以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (5): 32-37.doi: 10.16460/j.issn1008-9969.2021.05.032

• 循证护理 • 上一篇    下一篇

老年痴呆患者疼痛评估及管理最佳证据总结

朱玮玮1a, 许阳子1a, 霍婉君1b, 陈慈玉1c, 李远添1c, 凌冬兰2   

  1. 1.广东药科大学附属第一医院 a.护理部;b.重症医学科;c.神经内科,广东 广州 510080;
    2.广州医科大学附属第二医院 护理部,广东 广州 510260
  • 收稿日期:2020-11-29 出版日期:2021-03-10 发布日期:2021-04-08
  • 通讯作者: 凌冬兰（1981-）,女,广东梅县人,硕士,主管护师,南方医院JBI循证护理合作中心导师库成员。E-mail：lingdonglan@gzhmu.edu.cn
  • 作者简介:朱玮玮（1990-）,女,安徽蚌埠人,硕士,南方医院JBI循证护理师,护理部干事。
  • 基金资助:
    广东省教育厅广东药科大学“创新强校工程”资助项目（2017KQNCX106）

Best Evidence Summary for Assessment and Management of Pain in Elderly Patients with Dementia

ZHU Wei-wei1a, XU Yang-zi1a, HUO Wan-jun1b, CHEN Ci-yu1c, LI Yuan-tian1c, LING Dong-lan2   

  1. 1a. Dept. of Nursing Administration; 1b. Dept. of Intensive Care Unit; 1c. Dept. of Neurology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China;
    2. Dept. of Nursing Administration, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
  • Received:2020-11-29 Online:2021-03-10 Published:2021-04-08

PDF (PC)

603

赞

摘要： 目的 总结老年痴呆患者疼痛评估及管理的最佳证据,为老年痴呆患者疼痛的评估和管理提供证据支持,改善老年痴呆患者的疼痛护理质量。方法 用PICO模型构建循证护理问题,按照“6S”证据金字塔模型依次检索2010年1月1日—2020年2月29日发布在UpToDate、BMJ Best Practice、JBI、NICE、RNAO、CINAHL、中国生物医学数据库、知网、万方等数据库的相关文献,2名具备硕士学位的循证护理师独立进行文献质量评价及证据筛查,证据汇总后由项目团队综合归类。结果 共纳入文献12篇：证据总结3篇,指南2篇,系统评价5篇,随机对照试验2篇。从纳入的文献中共提取55条证据,最终综合成26条最佳证据共6个维度,分别是疼痛评估时机与量表、疼痛评估方法、干预措施、疼痛管理、培训与教育、组织保障。结论 临床管理者需重视老年痴呆患者疼痛评估,使用适宜疼痛评估工具及方法,采取针对性干预措施,并且需对医务人员进行老年痴呆患者疼痛相关知识的培训,在证据应用的过程中应评估临床情景及现有的医疗环境,制订符合临床实际的老年痴呆患者疼痛管理计划。

关键词: 老年痴呆, 疼痛, 评估, 管理, 循证护理

Abstract: Objective To summarize the best evidence of pain assessment and management in elderly patients with dementia, and provide reference for improving the quality of pain care for elderly patients with dementia. Methods The PICO was used to construct evidence-based nursing problems.According to the “6S” evidence pyramid model, we searched relevant literature published in UpToDate, BMJ Best Practice, JBI, NICE, RNAO, CINAHL,CBM, CNKI and Wanfang Data from January 1, 2010 to February 29, 2020. Two qualified researchers with master degree independently evaluated the quality of literature by using different appraisal tools. Then the evidence was summarized and integrated from eligible studies. Results Twelve articles were selected, including 2 guidelines, 3 evidence summaries, 5 systematic reviews and 2 randomized controlled trials. A total of 55 pieces of evidence on the evaluation and management in elderly patients with dementia were extracted and finally integrated into 26 pieces of best evidence and 6 dimensions: timing and scales of pain assessment, methods of pain assessment, intervention measures, pain management, training and education and organization guarantee. Conclusion Great importance should be attached to pain assessment for elderly dementia patients. Suitable pain assessment tools and methods, targeted intervention measures, pain-related training for medical staff and specific clinical situation and current medical environment are conducive to conducting individualized pain management for elderly dementia patients.

Key words: dementia, pain, assessment, management, evidence-based nursing

中图分类号: 

  • R473.74
[1] 苗茜.老年痴呆患者疼痛管理研究进展[J].中国中西医结合外科杂志,2019,25(3):414-417. DOI:10.3969/j.issn.1007-6948.2019.03.040.
[2] Rostad HM, Puts MTE, Cvancarova Smastuen M, et al.Associations between Pain and Quality of Life in Severe Dementia:A Norwegian Cross-sectional Study[J].Dement Geriatr Cogn Dis Extra,2017, 7(1):109-121. DOI:10.1159/000468923.
[3] 李昂,殷淑琴,徐勇,等.2010~2030年中国老年期痴呆的预测[J].中国老年学杂志,2015,35(13):3708-3711. DOI:10.3969/j.issn.1005-9202.2015.13.105.
[4] Hunt LJ, Covinsky KE, Yaffe K, et al.Pain in Community-dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study[J].J Am Geriatr Soc,2015,63(8):1503-1511. DOI:10.1111/jgs.13536.
[5] Bruneau B.Barriers to the Management of Pain in Dementia Care[J].Nurs Times,2014,110(28):14-16.
[6] Rajkumar AP, Ballard C, Fossey J, et al.Epidemiology of Pain in People with Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications[J].J Am Med Dir Assoc,2017,18(5):e1-e6. DOI:10.1016/j.jamda.2017.01.024.
[7] Monroe TB, Herr KA, Mion LC, et al.Ethical and Legal Issues in Pain Research in Cognitively Impaired Older Adults[J].Int J Nurs Stud, 2013, 50(9):1283-1287. DOI:10.1016/j.ijnurstu.2012.11.023.
[8] Tones C, Knapp P, Closs SJ.Creating a Better Picture of Chronic Pain: Improving Pain Pictogram Designs Through Systematic Evaluation of User Responses[J].Br J Pain,2016, 10(4):177-185. DOI:10.1177/2049463716657365.
[9] Sandra L, Deborah D.Johns Hopkins Nursing Evidence-based Practice Model and Guidelines[M].Indiana:Sigma Theta Tau International,2007:204-207.
[10] 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.
[11] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development, Reporting and Evaluation in Health Care[J].CMAJ,2010,182(18):839-842. DOI:10.1503/cmaj.090449.
[12] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志, 2011,11(9):1084-1089. DOI:10.3969/j.issn.1672-2531.2011.09.017.
[13] The Joanna Briggs Institute(JBI).Critical Appraisal Tools [EB/OL].(2017-07-15) [2020-02-20]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[14] 卢舒颖,刘宁,魏璐华,等.产后出血预防及管理的最佳证据总结[J].护理学报,2020,27(12):18-22. DOI:10.16460/j.issn1008-9969.2020.12.018.
[15] 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. DOI:10.16821/j.cnki.hsjx.2015.11.002.
[16] Registered Nurses' Association of Ontario(RNAO).Assessment and Management of Pain(3rd ed.)[EB/OL].(2013-12-17)[2020-02-20]. https://rnao.ca/bpg/guidelines/assessment-and-management-pain.
[17] Schofield P.The Assessment of Pain in Older People:UK National Guidelines[J].Age Ageing, 2018, 47(S1):1-22. DOI:10.1093/ageing/afx192.
[18] Plooij B, Scherder EJ, Eggermont LH.Physical Inactivity in Aging and Dementia:A Review of Its Relationship to Pain[J].J Clin Nurs,2012,21(21-22):3002-3008. DOI:10.1111/j.1365-2702.2011.03856.x.
[19] Achterberg WP, Pieper MJC, van Dalen-Kok AH, et al.Pain Management in Patients with Dementia[J].Clin Interv Aging,2013,8(11):1471-1482. DOI:10.2147/CIA.S36739.
[20] Corbett A, Husebo B, Malcangio M, et al.Assessment and Treatment of Pain in People with Dementia[J].Nat Rev Neurol,2012,8(5):264-274. DOI:10.1038/nrneurol.2012.53.
[21] Corbett A, Husebo BS, Achterberg WP, et al.The Importance of Pain Management in Older People with Dementia[J].Br Med Bull,2014,111(1):139-148. DOI:10.1093/bmb/ldu023.
[22] Hadjistavropoulos T, Herr K, Prkachin KM, et al.Pain Assessment in Elderly Adults with Dementia[J].Lancet Neurol,2014,13(12):1216-1227. DOI:10.1016/S1474-4422(14)70103-6.
[23] Vivek P, MBBS Student.Dementia (Older People): Pain Assessment[EB/OL].(2019-06-28) [2020-02-20]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=FEOOFPODKGEBJNGAIPAKCFOGCIGLAA00&Link+Set=S.sh.36%7c1%7csl_190.
[24] Madhava SS, MBBS Student.Pain: Assessment Tools[EB/OL].(2019-09-05) [2020-02-20]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=EJDLFPMDBMEBJNHEIPAKEHEHLPLBAA00&Link+Set=S.sh.18%7c1%7csl_190.
[25] Madhava SS,MBBS Student.Pain Management (Older Adults): Complementary Therapies[EB/OL].(2019-12-30)[2020-02-20]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=FEONFPLDKGEBJNOHJPAKCFBFCIGLAA00&Link+Set=S.sh.18%7c1%7csl_190.
[26] Pongan E, Tillmann B, Leveque Y, et al.Can Musical or Painting Interventions Improve Chronic Pain, Mood, Quality of Life, and Cognition in Patients with Mild Alzheimer's Disease? Evidence from a Randomized Controlled Trial[J].J Alzheimers Dis,2017,60(2):663-677. DOI:10.3233/JAD-170410.
[27] Rouch I, Pongan E,Leveque Y, et al.Personality Modulates the Efficacy of Art Intervention on Chronic Pain in a Population of Patients with Alzheimer's Disease[J].J Alzheimers Dis, 2018, 63(2):617-624. DOI:10.3233/JAD-170990.
[28] Pautex S, Herrmann F, Le Lous P, et al.Feasibility and Reliability of Four Pain Self-assessment Scales and Correlation with an Observational Rating Scale in Hospitalized Elderly Demented Patients[J].J Gerontol A Biol Sci Med Sci,2005,60(4):524-529. DOI:10.1093/gerona/60.4.524.
[29] Keela H, Patrick JC, Margo MC, et al.Pain Assessment in the Patient Unable to Self-report: Position Statement with Clinical Practice Recommendations[J].Pain Manag Nurs,2011,12(4):230-250. DOI:10.1016/j.pmn.2011.10.002.
[1] 杜易梅, 刘莉, 郭立丽, 卢吉, 付苗苗, 刘杰. 妇科恶性肿瘤患者性健康研究进展[J]. 护理学报, 2025, 32(4): 28-33.
[2] 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.
[3] 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.
[4] 李垚, 陈小敏, 夏敏, 吴茜, 张琳, 陈叡喆, 葛莉丽, 吴逸梅. 肿瘤患者衰弱评估工具应用的范围综述[J]. 护理学报, 2025, 32(4): 48-52.
[5] 刘璐, 朱钰, 曹义, 张华, 彭玉娜. 腹腔热灌注化疗患者术中实施不同目标体温管理的效果观察[J]. 护理学报, 2025, 32(4): 59-63.
[6] 李疆伟, 王树君, 李长仔, 胡宝山, 焦桂梅, 张卫红. 基于压力应对理论的护理干预对结直肠癌术后永久性肠造口患者心理压力、负性情绪及自我管理的影响[J]. 护理学报, 2025, 32(4): 64-69.
[7] 马小兰, 徐维昉. 基于症状管理理论的冰水喷雾对胸腔镜下肺叶切除术口渴患者的应用效果[J]. 护理学报, 2025, 32(4): 70-73.
[8] 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.
[9] 吴超瑜, 刘尚昆. 麻醉恢复室护士危机管理能力的质性研究[J]. 护理学报, 2025, 32(3): 17-21.
[10] 陈恩琳, 莫丰菱, 庄泽明, 张明哲, 周佳坤, 黄丽芳, 纪龙飞, 张莉芳. 脑卒中单侧空间忽略评估工具的范围综述[J]. 护理学报, 2025, 32(3): 43-49.
[11] 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.
[12] 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.
[13] 杨蓓, 叶红芳, 张宁, 相卢伟, 路诗雨. 老年2型糖尿病患者体力活动现状及影响因素研究[J]. 护理学报, 2025, 32(2): 7-12.
[14] 朱天顺, 朱可可, 薛会元, 焦聪聪, 魏长慧, 王贺. 信息框架效应理论在健康管理领域应用的范围综述[J]. 护理学报, 2025, 32(2): 44-49.
[15] 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.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!