| Objective Discomfort like pain after endoscopic sinus surgery(ESS)was the main problem patients with chronic rhinosinusitis(CRS)faced during nasal packing period.The best nursing program was selected by comparing the effect of different nursing programs in the perioperative period and then the satisfaction and pain control of patients receiving the best program were analyzed,to provide evidence support and improvement suggestions for perioperative nursing of CRS patients.Methods This study was divided into two parts:(1)Comparison of the effect of perioperative nursing program for patients with chronic sinusitis: Databases including China biology medicine(CBM),China National Knowledge Infrastructure(CNKI),Wanfang database(WF),websites were systematically searched and the references were traced to obtain the randomized controlled trials(RCTs)related to the perioperative nursing of ESS in China.The RCTs were screened according to the predefined inclusion and exclusion criteria,and the quality of the included studies was evaluated by the Cochrane bias risk assessment tool.The adjusted indirect comparison was conducted by Stata 13.0 software to analyze patients' pain score,anxiety score,depression score and complication rate;(2)Investigation of pain control and satisfaction of patients after endoscopic sinus surgery: A cross-sectional study was conducted to investigate the postoperative pain and satisfaction in CRS patients by Houston pain outcome instrument(HPOI),and SPSS 26.0 was used for single factor analysis and multiple linear stepwise regression analysis.Results(1)Comparison of the effect of perioperative nursing program for patients with chronic sinusitis: 65 RCTs with high risk of bias in the whole level related to perioperative nursing of patients with CRS were included.13 RCTs reported patients' pain scores and the pain scores of patients receiving traditional nursing combined with psychological nursing +preoperative behavior training +cold compress were lower than that of patients receiving traditional nursing combined with psychological nursing(MD=-2.28,95%CI:-3.65~-0.92,p < 0.05),preoperative behavior training(MD=-1.15,95%CI:-2.04~-0.26,p<0.05),psychological nursing + preoperative behavior training(MD=-2.36,95%CI:-3.46~-1.26,p < 0.05)or psychological nursing +cold compress(MD=-1.52,95%CI:-2.32~-0.71,p<0.05)with statistical significance.24 RCTs reported the patients' anxiety scores and the anxiety scores of patients receiving traditional nursing combined with preoperative behavior training were lower than that of patients receiving traditional nursing combined with psychological nursing(MD=-16.57,95%CI:-20.08~-13.05,p<0.05),cold compress(MD=-20.70,95%CI:-23.90~-17.49,p<0.05),psychological nursing +preoperative behavior training(MD=-20.80,95%CI:-24.05~-17.54,p < 0.05),psychological nursing +cold compress(MD=-20.90,95%CI:-24.10~-17.69,p<0.05),psychological nursing +preoperative behavior training + cold compress(MD=-13.55,95%CI:-21.67~-5.42,p<0.05)or psychological nursing +cold compress +oxygen inhalation(MD=-20.28,95%CI:-23.49~-17.08,p<0.05)with statistical significance.11 RCTs reported the patients' depression scores and the depression scores of patients receiving traditional nursing combined with psychological nursing were lower than that of patients receiving traditional nursing combined with cold compress(MD=-3.46,95%CI:-6.15~-0.76,p<0.05),psychological nursing +cold compress(MD=-3.44,95%CI:-6.14~-0.73,p<0.05)or psychological nursing +cold compress +oxygen inhalation(MD=-3.29,95%CI:-5.98~-0.59,p<0.05)with statistical significance.42 RCTs reported the incidence of postoperative complications and there was no statistical difference in patients receiving traditional nursing combined with psychological nursing,psychological nursing +preoperative behavior training,psychological nursing +cold compress,psychological nursing +preoperative behavior training +cold compress,psychological nursing +cold compress +oxygen inhalation,psychological nursing +preoperative behavior training +cold compress +oxygen inhalation +atomization,psychological nursing +preventive analgesia,psychological nursing +cold compress +preventive analgesia or psychological nursing +cold compress +atomization.(2)Investigation of pain control and satisfaction of patients after endoscopic sinus surgery: The current pain score,the strongest pain score in the past 24 hours and the general pain score were 3.14±0.98,5.41±1.58 and 4.24±1.28,respectively,and the impact of postoperative pain on patients' mood,body and daily life was moderate.The average score of pain control and pain education was higher than five scores,except the average score of patients for side effects of painkillers,and the overall satisfaction score was 6.19±1.06.There were significant differences in the three scores of pain experience among patients whether receiving patient controlled intravenous analgesia(PACI)and that who using different packing materials,and there was a negative correlation between the pain experience of patients and the using of PACI and Nasopore.Conclusion(1)Psychological nursing,preoperative behavior training and cold compress should be the routine nursing measures of CRS patients in the perioperative period.The effects of oxygen inhalation,preventive analgesia and atomization in patients with nasal packing need further study.(2)The existing measures need to be further improved to improve the effect of pain control.Patients satisfaction on pain control and pain education was slightly high but the education of side effects of painkillers should be strengthened.The hierarchical management of pain was suggested because there are differences in the pain degree of patients with different nasal packings,and drug analgesia on the first day after operation was also suggested because of the clear effect of PACI on pain control. |
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