有效减轻儿童静脉穿刺时的焦虑和疼痛：氧化亚氮、复方利多卡因乳膏及联合使用的镇痛效果比较

Effective reduction of anxiety and pain during venous cannulation in children: a comparison of analgesic efficacy conferred by nitrous oxide, EMLA and combination.

作者信息

Hee Hwan-Ing, Goy Raymond W L, Ng Agnes Suah-Bwee

机构信息

Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.

出版信息

Paediatr Anaesth. 2003 Mar;13(3):210-6. doi: 10.1046/j.1460-9592.2003.01051.x.

DOI:10.1046/j.1460-9592.2003.01051.x

PMID:12641682

Abstract

BACKGROUND

EMLA cream is the current technique of choice to reduce pain during venous cannulation in most paediatric practice. Its use is limited by logistic arrangements and failure to improve cooperation and allay anxiety. Nitrous oxide (N2O) would appear to be an effective alternative. A combination technique may be useful in selected patients.

METHODS

One hundred and twenty unpremedicated ASA 1 and 2 day surgery patients, aged 8-15 years were randomized into group 1 (EMLA + air/O2), group 2 (50% N2O/50% O2) and group 3 (EMLA + 50% N2O/50% O2). All patients underwent cannulation on the dorsum of the hand with a 22-G intravenous catheter. Pain behaviour before cannulation was assessed by an observer with Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Pain during cannulation was evaluated with CHEOPS by an observer and Visual Analogue Scale (VAS) (0-100 mm) by the patient. Satisfaction score (0-100%) for the experience were reported by the patient. Degree of ease of cannulation, time for cannulation were assessed. Heart rate, oxygen saturation were compared before, during and after cannulation.

RESULTS

The self-reported VAS for group 3 (10.10 +/- 14.99) was significantly lower than group 1 (26.13 +/- 27.59) and group 2 (18.35 +/- 18.11) (P = 0.003). No significant difference existed between VAS for group 1 and 2. There were also significantly more patients with VAS = 0 in group 3 (23/40) versus group 2 (11/40) versus group 1 (10/40), P = 0.004. The satisfactory score in group 3 (93 +/- 9.96) was significantly higher (P = 0.039) than group 1 (81.13 +/- 24.61) and group 2 (84 +/- 22.02). The increase in CHEOPS from before to during cannulation was significant only in group 1 (P = 0.002). There was no significant difference between frequency of patients with side-effects, ease of cannulation and time taken for cannulation in the three groups.

CONCLUSIONS

EMLA and 50% N2O are equally effective for pain reduction while a combination technique provides superior analgesia and satisfaction. N2O has an advantage over EMLA in reduction of pain related behaviour in older children.

摘要

背景

在大多数儿科实践中，EMLA乳膏是目前用于减轻静脉穿刺疼痛的首选技术。其使用受到后勤安排的限制，且未能提高患儿的配合度和减轻焦虑。氧化亚氮（N2O）似乎是一种有效的替代方法。联合技术可能对特定患者有用。

方法

120例未接受术前用药的8至15岁ASA 1级和2级日间手术患者被随机分为1组（EMLA+空气/O2）、2组（50% N2O/50% O2）和3组（EMLA+50% N2O/50% O2）。所有患者均使用22G静脉导管在手背进行穿刺。穿刺前的疼痛行为由观察者使用安大略东部儿童医院疼痛量表（CHEOPS）进行评估。穿刺期间的疼痛由观察者使用CHEOPS评估，患者使用视觉模拟量表（VAS，0 - 100mm）评估。患者报告对该体验的满意度评分（0 - 100%）。评估穿刺的难易程度、穿刺时间。比较穿刺前、穿刺期间和穿刺后的心率、血氧饱和度。

结果

3组患者自我报告的VAS评分（10.10±14.99）显著低于1组（26.13±27.59）和2组（18.35±18.11）（P = 0.003）。1组和2组的VAS评分无显著差异。3组中VAS = 0的患者也显著多于2组（11/40）和1组（10/40），分别为23/40，P = 0.004。3组的满意度评分（93±9.96）显著高于1组（81.13±24.61）和2组（84±22.02）（P = 0.039）。仅1组穿刺期间CHEOPS评分较穿刺前增加显著（P = 0.002）。三组患者副作用发生频率、穿刺难易程度和穿刺所需时间无显著差异。