患者性别对辅助医务人员疼痛管理方法的影响:快速回顾

Sooaad Dahoud, Paul Simpson, Navindhra Naidoo
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摘要

客观疼痛是一种主观的多维体验,会影响个人的身体、情绪和心理健康。无论是在紧急情况下还是非紧急情况下,都会经常联系辅助医务人员来缓解疼痛。病人的表现、评估工具和临床判断共同影响着辅助医务人员的决策,因此疼痛管理方法也不可避免地会有所不同。本研究旨在确定文献中与辅助医务人员疼痛管理相关的性别差异的性质和描述。研究方法采用 Cochrane 快速综述方法,于 2023 年 11 月 8 日对五个电子数据库和九种辅助医务人员专用期刊进行了检索。纳入的文章必须具备以下条件:调查救护车上的疼痛症状;分析药物镇痛管理;比较不同性别的管理方法;报告药物类型、剂量、用药时间或疼痛评分。对符合条件的文章进行了偏倚风险评估,并进行了叙述性综合。结果:在系统检索过程中,共发现了 2545 篇文章,最终有 13 项研究符合纳入条件。七项研究表明,在控制了混杂因素后,镇痛药物的使用存在性别差异,据统计,女性接受镇痛药物(尤其是阿片类药物)的可能性低于男性。五项研究发现,性别对镇痛剂的使用没有影响。一项研究指出,女性护理人员提供的镇痛总体效果更好,而两项研究则发现护理人员的性别对镇痛决定没有影响。五项研究表明,疼痛评分越高,使用镇痛剂的可能性就越大,其中三项研究强调所提供的镇痛剂能有效降低疼痛评分。结论:虽然一些研究发现辅助医务人员在疼痛管理方面没有性别差异,但更多的研究表明存在性别差异,其中发现女性使用低剂量镇痛的风险更高。文献显示,理想的疼痛管理方法是疼痛评分越高,镇痛率越高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influence of patient sex on pain management practices in Paramedicine: A rapid review
Objective: Pain is a subjective multidimensional experience that impacts an individual's physical, emotional, and mental wellbeing. Paramedics are regularly contacted to alleviate pain, in both an emergency and non-emergency capacity. Patient presentation, assessment tools, and clinical judgement, together influence paramedic decision making, and therefore pain management practices will inevitably vary. This research aimed to identify the nature and description of sex-specific discrepancies in the literature in relation to paramedic pain management. Methods: Using the Cochrane rapid review methodology, a search of five electronic databases and nine paramedic-specific journals was conducted on 8 November 2023. Articles were included if they: investigated ambulance presentations of pain; analysed pharmacological analgesic management; compared management between the sexes; and reported on either medication type, dosage, time to administration, or pain score. Eligible articles were assessed for risk of bias and subjected to narrative synthesis. Results: A total of 2545 articles were identified during the systematic search, resulting in 13 studies eligible for inclusion. Seven studies indicated a sex disparity in the administration of analgesia after controlling for confounders, with females statistically less likely to receive analgesia, particularly opioids, compared to males. Five studies found that sex had no effect on analgesic administration. One study noted female paramedics provided better analgesia overall, while two studies found paramedic sex had no influence on analgesic decisions. Five studies indicated that the higher the pain score, the greater the likelihood of analgesic administration, with three studies highlighting that the analgesia provided was effective in reducing pain score. Conclusions: While some studies identified no sex-specific differences in relation to paramedic pain management, a greater number of studies indicated a gender-disparity, where females were found to have higher risk of oligo-analgesia. Ideal pain management practices were demonstrated in the literature, with higher pain scores correlating to increased rates of analgesia.
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