非药物干预缓解成人肌内注射引起注射部位疼痛的网状Meta分析

目的:对多种缓解成人肌内注射引起的注射部位疼痛的非药物干预方法进行效果评估。方法:计算机检索PubMed、the Cochrane Library、EMbase、Web of Science、PsycINFO、万方、中国知网和中国生物医学文献数据库中有关非药物干预缓解成人肌内注射疼痛的随机对照试验,检索时间均为建库至2020年3月31日。按照纳入和排除标准筛选文献、评价纳入研究的偏倚风险并从中提取数据,采用Stata 14.0展现各研究之间的网状关系,并进行发表偏倚分析;通过累积排序概率图下面积呈现每个干预方法成为最佳干预的可能性。结果:共纳入15项RCT,涉及1180例病人、12种非药物干预措施。Meta分析结果显示,在减轻成人注射过程中疼痛方面,穴位按压优于常规注射。其余10种干预方法(两针头法、指压、使用shot blocker、Z径路、留置气泡、使用buzzy、综合干预、注射体位、伪穴按压、Z路径+留置气泡)的相关研究较少,尚不能确定其改善注射疼痛效果;但根据潜在有效性优劣结果排序提示,使用buzzy工具>使用shot blocker工具>皮肤牵拉、加压伴肌肉快速松解综合干预>伪穴按压>Z路径+留置气泡>两针头法>注射体位>注射点指压>Z径路法>留置气泡>常规注射。结论:现有证据表明穴位按压是缓解成人肌内注射部位疼痛的有效方式,但尚不能确定其余10种干预方法在缓解成人肌内注射引起的注射部位疼痛的有效性,建议开展更多研究以证实其潜在效果。

Efficacy of non-pharmacological interventions to relieve pain at injection site caused by intramuscular injection in adults:a network Meta-analysis

Objective:To evaluate the effects of multiple non-pharmacological interventions to relieve pain at the injection site for adults with intramuscular injection(IM).Methods:Randomized controlled trials(RCTs)on non-pharmacological interventions to relieve adult intramuscular injection pain,were retrieved from the Cochrane Library,PubMed,EMbase,Web of Science,PsycINFO,WanFang database,CNKI,and CBM databases.The retrieval time was from inception to March 31,2020.According to the inclusion and exclusion criteria,the literature was screened.The risk of bias of the included studies was evaluated,and data was extracted.Stata 14.0 was used to show the network relationship among the studies.And publication bias analysis was carried out.The probability of each intervention method becoming the best intervention was shown by the area under the cumulative ranking probability map.Results:A total of 15 RCTs were included,involving 1180 patients and 12 non-pharmacological interventions.Meta-analysis results showed that acupressure was superior than conventional injection on reducing pain during injection in adults.Currently,there were relatively few studies on remaining 10 types of interventions(the two-needle method,finger pressure,shot blocker,Z path,indwelling bubble,buzzy,comprehensive intervention,injection position,sham-acupressure,Z path+indwelling bubble).It was still unclear that their effects on improving pain caused by IM.However,according to the ranking of the potential effectiveness of the results,use the buzzy tool>use the shot blocker tool>skin traction,compression,and rapid muscle relaxation comprehensive intervention>sham-acupressure>Z path+indwelling bubble>two-needle method>body position during injection>finger pressure at injection point>Z path method>indwelling bubble>conventional injection.Conclusion:Current evidences shows that acupressure is an effective way to relieve the pain of injection site in adults with IM.But the effectiveness of the the other 10 interventions is uncertain on relieving the pain of the injection site in adults with IM.It is suggested that more studies should be carried out to confirm its potential effect.