Sanders Caroline, Young Andrea, McAndrew Helen F, Kenny Simon E
Department of Paediatric Urology, Royal Liverpool Children's NHS Trust (Alder Hey), Eaton Rd, Liverpool L12 2AP, UK.
J Pediatr Urol. 2007 Jun;3(3):209-13. doi: 10.1016/j.jpurol.2006.08.006. Epub 2006 Dec 12.
To determine whether the use of a novel dressing removal technique resulted in shorter removal times, reduced the child's experience of pain and/or reduced parental anxiety when compared to a standard approach.
This prospective unblinded randomized controlled trial of 53 consecutive boys undergoing primary hypospadias repair was powered using data from a prior feasibility study. Children were randomized to a standard control dressing (A) or standard dressing plus Cavilontrade mark (B) group. Removal was by (A) soaking the child and dressing in the bath or (B) application of an adhesive remover to the dressing. The primary outcome measure was dressing removal time. Secondary measures were: child pain scores on a visual analogue scale measured by the parent and nurse, and parental anxiety using the self-evaluative state anxiety measure. Data are expressed as median (range); P<0.05 is significant.
Dressing B was significantly quicker to remove than A: B 30 min (5-86 min) vs A 40 min (17-105 min), P=0.01, Mann-Whitney. No differences in parent/nurse pain scores between the two groups were seen. There was a strong correlation between parent and nurse reporting of pain scores at the time of dressing removal (Spearman 0.79, P<0.000). No significant differences in pre- and post-dressing removal parental anxiety scores were seen (P=0.159, Mann-Whitney). Several parents had high anxiety levels at both times.
The novel dressing removal approach (B) was significantly shorter than the standard one (A). There were no significant differences in child's pain or parental anxiety score between the two approaches.
与标准方法相比，确定使用一种新型敷料拆除技术是否能缩短拆除时间、减轻儿童的疼痛体验和/或减轻家长的焦虑。
这项前瞻性非盲随机对照试验纳入了53名连续接受原发性尿道下裂修复术的男孩，其样本量依据先前可行性研究的数据确定。儿童被随机分为标准对照敷料组（A）或标准敷料加皮肤保护膜（Cavilon）组（B）。拆除方法为：（A）让孩子泡在浴缸里使敷料浸湿后拆除，或（B）在敷料上涂抹粘合剂去除剂后拆除。主要结局指标是敷料拆除时间。次要指标包括：家长和护士用视觉模拟量表测量的儿童疼痛评分，以及用自我评估状态焦虑量表测量的家长焦虑程度。数据以中位数（范围）表示；P<0.05具有统计学意义。
敷料B的拆除速度明显快于A：B组为30分钟（5 - 86分钟），A组为40分钟（17 - 105分钟），P = 0.01，曼-惠特尼检验。两组家长/护士的疼痛评分没有差异。在拆除敷料时，家长和护士报告的疼痛评分之间存在很强的相关性（斯皮尔曼相关系数0.79，P<0.000）。拆除敷料前后家长的焦虑评分没有显著差异（P = 0.159，曼-惠特尼检验）。有几位家长在两个时间点的焦虑水平都很高。
新型敷料拆除方法（B）明显比标准方法（A）用时短。两种方法在儿童疼痛或家长焦虑评分方面没有显著差异。
