儿科门诊肌内注射苄星青霉素患者疼痛管理循证实践

目的　减轻儿科门诊肌内注射苄星青霉素患者的疼痛。方法　通过循证方法寻找减轻肌内注射导致疼痛的最佳证据，选取2019年10月至2020年6月广东省妇幼保健院门诊A族链球菌感染肌内注射苄星青霉素的360例患儿，通过随机数字表法分为基线调查组、第l轮证据应用组和第2轮证据应用组。基线调查组120例，男69例，女51例；第l轮证据应用组120例，男70例，女50例；第2轮证据应用组120例，男66例，女54例。3组患儿年龄均在5～15岁之间。比较研究对象的一般资料、证据应用前后护士最佳证据的执行情况、证据应用前后患儿疼痛评分及硬结发生率。采用单因素方差分析、卡方检验、非参数检验。结果　对最终纳入的10篇文献进行证据提取，共提取10条证据，制定出9个临床审查指标，运用证据前后对比，证据应用后患儿疼痛评分由8.42分下降为4.26分，注射30 min后疼痛评分由4.53分下降为2.18分，注射部位产生硬结发生率由75.8%（91/120）下降为32.5%（39/120），差异均有统计学意义（均P<0.001）。结论　一系列药物及非药物措施能减轻儿童程序性疼痛；Buzzy小蜜蜂装置（冷+振动+分散注意力）可以减轻肌内注射青霉素疼痛；正确的苄星青霉素配置方法、注射手法、注射部位、注射速度可以减轻肌内注射苄星青霉素的疼痛。

Evidence-based pain management for pediatric outpatients taking intramuscular injection of benzathine penicillin

Objective　To reduce the pain of pediatric outpatients taking intramuscular injection of benzathine penicillin. Methods　An evidence-based approach was used to find the best evidences to alleviate pain caused by the intramuscular injection of benzathine penicillin. Three hundred and sixty pediatric outpatients infected by group A streptococcus and treated in Guangdong Women and Children Hospital from October 2019 to June 2020 were selected, and they were 5-15 years old. They were divided into a baseline group (120 cases), including 69 boys and 51 girls, a round 1 evidence group (120 cases), including 70 boys and 50 girls, and a round 2 evidence group (120 cases), including 66 boys and 54 girls, by the random number table method. The general data and the implementation of the best evidences by the nurses and the pain scores and incidences of sclerosis before and after the evidence application were compared. The one way ANOVA, chi square test, and nonparametric test were applied. Results　A total of 10 evidences were extracted from the 10 finally included literatures, and 9 clinical review indicators were established. The children's pain score decreased from 8.42 before the evidence application to 4.26 after, the pain score 30 minutes after injection from 4.53 to 2.18, and the incidence of sclerosis at the injection site from 75.8% (91/120) to 32.5% (39/120), with statistical differences (all P<0.001). Conclusions　A series of drug and non-drug measures can reduce the procedural pain in children; the Buzzy little bee device (cold + vibration + distraction) reduces the pain of intramuscular penicillin injection; the correct configuration, injection technique, injection site, and injection speed of benzathine penicillin can alleviate the pain caused by intramuscular injection of benzathine penicillin.