Hsieh Ling-Yu, Chen Yi-Rong, Lu Mei-Chun
aDepartment of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi bDepartment of Medical Research, Kuang Tien General Hospital, Taichung cDepartment of Nursing, Hungkuang University, Taichung, Taiwan.
Medicine (Baltimore). 2017 Nov;96(46):e8642. doi: 10.1097/MD.0000000000008642.
Use of analgesics is the most common method to alleviate the pain induced by chest tube removal (CTR), but patient response to medication can vary and may not be achieved complete relaxation. This study was to determine the effectiveness of cold application in combination with standard analgesic administration before CTR on CTR-induced pain.
A prospective, randomized, single-blind, sham-controlled study was conducted. In addition to the same routine care, subjects in the experimental group (n = 30) received cold application of 600-g ice packs 15 minutes before CTR, whereas subjects in the sham group (n = 30) received tap water packs. Numerical rating scale was used to measure pain intensity before, immediately after, and 10 minutes after CTR.
The generalized linear estimating equation (GEE) model, adjusted for other factors, both the groups demonstrated a trend toward decreased pain during CTR over time (P < .001), but no significant differences between the 2 groups (P = .65), even stratifying by gender. If we fixed experimental group, women significant reduced pain score of 2.7 on immediately after CTR compared with before CTR (P < .0001) and reduced pain score of 2.05 on 10 minutes after CTR compared with before CTR (P < .0001). The sham group had no similar performance as the experimental group. In the male subgroup, both experimental and sham groups, men significantly reduced pain score on immediately after CTR and 10 minutes after CTR compared with before CTR (P < .0001).
The results indicate that cold application is not more effective than sham treatment in decreasing pain during CTR, even among gender. Although statistically non-significant, clinically important differences of decreased pain score were observed with cold application among women (Clinical Trial Registration: clinicaltrials.gov identifier NCT03307239).
使用镇痛药是缓解拔除胸腔引流管（CTR）所致疼痛的最常用方法，但患者对药物的反应可能存在差异，且可能无法完全放松。本研究旨在确定在CTR前联合标准镇痛给药进行冷敷对CTR所致疼痛的有效性。
进行一项前瞻性、随机、单盲、假对照研究。除相同的常规护理外，实验组（n = 30）的受试者在CTR前15分钟接受600克冰袋冷敷，而假处理组（n = 30）的受试者接受自来水袋处理。采用数字评分量表在CTR前、CTR后即刻和CTR后10分钟测量疼痛强度。
广义线性估计方程（GEE）模型在对其他因素进行校正后，两组在CTR期间疼痛均呈现随时间下降的趋势（P <.001），但两组之间无显著差异（P =.65），即使按性别分层也是如此。若固定实验组，女性在CTR后即刻的疼痛评分较CTR前显著降低2.7分（P <.0001），在CTR后10分钟的疼痛评分较CTR前降低2.05分（P <.0001）。假处理组没有与实验组类似的表现。在男性亚组中，实验组和假处理组的男性在CTR后即刻和CTR后10分钟的疼痛评分均较CTR前显著降低（P <.0001）。
结果表明，即使在不同性别中，冷敷在减轻CTR期间疼痛方面并不比假处理更有效。尽管在统计学上无显著差异，但在女性中观察到冷敷在降低疼痛评分方面具有临床重要差异（临床试验注册号：clinicaltrials.gov标识符NCT03307239）。
