术后急性疼痛患者自控镇痛管理相关指南的系统评价

doi:10.3761/j.issn.0254-1769.2021.12.018

摘要/Abstract

摘要：

目的对术后急性疼痛患者自控镇痛（patient controlled analgesia,PCA）管理相关指南进行质量评价和内容分析,为制订术后急性疼痛PCA管理规范提供依据。方法计算机检索国内外指南网、相关专业学会网站及数据库,检索术后疼痛PCA管理相关循证指南,检索时限为建库至2021年4月。应用临床指南研究与评价工具Ⅱ（appraisal of guidelines for research and evaluation instrument Ⅱ,AGREE Ⅱ）对指南进行质量评价,汇总术后疼痛PCA管理的推荐意见。结果初检到783篇文献,最终纳入9部指南,3部指南的总体质量评价为A级,6部为B级,整体质量较高。从9部指南中提取23条术后疼痛PCA管理相关推荐意见,涉及组织管理、教育与培训、镇痛模式的选择、患者教育、术前评估、术后监测与评估6个方面。结论纳入的指南质量整体较高,为术后急性疼痛PCA规范管理提供了依据,但在独立性、应用性领域有待提高;关于术后疼痛PCA管理的推荐意见散在分布,缺乏具体针对性的管理策略。

关键词: 术后疼痛, 患者自控镇痛, 指南, 质量评价, 循证护理学

Abstract:

Objective The quality evaluation and content analysis of the existing guidelines concerning management of patient-controlled analgesia（PCA） in adult patients with postoperative acute pain were conducted to provide recommendations for its management. Methods Evidence-based guidelines involving recommendations of PCA management with postoperative pain were searched in guidelines networks,websites of pain management and anaesthesiology,and databases from inception to April 2021. AGREE Ⅱ was used to appraise the quality of guidelines;the recommendations related to PCA management of postoperative pain were synthesized. Results A total of 783 pieces of the literature were initially detected,and finally 9 evidence-based guidelines were included,among which 3 were rated as A and 6 were rated as B,with the relatively high quality. 23 recommendations were extracted and summarized from 9 guidelines,involving 6 domains,namely organization management,education and training,analgesia mode selection,patient education,preoperative assessment,and postoperative monitoring and assessment. Conclusion The guidelines are of high quality in total,providing recommendations on PCA management of postoperative pain;however,the independence and applicability of the guidelines need to be improved. The recommendations of PCA management are scattered in different guidelines and lack targeted specific PCA management strategies.

Key words: Postoperative Pain, Patient-Controlled Analgesia, Guideline, Quality Appraisal, Evidence-Based Nursing

张俊峰, 蔡莹莹, 郑可欣, 陈妙婷, 刘兴玲, 吴艳妮. 术后急性疼痛患者自控镇痛管理相关指南的系统评价[J]. 中华护理杂志, 2021, 56(12): 1868-1875.

ZHANG Junfeng, CAI Yingying, ZHENG Kexin, CHEN Miaoting, LIU Xingling, WU Yanni. A systematic review of guidelines on the management of patient-controlled analgesia in adult patients with postoperative acute pain[J]. Chinese Journal of Nursing, 2021, 56(12): 1868-1875.

图/表 5

图1 指南筛选流程及结果注：NICE为英国国家卫生与临床优化研究所;SIGN为苏格兰校际指南网;RNAO为加拿大安大略护理学会;JBI为乔安娜布里格斯研究所;IASP为国际疼痛研究协会;APS为美国疼痛协会;ASA为美国麻醉医师学会;BPS为大不列颠疼痛协会;ANZCA为澳大利亚和新西兰麻醉医师协会;AGREEⅡ为临床指南研究与评价工具Ⅱ。

Figure 1 Guidelines screening process and results

表1 纳入指南基本信息表（n=9）

Tab.1 Characteristics of included guidelines（n=9）

表2 组内相关系数一致性检验结果（n=9）

Tab.2 Consistency test results of intraclass correlation coefficient（n=9）

表3 纳入指南临床指南研究与评价工具的各领域得分及总体质量评价（n=9）

Tab.3 AGREE Ⅱ scores in various domains and overall quality appraisal（n=9）

表4 术后急性疼痛患者自控镇痛管理相关推荐意见汇总

Tab.4 Summary of recommendations on PCA management for patients with postoperative acute pain

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