Jacobson R M, Swan A, Adegbenro A, Ludington S L, Wollan P C, Poland G A
Department of Pediatric and Adolescent Medicine, Mayo ClinicRochester, MN 55905, USA.
Vaccine. 2001 Mar 21;19(17-19):2418-27. doi: 10.1016/s0264-410x(00)00466-7.
The growing abundance of highly immunogenic vaccines has arrived with a burden of pain, distress, and common adverse reactions that in turn may interfere with parental compliance and aggravate anti-vaccine sentiment. In a study of 150 children in each of 2 age-groups, we found that approximately 20% of the subjects suffered serious distress or worse. During the procedural phase, approximately 90% of the 15-to-18 month old children and 45% of the 4-to-6 year old children showed serious distress or worse. To address non-adherence with pediatric vaccine schedules, we must consider all of the possible issues that might prevent a parent from taking a child to a health care provider for vaccination. In that same study we identified useful predictors for both preparatory and procedural distress - predictors that might be used in identifying children who might benefit from preventive interventions. Vaccine providers might consider a variety of interventions. Attitude, empathy, instruction, and practice have all been shown to have a salutatory effect upon pain and anxiety with medical procedures in general and specifically with vaccinations. Distraction has also been found to be an effective method for distress and pain prevention in children. More formal methods of clinical hypnosis which combine a deep state of relaxation with focused imagery and suggestion have also been found to be effective in helping children and adolescents prepare for, cope with, and tolerate the pain and anxiety associated with medical procedures. So-called 'sugar nipples' delivering small amounts of sucrose orally at the time of a painful procedure in an infant has been not been shown to decrease vaccination pain and studies on refrigerant topical anesthetics are mixed. Studies have found a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA) effective in providing adequate local anesthesia in children, but it suffers from problems in practical application. Studies with various injection techniques have not identified ready solutions, and although jet injection appears to provoke less anxiety and cause less immediate pain, studies also indicate a somewhat greater incidence of delayed local reactogenicity including soreness and edema. Other measures to prevent or rapidly treat other common adverse events have been shown effective and should be considered as well.
越来越多高免疫原性疫苗的出现伴随着疼痛、不适和常见不良反应的负担，这些反过来可能会干扰家长的依从性，并加剧反疫苗情绪。在一项针对两个年龄组各150名儿童的研究中，我们发现约20%的受试者遭受严重不适或更糟的情况。在操作阶段，15至18个月大的儿童中约90%以及4至6岁的儿童中约45%表现出严重不适或更糟的情况。为了解决不遵守儿童疫苗接种计划的问题，我们必须考虑所有可能阻止家长带孩子去医疗保健机构接种疫苗的问题。在同一研究中，我们确定了准备阶段和操作阶段不适的有用预测因素——这些预测因素可用于识别可能从预防性干预中受益的儿童。疫苗接种人员可以考虑多种干预措施。态度、同理心、指导和练习总体上对医疗程序尤其是疫苗接种过程中的疼痛和焦虑都显示出有益效果。分散注意力也被发现是预防儿童不适和疼痛的有效方法。更正式的临床催眠方法，即将深度放松状态与专注的意象和暗示相结合，也被发现能有效帮助儿童和青少年为医疗程序做准备、应对并耐受与之相关的疼痛和焦虑。在婴儿进行痛苦操作时口服少量蔗糖的所谓“糖奶嘴”并未被证明能减轻疫苗接种疼痛，关于冷冻局部麻醉剂的研究结果不一。研究发现2.5%利多卡因和2.5%丙胺卡因的共晶混合物（EMLA）能有效为儿童提供足够的局部麻醉，但在实际应用中存在问题。各种注射技术的研究尚未找到现成的解决方案，尽管喷射注射似乎引起的焦虑较少且即时疼痛较轻，但研究也表明延迟局部反应原性（包括酸痛和水肿）的发生率略高。预防或快速治疗其他常见不良事件的其他措施已被证明有效，也应予以考虑。
