床推广价值和应用前景，可作为腰椎融合术后残余神经痛患者的优选护理方案。

Abstract: Objective: To investigate the clinical effects of pain management interventions on pain intensity, lumbar function, quality of life, and complication rates in patients with residual neuropathic pain after lumbar spinal fusion surgery, clarify the application value of pain management in perioperative rehabilitation, and provide reliable clinical evidence for optimizing the clinical nursing protocol and improving the prognosis for these patients. Methods: A retrospective analysis was conducted on the complete clinical data of 120 patients with residual neuropathic pain after lumbar fusion surgery who were treated in the Pain Department of our hospital from January 2021 to December 2024. According to the different postoperative nursing protocols, all patients were divided into an observation group (n = 60) and a control group (n = 60). The control group received a conventional orthopedic nursing model, mainly including basic care measures such as vital signs monitoring, basic posture guidance, conventional pharmacological analgesia, and simple rehabilitation instruction. The observation group, based on the conventional care of the control group, received targeted and systematic pain management interventions, covering comprehensive measures such as multimodal analgesia management, individualized posture and rehabilitation nursing, psychological intervention and health education, and complication prevention. The Visual Analogue Scale (VAS) pain score and Oswestry Disability Index (ODI) were compared between the two groups at 1 week, 1 month, and 3 months postoperatively to assess pain relief and lumbar functional recovery. The 36-Item Short Form Health Survey (SF-36) was used to evaluate the quality of life at 3 months postoperatively. The incidence of postoperative complications (e.g., deep vein thrombosis of the lower limbs, pulmonary infection, surgical site infection), length of hospital stay, and nursing satisfaction assessed by a hospital-developed satisfaction scale were also compared between the two groups. Results: At all postoperative observation time points (1 week, 1 month, 3 months), the VAS pain scores and ODI scores in the observation group were significantly lower than those in the control group, with statistically significant differences (P < 0.05). Furthermore, the magnitude of decrease in these two indices over time was significantly greater in the observation group, indicating that pain management effectively alleviated residual neuropathic pain and promoted lumbar functional recovery. At 3 months postoperatively, all dimension scores (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health) of the SF-36 in the observation group were significantly higher than those in the control group, with statistically significant differences (P < 0.05), demonstrating that pain management can significantly improve patients’ quality of life. The postoperative complication rate in the observation group was 6.67% (4/60), significantly lower than the 20.00% (12/60) in the control group. The length of hospital stay in the observation group was significantly shorter, and nursing satisfaction was 96.67% (58/60), significantly higher than the 83.33% (50/60) in the control group. All these differences were statistically significant (P < 0.05). Conclusion: Implementing systematic and targeted pain management interventions for patients with residual neuropathic pain after lumbar spinal fusion surgery can effectively alleviate symptoms, improve lumbar function, enhance quality of life, reduce the risk of postoperative complications, shorten hospital stay, and increase patient satisfaction with nursing care. This approach holds high clinical value for promotion and application prospects, and can serve as a preferred nursing protocol for these patients.