老年痴呆患者疼痛评估及管理最佳证据总结

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。

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

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.