El Hams Samar, El Najar Noor, Abu El-Aish Khaled
Nursing Department, Al Helal Al Emirati hospital, Rafah, Gaza Strip, occupied Palestinian territory.
Pharmacy Department, Al Helal Al Emirati hospital, Rafah, Gaza Strip, occupied Palestinian territory.
Lancet. 2021 Jul;398 Suppl 1:S24. doi: 10.1016/S0140-6736(21)01510-5.
Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and postpartum depression, and delayed functional recovery. We investigated the role of nurse-supported care in acute pain management after caesarean delivery, which as far as we know has not previously been investigated in Gaza.
This was a comparative study done from March, 2018, to October, 2018, among women assigned to undergo caesarean delivery. Research nurses at the Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, were trained to give supportive pain management care to women after caesarean delivery, including individualised care and educational sessions on pain, nutrition, exercise, and wound care. Women were randomly assigned to receive nurse-supported care or usual care. Pain assessment scales (range 1-5, where 1=no pain and 5=pain as bad as it could be) were used to record pain at 1, 6, 12, 18, and 24 h after caesarean delivery. The time from the end of the caesarean delivery to the first request for analgesia and the total amounts and types of analgesics (pethidine ampules, diclofenac ampules, or indometacin suppositories) used in the first 24 h were recorded as primary outcomes. Secondary outcomes were nausea and vomiting scores (0-3, where 0=no nausea or vomiting and 3=severe and unresponsive to antiemetic drugs), sedation scores (0-3, where 0=patient awake and 3=severe sedation and patient difficult to rouse), and pruritis scores (0-2, where 0=no pruritis and 2=severe pruritis needing treatment). Data were analysed with SPSS (version 22.0). Groups were compared by using the Student's t-test and χ. P values less than 0·05 were significant. The study was approved by the Ministry of Health and Helsinki Committee, Gaza Strip. Women provided verbal informed consent for inclusion in the study when they were assigned to the caesarean delivery.
108 women participated, with a mean age of 29·2 years (SD 5·50). 49 women were randomly assigned to nurse-supported care and 59 to usual care. Pain was reduced in the nurse-supported care group compared with in the usual care group at 12 h (mean score 1·15 [SD 0·25] vs 1·60 [0·67], p=0·002) and at 18 h (1·08 [0·22] vs 1·26 [0·21], p=0·049) but did not differ significantly at other times. The time to first requesting analgesia was shorter in the nurse-supported care group than in the usual care group (mean 3·38 h [SD 1·01] vs 6·16 h [2·01], p=0·038). The proportions of women who asked for a first analgesic were similar in the two groups (30 [61%] and 36 [61%]), whereas seven (14%) women in the nurse-supported care group requested a second analgesic compared with 13 (22%) in the usual care group (p=0·045). There were no significant differences between the two groups for nausea and vomiting, sedation, or pruritis.
Nurse-supported care provided better analgesia than usual care in women who had undergone caesarean delivery. A multicentre study is needed to explore the types, duration, and repeatability of the effects of nurse supportive care on pain perception and duration of hospital stay after caesarean delivery.
None.
剖宫产术后的疼痛管理至关重要，因为术后急性疼痛与持续性疼痛、阿片类药物使用增加、产后抑郁以及功能恢复延迟有关。我们调查了护士支持性护理在剖宫产术后急性疼痛管理中的作用，据我们所知，此前加沙地区尚未对此进行过研究。
这是一项于2018年3月至2018年10月在计划接受剖宫产的女性中开展的比较研究。加沙地带拉法市阿联酋希拉尔医院的研究护士接受了培训，以便为剖宫产术后的女性提供支持性疼痛管理护理，包括个性化护理以及关于疼痛、营养、运动和伤口护理的教育课程。女性被随机分配接受护士支持性护理或常规护理。使用疼痛评估量表（范围为1 - 5，其中1表示无疼痛，5表示疼痛极其严重）记录剖宫产术后1、6、12、18和24小时的疼痛情况。记录从剖宫产结束到首次请求镇痛的时间以及术后24小时内使用的镇痛药物（哌替啶安瓿、双氯芬酸安瓿或吲哚美辛栓剂）的总量和类型作为主要结局。次要结局包括恶心和呕吐评分（0 - 3，其中0表示无恶心或呕吐，3表示严重且对抗呕吐药物无反应）、镇静评分（0 - 3，其中0表示患者清醒，3表示严重镇静且患者难以唤醒）以及瘙痒评分（0 - 2，其中0表示无瘙痒，2表示严重瘙痒需要治疗）。数据使用SPSS（版本22.0）进行分析。采用学生t检验和χ检验对组间进行比较。P值小于0.05具有统计学意义。该研究获得了加沙地带卫生部和赫尔辛基委员会的批准。女性在被安排进行剖宫产时口头同意参与本研究。
108名女性参与研究，平均年龄为29.2岁（标准差5.50）。49名女性被随机分配接受护士支持性护理，59名接受常规护理。与常规护理组相比，护士支持性护理组在术后12小时（平均评分1.15 [标准差0.25] 对1.60 [0.67]，p = 0.002）和18小时（1.08 [0.22] 对1.26 [0.21]，p = 0.049）时疼痛减轻，但在其他时间差异无统计学意义。护士支持性护理组首次请求镇痛的时间比常规护理组短（平均3.38小时 [标准差1.01] 对6.16小时 [2.01]，p = 0.038）。两组中首次请求镇痛的女性比例相似（分别为30名 [61%] 和36名 [61%]），而护士支持性护理组中有7名（14%）女性请求了第二次镇痛，常规护理组中有13名（22%）（p = 0.045）。两组在恶心和呕吐、镇静或瘙痒方面无显著差异。
对于接受剖宫产的女性，护士支持性护理比常规护理提供了更好的镇痛效果。需要开展多中心研究以探索护士支持性护理对剖宫产术后疼痛感知和住院时间影响的类型、持续时间及可重复性。
无。
