主动脉夹层患者术前疼痛管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2024.10.008

摘要/Abstract

摘要： 目的检索、评价和总结主动脉夹层术前疼痛管理的相关证据,为主动脉夹层患者术前疼痛管理方案的制订提供参考。方法系统检索国内外相关指南网站、专业协会网站、数据库中关于主动脉夹层患者术前疼痛管理的相关指南、专家共识、临床决策、推荐实践、证据总结、系统评价,检索时限为建库至2023年6月30日。由2名研究者独立进行文献质量评价和资料提取。结果共纳入18篇文献,其中指南5篇,专家共识9篇,临床决策、推荐实践、证据总结、系统评价各1篇。从疼痛管理原则、疼痛管理目标、疼痛评估、药物干预、非药物干预5个方面汇总了19条推荐意见。结论该研究总结了主动脉夹层患者术前疼痛管理的最佳证据,可为临床医务人员对主动脉夹层患者进行更科学、更有效的术前疼痛管理提供参考依据。

关键词: 主动脉夹层, 术前, 疼痛管理, 循证护理学, 证据总结

Abstract: Objective To retrieve,evaluate and summarize the best evidence of preoperative pain management for aortic dissection,and to provide references for clinical practice. Methods We searched the guideline websites,association official websites and databases to collect literature including guidelines,consensus,clinical decisions,recommend practice,evidence summaries,systematic reviews. The search period was from the establishment of the databases to June 30,2023. Two researchers independently evaluated quality of literature and extracted data. Results Totally 18 articles were enrolled,including 5 guidelines,9 expert consensuses,1 evidence summary,1 clinical decision,1 recommended practice and 1 systematic review. Finally 19 pieces of best evidence on pain management principles,pain management objectives,pain assessment tools,medication interventions,non-pharmacological interventions were summarized. Conclusion This study summarized the best evidence of preoperative pain management for aortic dissection,which can provide references for medical staffs to conduct more scientific and effective preoperative pain management in patients with aortic dissection.

Key words: Aortic Dissection, Preoperative, Pain Management, Evidence-Based Nursing, Best Evidence

张艳娟, 田青, 庞冉, 赵蕊, 康晓凤, 任华, 张志欣, 魏文宇, 王菲, 张辰. 主动脉夹层患者术前疼痛管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(10): 914-920.

ZHANG Yanjuan, TIAN Qing, PANG Ran, ZHAO Rui, KANG Xiaofeng, REN Hua, ZHANG Zhixin, WEI Wenyu, WANG Fei, ZHANG Chen. Best evidence of preoperative pain management for patients with aortic dissection[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(10): 914-920.

参考文献

[1] Mussa FF,Horton JD,Moridzadeh R,et al.Acute aortic dissection and intramural hematoma:a systematic review[J]. JAMA,2016,316(7):754-763.
[2] 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志,2017,33(11):641-654.
The Great Vessels Surgery Committee of Cardiovascular Surgery Branch of Chinese Physician Association. Chinese experts‘ consensus of standardized diagnosis and treatment for aortic dissection[J]. Chin J Thorac Cardiovasc Surg,2017,33(11):641-654.
[3] 刘裕文,李庆印,刘湉,等. 急性主动脉夹层患者急诊临床恶化动态预警方案的构建及应用研究[J]. 中华急危重症护理杂志,2022,3(6):485-490.
Liu YW,Li QY,Liu T,et al.The construction and application of dynamic warning plan for emergency clinical deterioration of patients with acute aortic dissection[J]. Chin J Emerg Crit Care Nurs,2022,3(6):485-490.
[4] Ohle R,Yan JW,Yadav K,et al.Diagnosing acute aortic syndrome:a Canadian clinical practice guideline[J]. J De L‘as-sociation Med Can,2020,192(29):E832-E843.
[5] Lombardi JV,Hughes GC,Appoo JJ,et al.Society for Vascular Surgery(SVS) and Society of Thoracic Surgeons(STS) reporting standards for type B aortic dissections[J]. J Vasc Surg,2020,71(3):723-747.
[6] 宋胜文,赵佳莲,褚丽花,等. 89例急性主动脉夹层患者急诊室早期镇痛情况分析[J]. 上海医学,2018,41(4):220-222.
Song SW,Zhao JL,Chu LH,et al.Analysis of early pain control in 89 patients with acute aortic dissection in emergency room[J]. Shanghai Med J,2018,41(4):220-222.
[7] 邢唯杰,胡雁,周英凤,等. 推动证据向临床转化(六)证据总结的制作与撰写[J]. 护士进修杂志,2020,35(12):1129-1132.
Xing WJ,Hu Y,Zhou YF,et al.Promoting the transformation of evidence into clinical practice:making and writing evidence summary[J]. J Nurses Train,2020,35(12):1129-1132.
[8] 谢利民,王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报,2012,10(2):160-165.
Xie LM,Wang WY.A brief introduction to Appraisal of Guidelines for Research and Evaluation Ⅱ[J]. J Chin Integr Med,2012,10(2):160-165.
[9] 胡雁,郝玉芳. 循证护理学[M]. 2版. 北京:人民卫生出版社,2018.
Hu Y,Hao YF.Evidence-based nursing[M]. 2nd ed. Beijing:People‘s Medical Publishing House,2018.
[10] Privitera D,Capsoni N,Vailati P,et al.Standardized nursing approach to acute aortic dissection patient:a practice update[J]. SAGE Open Nurs,2022,8:23779608221145124.
[11] 周雁荣,吴前胜,王萧萧,等. 主动脉夹层患者围手术期管理最佳证据总结[J]. 中华护理杂志,2022,57(22):2769-2776.
Zhou YR,Wu QS,Wang XX,et al.Best evidence summary on perioperative management of patients with aortic dissection[J]. Chin J Nurs,2022,57(22):2769-2776.
[12] 程卫平,张铁铮. Stanford A型主动脉夹层外科手术麻醉中国专家临床路径管理共识(2017)[J]. 麻醉安全与质控,2018,2(1):1-6.
Cheng WP,Zhang TZ.China experts‘ consensus on clinical pathway management of anesthesia in Stanford A aortic dissection surgery(2017)[J]. Perioper Saf Qual Assur,2018,2(1):1-6.
[13] 中华医学会外科学分会血管外科学组,符伟国,陈忠,等. Stanford B型主动脉夹层诊断和治疗中国专家共识(2022版)[J]. 中国血管外科杂志:电子版,2022,14(2):119-130.
Vascular Surgery Group of Surgery Branch of Chinese Medical Association,Fu WG,CHEN Z,et al. Chinese expert consensus on the diagnosis and treatment of Stanford type B aortic dissection(2022 edition)[J]. Chin J Vasc Surg Electron Version,2022,14(2):119-130.
[14] Writing Committee Members,Isselbacher EM,Preventza O,et al.2022 ACC/AHA guideline for the diagnosis and management of aortic disease:a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J]. J Thorac Cardiovasc Surg,2023,166(5):e182-e331.
[15] Erbel R,Aboyans V,Boileau C,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J]. Kardiol Pol,2014,72(12):1169-1252.
[16] Oberhuber A,Raddatz A,Betge S,et al.Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection[J]. Gefässchirurgie,2023,28(Suppl 1):1-28.
[17] 中华医学会胸心血管外科学分会胸腔镜外科学组,中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识(2018版)[J]. 中国胸心血管外科临床杂志,2018,25(11):921-928.
Thoracoscopic Surgery Group of Thoracic and Cardiovascular Surgery Branch of Chinese Medical Association,Minimally Invasive Surgery Expert Committee of the Chest Surgery Branch of Chinese Medical Association. Chinese expert consensus statement on perioperative pain management of thoracic surgery(version 2018)[J]. Chin J Clin Thorac Cardiovasc Surg,2018, 25(11):921-928.
[18] 中国心脏重症镇静镇痛专家委员会. 中国心脏重症镇静镇痛专家共识[J]. 中华医学杂志,2017,97(10):726-734.
Chinese Expert Committee on Sedation and Analgesia for Severe Cardiac Disease. Expert consensus on sedation and analgesia for severe cardiac diseases in China[J]. Natl Med J China,2017,97(10):726-734.
[19] 姚允泰,李立环. 右美托咪定在心血管麻醉和围术期应用的专家共识(2018)[J]. 临床麻醉学杂志,2018,34(9):914-917.
Yao YT,Li LH.Expert consensus on dexmedetomidine in cardiovascular anesthesia and perioperative period(2018)[J]. J Clin Anesthesiol,2018,34(9):914-917.
[20] Malaisrie SC,Szeto WY,Halas M,et al.2021 The American Association for Thoracic Surgery expert consensus document:surgical treatment of acute type A aortic dissection[J]. J Thorac Cardiovasc Surg,2021,162(3):735-758.e2.
[21] McGinigle KL,Spangler EL,Pichel AC,et al. Perioperative care in open aortic vascular surgery:a consensus statement by the Enhanced Recovery After Surgery(ERAS) Society and Society for Vascular Surgery[J]. J Vasc Surg,2022,75(6):1796-1820.
[22] 中华医学会心血管病学分会大血管学组,中华心血管病杂志编辑委员会. 急性主动脉夹层合并冠心病的诊断与治疗策略中国专家共识[J]. 中华心血管病杂志,2021,49(11):1074-1081.
Macrovascular Group of Cardiology Branch of Chinese Medi-cal Association,Editorial Board of Chinese Journal of Cardi-ology. Chinese expert consensus on management of patients with acute aortic dissection complicating with coronary artery disease[J]. Chin J Cardiol,2021,49(11):1074-1081.
[23] James H Black Ⅲ. Clinical features and diagnosis of acute aortic dissection[EB/OL].(2021-12-03)[2023-10-17]. https://www.uptodate.cn/contents/clinical-features-and-diagnosis-of-acute-aortic-dissection.
[24] Karcioglu O,Topacoglu H,Dikme O,et al.A systematic review of the pain scales in adults:which to use?[J]. Am J Emerg Med,2018,36(4):707-714.
[25] 马义祥,刘斯. 成人非创伤性急腹症早期镇痛专家共识[J]. 中国急救医学,2021,41(1):11-17.
Ma YX,Liu S.Expert consensus on early analgesia of adult non-traumatic acute abdomen[J]. Chin J Crit Care Med,2021,41(1):11-17.
[26] 李红,秦俊春,周越,等. 急诊科医护人员对疼痛管理的调查分析[J]. 华西医学,2017,32(11):1766-1769.
Li H,Qin JC,Zhou Y,et al.Investigation and analysis of pain management of medical staff in emergency department[J]. West China Med J,2017,32(11):1766-1769.
[27] Wilcox G.Nursing patients with acute aortic dissection in emergency departments[J]. Emerg Nurse,2019,27(3):32-41.
[28] Morello F,Santoro M,Fargion AT,et al.Diagnosis and management of acute aortic syndromes in the emergency department[J]. Intern Emerg Med,2021,16(1):171-181.
[29] 严美玲,谭璇. 视觉模拟疼痛评分在主动脉夹层患者疼痛中的应用[J]. 齐鲁护理杂志,2015,21(18):60-61.
Yan ML,Tan X.Application of Visual Analogue Pain Score in patients with aortic dissection[J]. J Qilu Nurs,2015,21(18):60-61.