以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (7): 38-43.doi: 10.16460/j.issn1008-9969.2020.07.038

• 循证护理 • 上一篇    下一篇

儿童扁桃体切除术后疼痛管理的最佳证据总结

吕云霞a, 冯少娟a, 李丹枫a, 吴宣霖a, 陈彦球a, 陈柳妹b, 刘洁a, 黄洁莹a, 刘正伟c   

  1. 广州市妇女儿童医疗中心 a.外科八区; b.麻醉科; c心血管科,广东 广州 510623
  • 收稿日期:2019-11-13 发布日期:2020-07-13
  • 通讯作者: 冯少娟（1974-）,女,广东广州人,本科学历,护师,护士长。
  • 作者简介:吕云霞（1987-）,女,河南周口人,研究生学历,主管护师。

Best Evidence Summary for Post-tonsillectomy Pain Management in Children

LV Yun-xiaa, FENG Shao-juana, LI Dan-fenga, WU Xuan-lina, CHEN Yan-qiua, CHEN Liu-meib, LIU Jiea, HUANG Jie-yinga, LIU Zheng-weic   

  1. a.Dept. of General Surgery, Section VIII; b. Dept. of Anesthesiology; c. Dept. of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
  • Received:2019-11-13 Published:2020-07-13

PDF (PC)

861

赞

摘要： 目的 检索并总结儿童扁桃体切除术后疼痛管理的相关证据,为临床提供参考,以促进儿童扁桃体切除术后疼痛的规范化管理,并减轻扁桃体切除术后患儿的疼痛。方法 应用循证护理的方法,针对儿童扁桃体切除术后疼痛管理提出问题,检索相关文献,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对获得的文献进行质量评价和证据分级。结果 共筛选文献14篇,包括临床决策3篇,指南2篇,证据总结1篇,系统评价8篇;结合专业人员的判断,从疼痛的识别和评估、疼痛管理的障碍因素、药物性干预措施、非药物性干预措施、围手术期健康教育5个方面的内容进行证据总结,形成30条最佳证据。结论 本研究总结了目前关于儿童扁桃体切除术后疼痛管理的最佳证据,可为临床医护人员提供循证依据。通过应用最佳证据,以科学的方法管理和降低儿童扁桃体切除术后疼痛,进而提高护理质量,提升家属满意度。

关键词: 扁桃体切除术, 儿童, 疼痛, 循证护理

Abstract: Objectives To retrieve and summarize the evidence of post-tonsillectomy pain management in children and to provide references for clinical practice and promote standardized management to alleviate the pain. Methods With the method of evidence-based nursing,the problems of post-tonsillectomy pain management in children were raised. Relevant literatures were searched,and the literature evaluation standard and evidence grading system of JBI evidence-based health care center in Australia were used to evaluate the quality and evidence grading of the obtained literatures. Results A total of 14 articles were selected, including 3 clinical decisions, 2 guidelines, 1 evidence summary and 8 systematic reviews. Thirty best evidences were summarized from the five aspects of pain recognition and evaluation, obstacle factors of pain management, pharmaceutical intervention measure, non-pharmaceutical intervention measures and perioperative health education. Conclusion This study summarizes the best evidence of pain management after tonsillectomy in children, which provides evidence for clinical professionals. The best evidence is conducive to scientifically managing and reducing post-tonsillectomy pain in children,and to improving the quality of care and family satisfaction.

Key words: tonsillectomy, children, pain, evidence-based nursing

中图分类号: 

  • R473.72
[1] Mitchell RB, Archer SM,Ishman SL,et al.Clinical Practice Guideline: Tonsillectomy in Children (Update)[J]. Otolaryngol Head Neck Surg,2019,160(1_suppl):S1-S42.DOI:10.1177/0194599818801757.
[2] Stewart DW, Ragg PG, Sheppard S, et al.The Severity and Duration of Postoperative Pain and Analgesia Requirements in Children after Tonsillectomy,Prchidopexy,or Inguinal Hernia Repair[J]. Paediatr Anaesth,2012,22(2):136-143. DOI:10.1111/j.1460-9592.2011.03713.x.
[3] Fortier MA,Maclaren JE,Martin SR,et al.Pediatric Pain after Ambulatory Surgery:Where's the Medication?[J]. Pediatrics,2009,124(4):e588-e595. DOI:10.1542/peds.2008-3529.
[4] Sutters KA,Savedra MC,Miaskowski C,et al.Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences with Nonpharmacologic Pain Management Strategies at Home Following Tonsillectomy[J]. J Spec Pediatr Nurs,2007,12(3):139-148. DOI:10.1111/j.1744-6155.2007.00107.x.
[5] Tan GX, Tunkel DE.Control of Pain after Tonsillectomy in Children: A Review[J]. JAMA Otolaryngology Head Neck Surg,2017,143(9):937-942. DOI:10.1001/jamaoto.2017.0845.
[6] Baugh RF, Archer SM,Mitchell RB,et al.Clinical Practice Guideline: Tonsillectomy in Children[J]. Otolaryngol Head Neck Surg,2011,144(1_suppl):S1-S30.DOI:10.1177/0194599810389949.
[7] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[8] Dicenso A, Bayley L,Haynes RB.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs,2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[9] 韦当,王聪尧,肖晓娟,等. 指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319. DOI:10.3969/j.issn.1673-5501.2013.04.017.
[10] 胡雁,郝玉芳. 循证护理学[M].北京:人民卫生出版社,2018.
[11] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015,30(11):964-967.
[12] Messner AH. Tonsillectomy and/or Adenoidectomy in Children: Preoperative Evaluation and Care[EB/OL].(2017-11-21)[2019-03-07].https://www.uptodate.com/contents/tonsillectomy-and-or-adenoidectomy-in-children-preoperative-evaluation-and-care?search=%E6%89%81%E6%A1%83%E4%BD%93%E5%88%87%E9%99%A4%E6%9C%AF&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=4~109.
[13] Messner AH. Tonsillectomy (With or Without Adenoidectomy) in Children: Postoperative Care and Complications[EB/OL].(2018-09-06)[2019-03-07].https://www.uptodate.com/contents/tonsillectomy-With-or-Without-adenoidectomy-in-children-postoperative-care-and-complications?search=%E6%89%81%E6%A1%83%E4%BD%93%E5%88%87%E9%99%A4%E6%9C%AF&source=search_result&selectedTitle=2~109&usage_type=default&display_rank=2.
[14] Sadhasivam S. Anesthesia for Tonsillectomy with or without Adenoidectomy in Children[EB/OL]. (2018-04-12)[2019-03-07]. https://www.uptodate.com/contents/anesthesia-for-tonsillectomy-With-or-Without-adenoidectomy-in-children?search=%E6%89%81%E6%A1%83%E4%BD%93%E5%88%87%E9%99%A4%E6%9C%AF&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=3~109.
[15] Scottish Intercollegiate Guidelines Network. Management of Sore Throat and Indications for Tonsillectomy[EB/OL].(2010-04-01)[2019-03-07]. https://www.sign.ac.uk/sign-117-management-of-sore-throat-and-indications-for-tonsillectomy.html.
[16] Le LK. Pain Relief (Post-Tonsillectomy): Peri-Operative Local Anesthesia[J]. The Joanna Briggs Institute EBP Database, JBI@Ovid, 2017,JBI804.
[17] Hollis LJ,Burton MJ,Millar JM.Perioperative Local Anaesthesia for Reducing Pain Following Tonsillectomy[J]. Cochrane Database Syst Rev,2000(2):D1874. DOI:10.1002/14651858.CD001874.
[18] Fedorowicz Z, van Zuuren EJ, Nasser M, et al. Oral Rinses, Mouthwashes and Sprays for Improving Recovery Following Tonsillectomy[J]. Cochrane Database Syst Rev, 2013(9):D7806.DOI:10.1002/14651858.CD007806.pub4.
[19] Steward DL,Grisel J,Meinzen-Derr J.Steroids for Improving Recovery Following Tonsillectomy in Children[J]. Cochrane Database Syst Rev,2011(8):D3997. DOI:10.1002/14651858.CD003997.pub2.
[20] Dhiwakar M, Clement WA,Supriya M,et al.Antibiotics to Reduce Post-tonsillectomy Morbidity[J].Cochrane Database Syst Rev,2012(12):D5607.DOI:10.1002/14651858.CD005607.pub4.
[21] Lewis SR,Nicholson A,Cardwell ME,et al.Nonsteroidal Anti-inflammatory Drugs and Perioperative Bleeding in Paediatric Tonsillectomy[J]. Cochrane Database Syst Rev,2013(7):D3591. DOI:10.1002/14651858.CD003591.pub3.
[22] Hobson A, Wiffen PJ, Conlon JA.As Required Versus Fixed Schedule Analgesic Administration for Postoperative Pain in Children[J]. Cochrane Database Syst Rev,2015(2): D11404. DOI:10.1002/14651858.CD011404.pub2.
[23] Schnabel A, Reichl SU,Meyer-Friessem C,et al.Tramadol for Postoperative Pain Treatment in Children[J]. Cochrane Database Syst Rev,2015(3):D9574. DOI:10.1002/14651858.CD009574.pub2.
[24] Lal A,Chohan K,Chohan A,et al.Role of Honey after Tonsillectomy:A Systematic Review and Meta-analysis of Randomised Controlled Trials[J]. Clin Otolaryngol,2017,42(3): 651-660. DOI:10.1111/coa.12792.
[25] Sertel S, Herrmann S, Greten HJ,et al.Additional Use of Acupuncture to NSAID Effectively Reduces Post-tonsillectomy Pain[J]. Eur Arch Otorhinolaryngol,2009, 266(6): 919-925. DOI:10.1007/s00405-008-0851-1.
[26] Macassey E,Dawes P,Taylor B, et al.The Effect of a Postoperative Course of Oral Prednisone on Postoperative Morbidity following Childhood Tonsillectomy[J]. Otolaryngol Head Neck Surg, 2012,147(3):551-556.DOI:10.1177/0194599812447776.
[27] Kain ZN,Caldwell-Andrews AA,Mayes LC, et al.Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children: a Randomized Controlled Trial[J]. Anesthesiology,2007,106(1):65-74.DOI:10.1097/00000542-200701000-00013.
[28] Kain ZN, Mayes LC,Caldwell-Andrews AA,et al.Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery[J]. Pediatrics,2006,118(2):651-658. DOI:10.1542/peds.2005-2920.
[29] Nafiu OO, Shanks A, Abdo S, et al.Association of High Body Mass Index in Children with Early Post-tonsillectomy Pain[J]. Int J Pediatr Otorhinplaryngol,2013, 77(2):256-261. DOI:10.1016/j.ijporl.2012.11.012.
[30] Sutters KA,Holdridge-Zeuner D,Waite S,et al.A Descriptive Feasibility Study to Evaluate Scheduled Oral Analgesic Dosing at Home for the Management of Postoperative Pain in Preschool Children Following Tonsillectomy[J].Pain Med,2012,13(3):472-483.DOI:10.1111/j.1526-4637.2011.01324.x.
[31] Rony RY, Fortier MA, Chorney JM, et al.Parental Postoperative Pain Management: Attitudes, Assessment, and Management[J]. Pediatrics,2010,125(6):e1372-e1378. DOI:10.1542/peds.2009-2632.
[32] Bhattacharyya N,Shapiro NL.Associations between Socioeconomic Status and Race with Complications after Tonsillectomy in Children[J]. Otolaryngol Head Neck Surg,2014,151(6):1055-1060. DOI:10.1177/0194599814552647.
[33] Sutters KA, Miaskowski C, Holdridge-Zeuner D, et al.A Randomized Clinical Trial of the Efficacy of Scheduled Dosing of Acetaminophen and Hydrocodone for the Management of Postoperative Pain in Children after Tonsillectomy[J]. Clin J Pain, 2010,26(2):95-103.DOI:10.1097/AJP.0b013e3181b85f98.
[34] Ciszkowski C, Madadi P, Phillips MS, et al.Codeine, Ultrarapid-metabolism Genotype, and Postoperative Death[J]. N Engl J Med,2009,361(8):827-828.DOI:10.1056/NEJMc0904266.
[35] Kelly LE, Rieder M, van den Anker J, et al. More Codeine Fatalities after Tonsillectomy in North American Children[J]. Pediatrics,2012,129(5):e1343-e1347.DOI:10.1542/peds.2011-2538.
[36] Schymik FA,Lavoie SE,Voepel-Lewis T.Parental Analgesic Knowledge and Decision Making for Children with and without Obstructive Sleep Apnea after Tonsillectomy and Adenoidectomy[J]. Pain Manag Nurs,2015,16(6):881-889. DOI:10.1016/j.pmn.2015.07.003.
[37] 刘雪莲,李漓. 临床护士疼痛管理核心能力知识水平现状分析[J].护理学报,2018,25(9):12-16.DOI:10.16460/j.issn1008-9969.2018.09.012.
[1] 蔡莹莹, 凌晨, 刘绵珠, 周杰, 张俊峰, 陈连华, 田潇飞, 罗斌, 陈梦云. 成人癌痛评估与管理指南的方法学质量评价[J]. 护理学报, 2025, 32(4): 34-40.
[2] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[3] 李亚可, 苏晴晴, 吕静, 李琪, 娄琳彤, 李海燕. 全膝关节置换患者疼痛与睡眠质量纵向关联的组基础模型双轨迹分析[J]. 护理学报, 2025, 32(3): 6-11.
[4] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[5] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[6] 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[7] 李嘉琪, 莫文娟, 王一棋, 王洁, 李梦楠, 刘兴, 冯佳. 基于COSMIN方法对慢性疼痛患者恐动症坦帕评分表的系统评价[J]. 护理学报, 2025, 32(2): 56-62.
[8] 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[9] 刘莉, 于卫华, 肖娟, 汪阿慧, 凌雅. 便利蜷曲联合甜味剂棉签减轻早产儿气管内吸痰疼痛的效果研究[J]. 护理学报, 2024, 31(9): 10-14.
[10] 陈莹莹, 丁红, 张根生. 患儿术后谵妄影响因素的研究进展[J]. 护理学报, 2024, 31(9): 32-35.
[11] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[12] 符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[13] 纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[14] 张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[15] 周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!