日間手術麻醉專家共識-預覽頁
【正文】 影響睡眠，但仍可入睡），７分和７分以上為重度疼痛（疼痛導致不能睡眠或從睡眠中痛醒）。圖1 WongBaker 面部表情量表參照2016年APS／ASRA／ASA術后疼痛管理指南［１８］，術后建議采用多模式鎮(zhèn)痛方法，原則上以口服、局部鎮(zhèn)痛為主，包括切口局部浸潤和區(qū)域阻滯，聯合使用NSAIDS藥物（表４），必要時輔助小劑量的阿片類藥物。影響術后惡心嘔吐的因素很多，目前認為與患者自身相關的因素中女性、術后使用阿片類鎮(zhèn)痛藥者、非吸煙者、有PONV史或暈動癥、年齡（成人＜50歲）是主要的危險因素。具體可參照中華醫(yī)學會麻醉學分會2014版《術后惡心嘔吐防治專家共識》。３、麻醉醫(yī)師和手術醫(yī)師共同評估患者是否可以出院，并告知術后回家期間注意事項，提供給患者日間手術中心聯系電話以備急需。表６ 麻醉后離院評分標準（postanesthesia dischargescore,PADS）離院標準評分（分）1生命體征波動在術前值的20％之內2波動在術前值的20%～40%1波動大于術前值的40%02活動狀態(tài)步態(tài)平穩(wěn)而不感頭暈，或達術前水平2需要攙扶才可行走1完全不能行走03惡心嘔吐輕度：不需治療2中度：藥物治療有效1重度：治療無效04疼痛VAS0～3分，離院前疼痛輕微或無疼痛2VAS 4～6分，中度疼痛1VAS 7～10分，重度疼痛05手術部位出血輕度：不需換藥2中度：最多換2次藥，無繼續(xù)出血1重度：需換藥2次以上，持續(xù)出血0 注：總分為10分，此評分需≥９分方可出院。ppe T,et anesthesia for ambulatory surgery:Clinical pharmacological considerations on the practical ,2014,63(11):865870,872874.[15] Michel F,Constantin inside and outside the operating Opin Pharmacother,2009,10(5):861873.[16] ,2012,34(8):635636.[17] Ip HY,Abrishami A,Peng PW,et of postoperative pain and analgesic consumption:aqualitative systematic ,2009,111(3):657677. [18] Chou R,Gordon DB,de LeonCasasola OA,et of postoperative pain:A clinical practice guideline from the American Pain society,the American Society of Regional Anesthesia and pain medicine,and the American Society ofAnesthesiologists’mittee on regional anesthesia,executive mittee,and administrative Pain,2016,17(2):131157.[19] Vadivelu N,Kai AM,Kodumudi V,et of pain control and the role of the ambulatory pain specialist in the outpatient surgery Pain Res,2016,17(9):425435.[20] WarrenStomberg M,Brattwall M,Jakobsson analgesics for pain management following ambulatory surgery:a review. Minerva Anestesiol 2013, 79 (9):10771087.[21] White PF,Tang J,Wender RH,et effects of oral ibuprofen and celecoxib in preventing pain,improving recovery outes and patient satisfaction after ambulatory surgery. Anesth Analg,2011,112(2):323329.[22] Apfel CC,LaaraE,Koivuranta M,et simplified risk score for predicting postoperative nausea and vomiting:conclusions from crossvalidations between two ,1999,91(3):693700.[23] 吳新民,羅愛倫,田玉科,(2012).臨床麻醉學雜志,2012,28(4):413416.[24] Gan TJ,Diemunsch P,Habib AS,et guidelines for the management of postoperative nausea and Analg,2014,118(1):85113.[25] 李蕓,2011,32(6):742746.11
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