老年患者围术期疼痛管理的最佳证据总结

Summary of best evidence for perioperative pain management in the elderly

摘要:

目的:检索老年患者围术期疼痛管理的最佳证据。方法:依据“6S”证据模型,自上而下检索 Up To Date、BMJ 最佳临床实践、澳大利亚 JBI 循证卫生保健中心数据库、加拿大安大略护理学会网站 (RNAO)、围手术注册护士协会(AORN) 、英国国家医疗保健优化研究所(NICE)、国际指南协作网(Guidelines International Network,GIN)、中国指南网、Cochrane Library、CINAHL、PubMed、中国知网和万方数据库中与老年患者围术期疼痛管理相关的证据,包括临床决策、指南、证据总结、系统评价、专家共识及相关原始研究。检索时限为建库至 2023 年10月11日。两名研究人员独立进行文献质量评价,并结合专业人士的判断,提取和总结符合标准的文献证据。结果:共纳入8篇文献,包括专家共识2篇、证据总结1篇、指南3篇、系统评价1篇、立场声明1篇。最终从疼痛管理原则、疼痛评估、干预策略、疼痛管理与教育4个方面总结了18条最佳证据。 结论:本研究汇总了目前老年患者术后疼痛相关文献,为临床老年患者疼痛管理提供循证依据,临床人员应依据最佳临床证据及医院实际医疗情况进行证据的运用,以提高护理质量。

Abstract:

OBJECTIVE: To retrieve the best evidence for perioperative pain management in older patients. Methods: Based on the "6S" evidence model, a top-down search was performed on Up To Date, BMJ Best Clinical Practice, Australian JBI Centre for Evidence-Based Health Care database, Canadian Nursing Association of Ontario (RNAO), Association of Registered Nurses in Perioperative Surgery (AORN), National Institute for Healthcare Optimisation (NICE), Guidelines International Network (GIN), Chinese Guidelines Network, Cochrane Library, CINA, CINA, and the National Institute for Healthcare Excellence (NIHE) in England. (NICE), Guidelines International Network (GIN), China Guidelines, Cochrane Library, CINAHL, PubMed, China Knowledge, and Wanfang databases related to perioperative pain management in older patients, including clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus, and related information. We also searched the Cochrane Library, CINAHL, PubMed, China Knowledge and WanWei databases for evidence related to perioperative pain management in elderly patients, including clinical decisions, guidelines, evidence summaries, systematic evaluations, expert consensus, and relevant original studies. The search timeframe was from the construction of the database to 11 October 2023. Two researchers independently assessed the quality of the literature and combined professional judgement to extract and summarise evidence from the literature that met the criteria. RESULTS: A total of eight papers were included, including two expert consensus papers, one evidence summary, three guidelines, one systematic evaluation, and one position statement. Ultimately, 18 best evidence items were summarised in 4 areas: pain management principles, pain assessment, intervention strategies, and pain management and education. CONCLUSION: This study summarises the current literature related to postoperative pain in elderly patients and provides an evidence-based basis for clinical pain management in elderly patients, and clinical staff should use the evidence based on the best clinical evidence and the actual medical situation in hospitals in order to improve the quality of care.