儿科急诊科使用鼻内镇痛治疗急性疼痛：随机对照试验的系统综述与荟萃分析。
完整摘要 · 中文译文
背景：疼痛是儿科急诊就诊最常见的原因之一，但及时有效的镇痛仍未能持续落实。鼻内（IN）镇痛药为注射途径提供了一种无创替代方案，但不同药物之间以及不同给药途径之间的相对有效性、安全性和可接受性仍未完全明确。 方法：我们开展了一项系统评价和网络荟萃分析，纳入评估鼻内镇痛药用于急诊或院前环境中0-18岁儿童急性疼痛管理的随机对照试验。符合条件的研究将鼻内药物与其他鼻内制剂、静脉注射、肌内注射、口服镇痛药或安慰剂进行比较。主要结局为在预设时间点使用经过验证的儿科疼痛量表测量的疼痛减轻程度。次要结局包括需要补救镇痛、不良事件、可接受性以及急诊科停留时间。 结果：共纳入15项随机对照试验，涉及1388例儿科患者。在所有评估的时间点（包括主要结局以及10、15、20、30和60分钟时的评估）中，与鼻内芬太尼相比，没有任何鼻内或静脉镇痛药在疼痛减轻方面显示出统计学上的优效性。不同治疗之间的补救镇痛需求同样相当。与标准剂量鼻内芬太尼相比，鼻内氯胺酮的不良事件风险显著更高，但事件大多为轻度和一过性。患者、照护者和医务人员对鼻内给药的可接受性总体较高。 在药物方面，现有数据表明急诊科停留时间没有临床意义的差异。
完整摘要 · 英文原文
BACKGROUND: Pain is one of the most common reasons for presentation to pediatric emergency departments, yet timely and effective analgesia remains inconsistently delivered. Intranasal (IN) analgesics offer a noninvasive alternative to injectable routes, but their comparative effectiveness, safety, and acceptability across agents and routes remain incompletely defined. METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0-18 years presenting to emergency or prehospital settings. Eligible trials compared IN agents with alternative IN formulations, intravenous, intramuscular, oral analgesics, or placebo. Pain reduction measured using validated pediatric pain scales at predefined timepoints was the primary outcome. Secondary outcomes included need for rescue analgesia, adverse events, acceptability, and emergency department length of stay. FINDINGS: Fifteen randomized controlled trials involving 1388 pediatric patients were included. Across all evaluated timepoints, including the primary outcome and assessments at 10, 15, 20, 30, and 60 min, no IN or intravenous analgesic demonstrated statistically superior pain reduction compared with IN fentanyl. Requirements for rescue analgesia were similarly comparable across treatments. IN ketamine was associated with a significantly higher risk of adverse events compared with standard-dose IN fentanyl, although events were predominantly mild and transient. Acceptability among patients, caregivers, and providers was high across IN agents, and available data indicated no clinically meaningful differences in emergency department length of stay.