運用冰敷於胸管移除時疼痛減輕之成效－－系統性文獻回顧

The Effectiveness of a Cold Application for Pain Associated with Chest Tube Removal: A Systematic Review

背景：目前已有數篇探討運用冰敷於減輕胸管移除疼痛之研究，但其成效結果並未一致。目的：確定冰敷對減輕胸管移除所造成疼痛之成效。方法　搜尋2014年6月以前的中、英文文獻，資料庫包含Cochrane、PubMed、Medline、CINAHL、ProQuest、華藝線上圖書館及台灣博碩士論文網，以PICO（patient, intervention, comparion, outcome）建立中、英文關鍵字，分別為P：胸管移除（chest tube removal），I：冰敷（cold application），O：疼痛（pain）。文獻選取標準為需是運用冰敷於胸管移除時疼痛減輕之隨機控制試驗，並以modifiedJadad scale作為篩選文章品質之工具。結果　共納入五篇文獻，研究對象包含426位心胸外科病人，平均年齡自48.7（SD=16.5）至60.2（SD=6.2）歲。冰敷樣式以冰袋為主，冰敷區域為以胸管口為中心直徑5~15公分範圍。雖冰敷對減輕胸管移除時疼痛之成效並未達一致性，但在冰敷執行後，會確定皮膚溫度達13℃時才移除冰袋、或冰敷時間為20分鐘之研究中，其結果支持冰敷能有效減輕移除胸管後即刻的疼痛程度，且延後使用止痛藥的時間；而其中兩篇研究在各組措施介入前1小時會先予止痛藥使用，結果顯示合併藥物與冰敷措施對緩解疼痛之成效顯著優於僅使用藥物者。結論　研究結果可作為移除胸管過程的疼痛管理，未來仍應繼續執行嚴謹、盲化、大規模的隨機控制試驗，以驗證並更新此實證結果。

Background: Several previous studies have investigated the effectiveness of cold applications for pain associated with chest tube removal (CTR). However, the results of these studies are mutually contradictory. Purpose: The aim of this study was to determine the evidence related to the effectiveness of using a cold application to reduce the pain associated with CTR. Methods: This review focused on studies published before June 2014 that were indexed in the following databases: Cochrane Library, PubMed, MEDLINE, CINAHL, ProQuest, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan. Keywords that were searched included: chest tube removal, cold application, and pain within a search design based on the PICO (patient, intervention, comparion, outcome) structure. Only randomized controlled trials (RCTs) that evaluated the efficacy of cold application in patients before CTR were included in analysis. Study quality was assessed using the Modified Jadad scale. Results: Five RCTs that enrolled a total of 426 patients were included in the analysis. The mean age of participants ranged from 48.7 (SD=16.5) to 60.2 (SD=6.2) years. Ice packs were most widely used and applied to an area approximately 5-15 cm in diameter, with the chest tube entry point at the center. The findings of the effectiveness of the cold application were inconsistent among the studies. The researchers terminated the cold application when patients' skin temperature reached 13℃ or after 20 min, which showed that the cold application immediately reduced the pain associated with CTR. It was also observed that the cold application prolonged the duration of time between the CTR and the administration of analgesics. Additionally, two studies in which analgesics were administered to participants 60 min before CTR showed that cold application in combination with analgesics administration reduced patient pain due to the enhancement affects of CTR, which obtained results that were better than analgesics administration alone. Conclusion: The results of this study may be used as a reference for reducing pain associated with CTR in clinical practice. However, further studies with larger sample sizes are required to support these results.