4-11岁患儿外周静脉穿刺疼痛管理的最佳证据应用  

Application of best evidence for management of peripheral venipuncture pain in children 4 to 11 years of age

作　　者：宇丽[1] 栾贝贝[1] 汤玉霞[1] 余淼[1] 周其莲[1] 余竹春[1] 余丽娟 胡少华[1] Yu Li;Luan Beibei;Tang Yuxia;Yu Miao;Zhou Qilian;Yu Zhuchun;Yu Lijuan;Hu Shaohua(The Pediatric Intensive Care Unit,the First Affiliated Hospital of Anhui Medical University;The Nursing Department,the First Affiliated Hospital of Anhui Medical University)

机构地区：[1]安徽医科大学第一附属医院,安徽合肥230022

出　　处：《护士进修杂志》2020年第18期1639-1644,共6页Journal of Nurses Training

基　　金：2019年安徽省级临床重点专科建设项目。

摘　　要：目的评估目前与4~11岁患儿外周静脉穿刺疼痛管理相关的循证证据,将其最佳证据应用到护理实践中,规范儿科护士疼痛管理,促进专科护理质量提升。方法检索患儿静脉穿刺疼痛相关领域的计算机决策支持系统、临床实践指南、系统评价、原始研究等循证资源。通过文献质量评价,纳入8篇指南、1篇证据总结和3篇系统评价作为证据资源的参考文献。总结证据,通过可行性、适宜性和临床意义进行评价,产生23条最佳证据,并转化为15条临床审查指标。遵循JBI循证护理实践步骤进行临床实践,共168例4~11岁患儿、22名护士被纳入研究,采用问卷调查法、现场观察法、访谈、查阅护理记录收集数据。以护士每条审查指标执行率、患儿外周静脉穿刺疼痛评分、患儿医疗恐惧评分及患儿心率、哭闹时间血氧饱和度变化差值来评价证据应用效果。结果证据应用后,15条审查指标的执行率较前提高。患儿外周静脉穿刺疼痛评分、医疗恐惧评分降低,差异有统计学意义(P<0.01)。证据应用前后患儿哭闹时间比较,差异有统计学意义(P<0.05),心率、血氧饱和度变化差值比较,差异无统计学意义(P>0.05)。结论在临床护理中应用基于循证的4~11岁患儿外周静脉穿刺疼痛管理最佳证据,可改善患儿外周静脉穿刺疼痛体验及医疗恐惧,促进护理人员及患儿家长对疼痛管理的重视,规范疼痛管理,提升护理服务品质。Objective To evaluate the current evidence related to the management of peripheral venipuncture pain in children aged 4~11 years,apply the best evidence to nursing practice,standardize the management of pediatric nurses'pain and promote the improvement of the quality of specialized care.Methods Search the evidence-based resources such as computer decision support systems,clinical practice guideline,systematic review,and original studies in the field of venipunctal pain in children.Through literature quality evaluation,8 guidelines,1 evidence summary and 3 systematic reviews were included.Summarize the evidence,and evaluate it,23 items of best evidence were produced and translated into 15 clinical review indicators.Follow JBI evidence-based nursing practice steps for clinical practice,A total of 168 children aged 4 to 11 years and 22 nurses were included in the study.Data were collected by questionnaire survey,on-site observation,interview,and nursing records.The effect was evaluated by the implementation rate of each review indicator of nurses,peripheral venipunctuate pain score,medical fear score and the blood oxygen saturation,heart rate and crying time of children.Results After the application of evidence,the implementation rate of the 15 review indicators was higher than before.The scores of peripheral venipuncture pain and medical fear were lower,Difference was statistically significant(P<0.01).The difference of crying time before and after the application of evidence was statistically significant(P<0.05),The difference of heart rate and blood oxygen saturation was not statistically significant(P>0.05).Conclusion Application of best evidence for the management of peripheral venipelic pain in children aged 4-11 years,It can improve peripheral venipunctuate pain and medical fear,To promote the attention of nursing staff and parents to pain management,Standardize pain management and improve nursing service quality.

关 键 词：患儿 外周静脉穿刺 疼痛管理 最佳证据 循证护理 

分 类 号：R654.3[医药卫生—外科学] R473.72[医药卫生—临床医学]