非药物干预在儿童肿瘤治疗过程中作用的Meta分析

Meta-analysis of non-pharmacological interventions in the treatment of pediatric cancer patients

目的:分析评价非药物干预方法是否能减轻肿瘤患儿治疗过程中相关疼痛及焦虑不安、害怕等不良情绪症状,保障患儿治疗效果。方法:通过PubMed、ScienceDirect、Cochrane Library、中国知网、万方数据和维普数据库,筛选有关非药物干预方法减轻肿瘤患儿治疗过程中相关疼痛及焦虑不安、害怕等不良情绪的对照试验,检索年限均为从建库至2022年10月,使用RevMan 5.3软件进行Meta分析。结果:共纳入10篇英文文献,总共370例病例,其中治疗组(非药物干预疗法)180例,对照组(常规治疗)190例。合并分析结果显示治疗组较对照组更能减轻肿瘤患儿治疗过程中的疼痛及焦虑不安、害怕症状,差异有统计学意义(疼痛:SMD=-1.07,95%CI:-1.71~-0.43,P=0.001;焦虑不安、害怕:SMD=-1.42,95%CI:-2.15~-0.70,P=0.0001)。亚组分析中,相对于常规治疗,催眠疗法效果更有效(疼痛:SMD=-1.89,95%CI:-3.01~-0.77,P=0.0009;焦虑不安、害怕:SMD=-2.62,95%CI:-4.42~-0.83,P=0.004)。结论:非药物干预疗法(催眠、分散注意力)能够减轻肿瘤患儿治疗过程中的疼痛及焦虑不安、害怕症状,其中催眠疗法效果更佳。

Objective:To evaluate non-pharmacological interventions to reduce procedural pain and anxiety,fear,and other adverse emotional symptoms during treatment in children with cancer and to ensure the treatment effect.Methods:The relevant controlled trials about non-pharmacological interventions to reduce procedural pain and anxiety or fear symptoms during treatment in children with cancer were retrieved from the databases of PubMed,ScienceDirect,Cochrane Library,China National Knowledge Infrastructure,Wan Fang and VIP Database.The years of retrieval was from the database construction to October 2022,and the Meta-analysis was performed by using RevMan 5.3 software.Results:Ten controlled trials were included in this Meta-analysis.There were 370 cases,of which 180 cases in experience group(non-pharmacological interventions)versus 190 cases in control group(standard medical treatment).Meta-analysis showed that the treatment group reduced more pain and anxiety or fear symptoms than those in the control group during treatment in children with cancer,and the difference was statistically significant(pain:SMD=−1.07,95%CI:−1.71-−0.43,P=0.001;anxiety or fear:SMD=−1.42,95%CI:−2.15-−0.70,P=0.0001).In the analysis of subgroups,compared with the standard medical treatment,the hypnotherapy was more effective(pain:SMD=−1.89,95%CI:−3.01-−0.77,P=0.0009;anxiety or fear:SMD=−2.62,95%CI:−4.42-−0.83,P=0.004).Conclusion:Non-pharmacological interventions(hypnosis and distraction)can reduce pain,anxiety and fear symptoms during treatment in children with cancer,of which hypnotherapy was more effective.