Ding Yiwen, Yin Huiru, Wang Shuo, Meng Qiuyan, Yan Mingli, Zhang Yining, Chen Li
School of Nursing, Jilin University, Changchun, China.
First Hospital of Jilin University, Changchun, China.
J Clin Nurs. 2022 Nov;31(21-22):3000-3010. doi: 10.1111/jocn.16195. Epub 2022 Jan 5.
Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings.
To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay.
Systematic review and meta-analysis of randomised controlled studies.
PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020.
Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA.
Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2-7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels.
Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2-7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.
接受医疗程序的儿童中疼痛很常见，且缺乏足够的认识和管理。此外，接受涉及疼痛的医疗程序的儿童也可能经历压力、哭闹和住院时间延长。小丑干预是一种有前景的非药物干预措施。然而，关于小丑干预在疼痛管理中有效性的研究报告结果相互矛盾。
评估小丑干预在减轻儿童疼痛方面的有效性，以及其对皮质醇水平、哭闹持续时间和住院时间的影响。
对随机对照研究的系统评价和荟萃分析。
从创刊日期至2020年12月31日，系统检索了PubMed、科学网（SCI）、Embase、PsycINFO、考克兰图书馆、中国知网（CNKI）、维普（VIP）、万方数据和中国生物医学文献数据库。
两名综述员独立使用考克兰偏倚风险工具评估纳入研究的偏倚风险。有数据时进行荟萃分析，否则进行叙述性描述。使用Review Manager 5.3分析数据。根据系统评价和荟萃分析优先报告条目（PRISMA）报告综述过程。
9项研究共852名儿童符合纳入标准。结果显示，与标准护理相比，小丑干预有助于减轻疼痛。进一步的亚组分析表明，对2至7岁的儿童更有效。术后哭闹持续时间和住院时间缩短，但皮质醇水平无显著差异。
小丑干预可能是减轻儿童急性疼痛的一种有前景的方法，尤其是2至7岁的儿童。它似乎还能缩短哭闹持续时间和住院时间，但对皮质醇水平的影响仍不确定。需要更多高质量的随机对照试验来证实这些结果，并考虑不同年龄组、文化背景和特定人群。
