扁桃体手术病人疼痛干预措施的最佳证据总结

Summary of the best evidence for pain intervention in patients undergoing tonsil surgery

目的:总结扁桃体手术病人疼痛干预的最佳证据。方法:系统检索BMJ最佳临床实践、JBI循证卫生保健中心数据库、加拿大安大略注册护士协会网、苏格兰学院间指南网、医脉通指南网、Cochrane Library、Pub Med、Up To Date、中国生物医学文献数据库、万方数据库、中国知网数据库中所有关于扁桃体术后疼痛干预相关的证据,包括指南、专家共识、证据总结、系统评价,Meta分析,检索时限为建库至2020年4月30日。由2名研究者独立完成纳入文献的质量评价,并结合专业人士的判断,对符合质量标准的文献进行证据提取及总结。结果:共纳入19篇文献,包括1篇指南、18篇系统评价或Meta分析。总结了包括药物和非药物在内的18条有关扁桃体手术病人疼痛干预措施的证据,其中11条证据给予A级推荐,7条证据给予B级推荐;干预方式涉及药物、局部麻醉、心理指导、疼痛管理、冷流质饮食、口服蜂蜜、冰敷和分散注意力。结论:扁桃体切除术病人围术期疼痛干预证据应用过程中应结合临床情境,选择最佳证据,减轻病人术后疼痛程度。

Objective:To summarize the best evidence of postoperative pain intervention for patients undergoing tonsil surgery.Methods:All evidence related to tonsil postoperative pain intervention was systematically retrieved from BMJ Best Clinical Practice,JBI Evidence⁃Based Health Care Center Database,the Registered Nurses'Association of Ontario(RNAO)Network,the Scottish Intercollegiate Guidelines Network(SIGN),Yimaitong Network,Cochrane Library,PubMed,UpToDate,Chinese Biomedical Literature Database,Wanfang Database,and China National Knowledge Infrastructure,including guidelines,expert consensus,evidence summary,systematic reviews,and meta⁃analysis.The search time limit was from the establishment of the database to April 30,2020.Two researchers independently completed the quality evaluation of the included literature,then extracted and summarized the evidence that meets the quality standards combined with the judgment of professionals.Results:A total of 19 articles were included,involving 1 guideline and 18 systematic reviews or meta⁃analysis,which summarized 18 pieces of evidence concerning postoperative pain interventions for patients undergoing tonsillectomy,including drugs and non⁃drugs.Among the evidences,11 pieces were given grade A recommendation and 7 pieces with grade B recommendation;intervention methods involved drugs,local anesthesia,psychological guidance,pain management,cold liquid diet,oral honey,ice compress,and distraction.Conclusions:When applying perioperative pain intervention evidence for patients undergoing tonsil surgery,the clinical situation should be concerned,and the best evidence should be selected to reduce the degree of postoperative pain.