紧急腹腔切除术的止痛:一个系统的审查
Neha N Passi1, Aayushi Gupta2, Eimear Lusby3
1Department of Anaesthesia, Whipps Cross Hospital, London, UK.
概括
这一系统性审查没有发现支持紧急腹腔切除术疼痛预防性止痛的证据. 目前的做法可能需要重新评估,以改善这种重大手术后的患者结果.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 基于证据的医学基于证据的医学.
背景情况:
- 紧急情况后的腹腔切除术疼痛不受充分控制,导致患者的痛苦和并发症.
- 有效的疼痛管理对于康复和改善主要腹部手术后的生活质量至关重要.
- 预防性止痛策略通常用于选择性手术,但它们在紧急腹腔切除术中的作用尚不清楚.
研究的目的:
- 系统地审查和比较预防性镇痛干预措施的疗效,以管理成年紧急腹腔切除术患者的术后疼痛.
- 确定和评估现有的关于手术前和手术内策略的研究,旨在减少紧急腹腔切除术后的急性和慢性疼痛.
- 通过评估在这种特定的手术环境中预防性止痛的证据基础,为临床实践提供信息.
主要方法:
- 在多个数据库 (MEDLINE,Embase,PubMed,Web of Science,SCOPUS) 中进行全面的文献搜索.
- 纳入标准侧重于对成人紧急腹腔切除术中术后疼痛的术前/术内干预措施的比较研究.
- 排除关于非腹部手术,术后镇静,非正式疼痛评估和非英语手稿的研究;对所有符合条件的论文进行双重选.
主要成果:
- 最初的搜索确定了2389篇论文;1147篇经过复制和手工搜索后进行了选.
- 没有确定符合条件的研究,这些研究符合紧急腹腔切除术中预防性止痛的纳入标准.
- 许多被排除在外的研究涉及选择性或腹腔镜手术,突出了急诊腹腔切除术的研究缺口.
结论:
- 目前缺乏证据支持在紧急腹腔切除术中使用预防性止痛策略.
- 这与选择性外科手术程序的既定证据基础形成鲜明对比.
- 可能的原因包括临床实践的变化,对生理稳定的优先考虑,以及在紧急情况下对神经轴技术的担忧.
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