Abstract: Objective　To explore the efficacy of graded analgesia in the care of pain in patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy. Methods　Forty-two patient undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy at The 73rd Army Hospital of The Army from October 2019 to July 2020 were set as a control group, including 17 males and 25 females who were 35-66 (43.75±7.69) years old. And 46 patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy from August 2020 to May 2021 were set as an observation group, including 16 males and 30 females who were 32-64 (43.59±7.80) years old. The control group were given routine analgesia care, and the observation group were given graded analgesia care. The pain status (NRS score), application dosages of analgesic drugs, analgesic satisfaction scores, and adverse reactions related to opioid analgesics were compared between the two groups at different times after the surgery. The data were analyzed by SPSS 22.0. χ² and t tests and MANOVA of repeated measuring were used for the analysis. Results　The NRS scores 5, 7, and 10 days after the surgery were (4.73±0.87), (4.03±0.64), and (2.17±0.51) in the observation group, and were (5.18±0.92), (4.67±0.77), and (3.85±0.62) in the control group, with statistical differences (all P<0.05). The postoperative dosages of fentanyl transdermal patches, morphine sulfate sustained-release tablets, tramadol, and acetaminophen tablets in the observation group were lower than those in the control group [(2.840±0.520) mg vs. (3.180±0.585) mg, (135.30±32.60) mg vs. (160.40±38.40) mg, (0.56±0.10) g vs. (0.72±0.07) g, and (8.42±1.69) g vs. (10.60±1.48) g], with statistical differences (t=2.886, 3.314, 8.164, and 6.411; P=0.005 and 0.001, <0.001, and <0.001). The satisfaction score of analgesia in the observation group was higher than that in the control group [(1.84±0.38) vs. (1.62±0.61)], with a statistical difference (t=2.364, P=0.021). The incidence of total opioid adverse reactions in the observation group was lower than those in the control group, with a statistical difference (P<0.05). Conclusions　Using the concept of graded analgesia to manage the pain of patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy can reduce their pain, the dosages of analgesic drugs, and the incidence of adverse reactions, and improve their analgesic satisfaction score.

Key words: Graded analgesia concept, Ⅲ-Ⅳ degree, Mixed hemorrhoidectomy, Pain management

摘要： 目的　探讨分级镇痛理念在Ⅲ～Ⅳ度混合痔切除术患者疼痛护理中的效果。方法　将陆军第七十三集团军医院2019年10月至2020年7月接收的Ⅲ～Ⅳ度混合痔切除术患者42例作为对照组，男17例，女25例，年龄35～66（43.75±7.69）岁；2020年8月至2021年5月接收的Ⅲ～Ⅳ度混合痔切除术患者46例作为观察组，男16例，女30例，年龄32～64（43.59±7.80）岁。对照组给予常规镇痛护理，观察组实施分级镇痛护理；对比两组患者术后不同时间疼痛状况（NRS评分）、镇痛药物应用剂量、镇痛满意度评分及阿片类镇痛药物相关不良反应情况。数据处理采用SPSS 22.0统计学软件，采用χ²、t检验及重复测量方差等分析。结果　观察组术后5 d、术后7 d及术后10 d的NRS评分分别为（4.73±0.87）分、（4.03±0.64）分、（2.17±0.51）分，均低于对照组同期［分别为（5.18±0.92）分、（4.67±0.77）分、（3.85±0.62）分］，两组比较，差异均有统计学意义（均P<0.05）。观察组术后芬太尼透皮贴剂使用量为（2.840±0.520）mg、硫酸吗啡缓释片使用量为（135.30±32.60）mg、曲马多使用量为（0.56±0.10）g、对乙酰氨基酚片使用量为（8.42±1.69）g，均低于对照组［分别为（3.180±0.585）mg、（160.40±38.40）mg、（0.72±0.07）g、（10.60±1.48）g］，两组比较，差异均有统计学意义（t=2.886、3.314、8.164、6.411，P=0.005、0.001、<0.001、<0.001）。观察组镇痛满意评分为（1.84±0.38）分，对照组为（1.62±0.61）分，两组比较，差异有统计学意义（t=2.364，P=0.021）。观察组总阿片类药物各类不良反应发生情况低于对照组，差异均有统计学意义（均P<0.05）。结论　采用分级镇痛理念在Ⅲ～Ⅳ度混合痔切除术患者疼痛管理，可减轻患者疼痛程度，减少镇痛药物应用剂量，提升患者的镇痛满意度评分，并减少不良反应发生率。

关键词: 分级镇痛理念, Ⅲ～Ⅳ度, 混合痔切除术, 疼痛管理