分散注意力用于儿童静脉穿刺干预效果的meta分析

A Meta-analysis on the application effect of distraction in children during venipuncture

目的通过meta分析评价分散注意力以及主动和被动分散注意力用于儿童静脉穿刺的干预效果,为临床选择干预措施提供依据。方法计算机检索Web of Science、Pub Med、EMBASE、Cochrane、中国生物医学文献数据库(CBM)、万方数据库、维普数据库(VIP)和中国知网(CNKI)数据库中分散注意力干预儿童静脉穿刺的随机对照试验,同时筛检纳入研究的参考文献。由两名研究者对文献进行质量评价和数据提取,对符合标准的研究采用Review Manager 5.3软件进行meta分析。结果纳入14项符合标准的随机对照研究,包括儿童1357例。meta分析结果显示,13项研究显示分散注意力可以减轻儿童自我报告疼痛评分[SMD=-0.60,95%CI=(-0.96,-0.25),P=0.000 8];4项研究显示分散注意力可以降低医务人员报告儿童疼痛评分[SMD=-1.06,95%CI=(-2.05,-0.06),P=0.04];3项研究显示分散注意力可以降低父母报告儿童疼痛评分[SMD=-0.82,95%CI=(-1.57,-0.07),P=0.03];3项研究显示分散注意力可以降低行为评估儿童疼痛评分[SMD=-0.63,95%CI=(-1.25,-0.02),P=0.04]。3项研究显示分散注意力可以降低父母报告儿童焦虑评分[SMD=-0.90,95%CI=(-1.65,-0.16),P=0.02];3项研究显示分散注意力可以降低行为评估儿童焦虑评分[SMD=-0.62,95%CI=(-0.99,-0.26),P=0.000 9];2项研究显示干预组和对照组医务人员报告儿童焦虑评分差异无统计学意义[SMD=-1.16,95%CI=(-2.74,0.42),P=0.15]。2项研究显示主动与被动分散注意力干预相比,儿童疼痛评分差异无统计学意义[SMD=0.43,95%CI=(-0.12,0.97),P=0.13]。1项研究显示干预措施可以降低儿童血浆皮质醇浓度(P<0.05);父母焦虑评分差异无统计学意义(P>0.05)。1项研究显示干预措施可以提高儿童合作性(P<0.05)。1项研究显示干预措施可以缩短儿童哭闹持续时间(P<0.05);操作持续时间差异无统计学意义(P>0.05)。1项研究显示穿刺成功率差异无统计学意义(P>0.05)。结论分散注意力有助于减轻儿童静脉穿刺过程中的疼痛焦虑评分,在选择干预措施时应注重儿童个体化。

Objective To assess the effect of distraction（ active and passive） in the intervention of children during venipuncture by meta-analysis,to provide evidence for clinical interventions.Methods Web of Science,Pub Med,EMBASE,Cochrane,CBM,Wanfang,VIP and CNKI databases were searched to collect randomized controlled trails（ RCTs） about the application of distraction in children during venipuncture. The quality of RCTs was critically appraised and the data were extracted by two investigators independently. Meta-analysis was conducted for eligible RCTs using Review Manager 5. 3 software. Results Fourteen RCTs and 1357 children were included. The meta-analysis of 13 studies showed that distraction could reduce children＇s self-reported pain scores [SMD =-0.60,95%CI =（-0.96,-0.25）,P = 0.0008]. Four studies showed distraction decreases children＇s observer-reported pain scores[SMD =-1.06,95%CI =（-2.05,-0.06）,P= 0.04]. Three studies showed that distraction could reduce children＇s parents-reported pain scores[SMD =-0.82,95% CI =（-1. 57,-0. 07）,P = 0. 03]. Three studies showed that distraction could reduce children ＇ s behavioral measures-pain scores [SMD =-0.63,95%CI =（-1.25,-0.02）,P = 0.04]. Three studies showed that distraction could reduce children＇s parents-reported anxiety scores [SMD =-0.90,95% CI =（-1.65,-0.16）,P= 0.02]. Three studies showed that distraction could reduce children＇s behavioral measures-anxiety scores [SMD=-0.62,95% CI =（-0. 99,-0. 26）,P = 0. 0009]. Two studies showed that the children ＇s observer-reported anxiety scores in the intervention group and the control group were not statistically significant [SMD =-1.16,95%CI =（-2.74,0.42）,P = 0.15]. Two studies showed that there were no statistically significant differences in pain scores between active and passive distractions[SMD = 0. 43,95% CI =（-0. 12,0. 97）,P = 0. 13]. One study showed that distraction could reduce plasma cortisol levels in children（ P 〈 0. 05）. There were no significant differences between the two groups in the scores for level of parental anxiety（ P 〉 0. 05）. One study showed that distraction can improve children cooperation（ P 〈 0. 05）. One study showed that distraction could shorten the duration of crying in children（ P 〈 0. 05）. There were no significant differences between the two groups in the duration of process（ P 〉0. 05）. One study showed no significant differences between the two groups in puncture success rate（ P 〈 0. 05）. Conclusions Distraction could reduce pain and anxiety during venipuncture in children,and should focus on individualization when selecting interventions.