Efficacy of predictive pain intervention in patients with aortic dissection

Abstract

BACKGROUND:

Aortic dissection is usually managed with interventional therapy, conservative therapy, and surgery to inhibit disease progression and improve prognoses. Nevertheless, the absence of meticulous and effective nursing during the treatment greatly increases the complication rates, which is detrimental to the recovery of patients.

OBJECTIVE:

This study aimed to explore the efficacy of predictive pain intervention in the nursing process of patients with aortic dissection.

METHODS:

Sixty patients with aortic dissection who were admitted to our hospital from December 2018 to December 2020 were observed in this study. Specifically, these patients were randomly and equally classified into Group A (patients who were given conventional nursing intervention) and Group B (patients who were given predictive pain intervention). Subsequently, the pain score, complication rates, and nursing satisfaction in the two groups were compared and analyzed.

RESULTS:

Compared with patients in Group A, patients in Group B had significantly lower pain scores ( $P<$ 0.05); complication rates were significantly lower in Group B than in Group A (6.67% vs. 23.33%, $P<$ 0.05); patient satisfaction with care was significantly better in Group B compared to Group A (96.67% vs. 73.33%, $P<$ 0.05).

CONCLUSION:

Predictive pain intervention is widely recognized as useful in the treatment of patients with aortic dissection. It has significant clinical application value as it can largely alleviate pain and is relatively safe for patients.

Keywords

Aortic dissection efficacy predictive pain intervention

1. Introduction

Aortic dissection is a common clinical vascular condition characterized by aortic compression induced by hematoma and sudden, severe pain and shock. Aortic dissection at the acute stage may be complicated by cardiac tamponade, arrhythmia, and dissection rupture, which can severely threaten the lives of patients [1]. Aortic dissection is usually managed with interventional therapy, conservative therapy, and surgery to inhibit disease progression and improve prognoses. Nevertheless, the absence of meticulous and effective nursing during the treatment greatly increases the complication rates, which is detrimental to the recovery of patients. Therefore, a more meticulous and effective nursing approach is warranted in clinical practice. Predictive pain intervention is an advanced, specialized nursing mode that is always patient-centered, providing comprehensive, humanized, and personalized nursing services to reduce pain and complication rates and accelerate recovery in patients [2]. In this paper, we primarily explore the efficacy of predictive pain intervention in the nursing process for patients with aortic dissection.

2. Materials and methods

2.1 Clinical information

In this study, 60 patients with aortic dissection who were admitted to our hospital from December 2018 to December 2020 were enrolled and randomly and equally classified into two groups – Group A (patients who were given conventional nursing intervention) and Group B (patients who were given predictive pain intervention).

Inclusion criteria were as follows: all patients diagnosed with aortic dissection by computerized tomography examination who met the diagnostic requirements for aortic dissection.

The exclusion criteria were summarized as follows: patients with severe dysfunction of the liver, kidney, heart, and other organs; patients with speech disorders or the inability to take care of oneself; patients with mental or psychological disorders; patients recently treated with other methods.

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Nantong First Peoples’ Hospital. Written informed consent was obtained from all participants.

2.2 Methods

All patients receive both open and endovascular treatment. Patients in Group A received conventional nursing interventions. Specifically, the nursing staff gave patients drugs strictly in accordance with the orders of doctors and used a scientific and effective intervention method to stabilize the condition of patients within a short time and relieve their pain. They also closely observed the complaints and vital signs of patients. At the same time, nursing staff preoperatively explained to patients about the disease, treatment method, and precautions in detail to enable patients to prepare for surgery [3].

Patients in Group B were given a predictive pain intervention.

The details of the treatment are as follows:

(1)
A pain intervention was conducted. In detail, the nursing staff strengthened communication with patients, provided them with comprehensive care, closely observed their vital signs and changes in condition, recorded their complaints, and collected information on their medical history. In addition, they also clarified whether the patients were in pain, analyzed the cause of the pain, and then informed the responsible doctor of the detailed situation of the patients so that the doctor could recommend effective treatment. Since patients with acute aortic dissection often show signs of shock such as profuse sweating, a weak pulse, and facial pallor, nursing staff must closely observe the location, nature, duration, and degree of pain and then give patients strong analgesics for treatment [4]. In general, if the surgical wounds of the patients were normal, analgesics were given as prescribed by the doctor, including intramuscular morphine, intravenous ketorolac tromethamine, and intravenous analgesic pumps. During this process, nursing staff closely observed for any adverse reactions in patients after medication, as well as accurately evaluated and carefully recorded the analgesic effect of the administered medicine. Then, the nursing staff informed the doctor immediately in case of any incidents. If the pain of patients expanded or increased, they informed the doctor immediately so that effective medication may immediately be prescribed for analgesia.
(2)
The details of the predictive pain intervention are as follows: the nursing staff carefully observed the vital signs of patients and closely monitored their blood pressure and electrocardiogram. If their blood pressure was abnormally high, vasodilators were utilized to rapidly lower blood pressure. For instance, nitroglycerin was first administered by a micro-pump with a combination of nicardipine or urapidil if the effect was not obvious, and then the dose was reasonably adjusted based on the blood pressure response of patients to ensure that systolic blood pressure was always maintained between 100 and 120 mmHg and diastolic blood pressure between 60 and 80 mmHg. During this process, nursing staff closely observed the degree and rate of change in the blood pressure of patients and immediately informed the doctor if the blood pressure decreased continuously [5].
(3)
The details of the conventional nursing intervention are as follows: nursing staff skillfully observed and discovered different characteristics of various types of patients and developed personalized and targeted nursing programs in combination with the different nursing needs of patients; they maintained a pleasant demeanor toward patients and provided them with sufficient care. Additionally, they used verbal and video-based learning [6] to enable patients to understand the disease and treatment method more comprehensively and addressed the adverse emotions of patients, including nervousness and anxiety, through music, meditation, and other methods to increase their enthusiasm for treatment. At the same time, the nursing staff appropriately modified the dietary structure of patients as per their specific situation. For example, patients with acute aortic dissection were provided liquid food instead of solid food until seven days after surgery and maintained a balanced diet of three meals with adequate intake of dietary fiber and sufficient water to ensure smooth defecation and avoid triggering of pain. All patients received the same ICU care and blood pressure control.

2.3 Effectiveness evaluation

The pain scores of patients were observed. Specifically, the pain of patients before and after the intervention was determined using a visual analog scale scoring system with a total of 10 points, where lower scores indicated less pain. The complication rates were analyzed; that is, the complications that occurred during the treatment were recorded in detail. The nursing satisfaction of patients was evaluated, and “satisfied,” “basically satisfied,” and “dissatisfied” were used as the basis of judgment, with a total of 100 points – a score of over 80 indicated the patients were satisfied, 60 to 80 indicated they were basically satisfied, and less than 60 indicated they were dissatisfied.

2.4 Statistical analysis

The data obtained were processed using SPPS 20.0 statistical software; the count data are expressed as percentages (%) and the measurement data are summarized as mean $\pm$ standard deviation ( $\bar{x}\pm s$ ). The measurement data were compared by Student’s $t$ -test. Chi-squared or Fisher’s exact test was used for count data. $P<$ 0.05 represented a statistically significant difference.

3. Results

3.1 Patients demographic

Patients in Group A included 20 males and 10 females and were aged from 45 to 75 years (a mean age of [54 $\pm$ 3.28] years), with a duration from onset to admission of 22–60 min (a mean duration of [36 $\pm$ 8.87] min). In addition, there were 8 cases of abdominal aortic dissection, 10 cases of ascending aortic dissection, and 12 cases of mid-thoracic aortic dissection. In Group B, there were 20 males and 10 females, including 9 cases of abdominal aortic dissection, 10 cases of ascending aortic dissection, and 11 cases of mid-thoracic aortic dissection. Additionally, patients in this group were aged 45–75 years (a mean age of [53 $\pm$ 3.19] years), with a duration from onset to admission of 21–60 min (a mean duration of [35 $\pm$ 8.72] min). These data were not different between the two groups ( $P>$ 0.05) (Table 1).

Table 1
Demographics of patients

	Group A ( $n=$ 30)	Group B ( $n=$ 30)	$P$
Gender			$>$ 0.05
Female	10	20
Male	20	10
Age (years)	54 $\pm$ 3.28	53 $\pm$ 3.19	$>$ 0.05
Duration from onset to admission (min)	36 $\pm$ 8.87	35 $\pm$ 8.72	$>$ 0.05
Surgical methods			$>$ 0.05
Abdominal aortic dissection	8	9
Ascending aortic dissection	10	10
Mid-thoracic aortic dissection	12	11

3.2 Comparison of the pain scores of patients between the two groups

The pain score of patients in Group A was (7.92 $\pm$ 2.19) before the intervention and (4.27 $\pm$ 0.20) after the intervention, and that of patients in Group B was (7.85 $\pm$ 2.03) before the intervention and (2.39 $\pm$ 0.94) after the intervention. No differences were found in the pre-intervention pain score of patients between the two groups. Conversely, the post-intervention pain score of patients in Group B was significantly lower than that of those in Group A ( $P<$ 0.05).

3.3 Complication rates in the two groups

After the corresponding nursing intervention, complication rates were significantly lower in Group B (6.67%) than in Group A (23.33%) ( $P<$ 0.05; Table 2).

Table 2
Comparison of complicates rates between the two groups ( $n$ /%)

Groups	Cases	Embolism	Hypertension	Pulmonary infection	Dissection rupture	Incidence (%)
Group A	30	1	2	2	2	23.33
Group B	30	0	1	1	0	6.67

Table 3

Comparison of nursing satisfaction between the two groups ( $n$ /%)

Groups	Cases	Satisfaction	Basic satisfaction	Dissatisfaction	Degree of satisfaction (%)
Group A	30	15	7	8	73.33
Group B	30	25	4	1	96.67

3.4 Nursing satisfaction in the two groups

After interventions, the level of nursing satisfaction in Group B (96.67%) was substantially higher as compared to that in Group A (73.33%) ( $P<$ 0.05; Table 3).

4. Discussion

The onset of an aortic dissection is precipitated by a sudden rip in the aortic wall’s inner layer, which is caused by a rupture of the middle-layer nutrient artery due to the impact of high-velocity blood flow in the middle layer of the aortic wall or by hematoma and high pressure due to the entry of blood into the middle layer. Dissecting hematomas, which can cause serious consequences including fainting or even heart failure, are formed when blood surges to the aortic wall from the aortic lumen through the rip. Aortic dissection is a devastating cardiovascular condition where the mortality rate directly correlates with the quality of care received. Aortic dissections can be further subdivided into categories A and B. Type A has a higher risk of dying initially, whereas type B has a better prognosis overall, however this might change depending on the presence or absence of complex conditions including organ ischemia or rupture, all of which can significantly increase morbidity [7]. Type A requires surgical intervention, but type B can be managed medically, despite its complexities [8, 9]. During the occurrence of aortic dissection, patients will have severe pain [10, 11], which will lead to patients’ anxiety, fear, depression and other adverse emotions, which have a great impact on the prognosis. Patients with aortic dissection have a better chance of recovery when they receive care from medical professionals that use cutting-edge diagnostic and therapeutic techniques. In addition, a clinical trial has shown that patients with aortic dissection can benefit greatly from predictive nursing intervention in therapy, as well as appropriate postoperative medicine and life advice [1]. In order to reduce pain and improve compliance with treatment, nurses must keep a close eye on their patients’ conditions in the clinic and use predictive awareness and early diagnosis to develop individualized and targeted nursing interventions. These interventions include providing patients with psychological nursing, health education, and dietary guidance [12].

The results of this study showed that after the corresponding nursing interventions, patients in Group B had significantly lower pain scores than those in Group A, accompanied by significantly lower complication rates (6.67% vs. 23.33%) and a substantially higher level of nursing satisfaction (96.67% vs. 73.33%) ( $P<$ 0.05).

The were some limitations in the present study. Not taking into account the subjective differences in the treatment of the two groups of patients by nursing staff may cause certain biases in the results. In addition, this study is a single center study with a small sample size, and further validation with larger sample sizes from multiple centers is needed in the future.

5. Conclusion

Patients with aortic dissection can benefit greatly from the incorporation of predictive pain intervention into the nursing process, as it can dramatically reduce pain, significantly reduce complication rates, boost nursing satisfaction, and speed up the healing process.

Footnotes

Conflict of interest

The authors declare that there are no conflicts of interest.

Funding

This study was supported by the Project of Nantong Science and Technology Bureau (No. JCZ20026).

References

Ruan

Shao

. Effect of predictive pain nursing in holistic nursing of aortic dissection. J Qiaihar Med Univ. 2019; 40(21): 2763-2764.

Cui

Liu

Yang

Jia

. Evidence based nursing intervention in perioperative period of aortic dissecting aneurysm. Chin J Cancer Prev Treat. 2018; 25(S2): 285-286.

Liang

. Evidence based nursing intervention in perioperative period of aortic dissecting aneurysm. J Clin Nurs Prac. 2017; 3(04): 133-135.

Song

. Evidence based nursing intervention in perioperative period of aortic dissecting aneurysm. Gems of Health. 2020; (28): 219.

. Effect of predictive pain intervention on aortic dissection. Journal of Mathematical Medicine. 2021; 34(02): 313-314.

Brucker-Kley

Kleinberger

Keller

Christen

Keller-Senn

Koppitz

. Identifying research gaps: A review of virtual patient education and self-management. Technol Health Care. 2021; 29(6): 1057-1069. doi: 10.3233/THC-202665. PMID: 33998564.

Sen

Erben

Franco-Mesa

DeMartino

. Epidemiology of aortic dissection. Semin Vasc Surg. 2021; 34(1): 10-17.

Erbel

Aboyans

Boileau

Bossone

Bartolomeo

Eggebrecht

Evangelista

Falk

Frank

Gaemperli

Grabenwöger

Haverich

Iung

Manolis

Meijboom

Nienaber

Roffi

Rousseau

Sechtem

Sirnes

Allmen

Vrints

. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur. Heart J. 2014; 35(41): 2873-2926.

Zhang

Peng

Luo

Che

Zheng

Anzai

Ohta

Shu

. Elongation of the proximal descending thoracic aorta and associated hemodynamics increase the risk of acute type B aortic dissection. Technol Health Care. 2023 Aug 3. doi: 10.3233/THC-230194. Epub ahead of print. PMID: 37545271.

10.

Dong

Sun

Cheng

Zhang

Shi

. Sudden aortic dissection: A cautionary tale for the unexplained back pain during bevacizumab treatment. Radiol Case Rep. 2023; 18(7): 2366-2369. doi: 10.1016/j.radcr.2023.03.055. PMID: 37179807; PMCID: PMC10172617.

11.

Kaufeld

Martens

Beckmann

Rudolph

Krüger

Natanov

Arar

Korte

Schilling