Li Adrienne L K, Gomez Manuel, Fish Joel S
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Burn Care Res. 2010 Jan-Feb;31(1):73-82. doi: 10.1097/BCR.0b013e3181cb8e94.
The purpose of this study was to evaluate the effectiveness of pain management after electrical injury. A retrospective hospital chart review was conducted among electrically injured patients discharged from the outpatient burn clinic of a rehabilitation hospital (July 1, 1999, to July 31, 2008). Demographic data, numeric pain ratings (NPRs) at initial assessment and discharge, medications, nonpharmacologic modalities, and their effects before admission and after rehabilitation were collected. Pain management effects were compared between high (> or =1000 v) and low (<1000 v) voltage, and between electrical contact and electrical flash patients, using Student's t-test and chi, with a P < .05 considered significant. Of 82 electrical patients discharged during the study period, 27 were excluded because of incomplete data, leaving 55 patients who had a mean age +/-SD of 40.7 +/- 11.3 years, TBSA of 19.2 +/- 22.7%, and treatment duration of 16.5 +/- 15.7 months. The majority were men (90.9%), most injuries occurred at work (98.2%), mainly caused by low voltage (n = 32, 58.2%), and the rest caused by high voltage (n = 18, 32.7%). Electrical contact was more common (54.5%) than electrical flash (45.5%). Pain was a chief complaint (92.7%), and hands were the most affected (61.8%), followed by head and neck (38.2%), shoulders (38.2%), and back torso (38.2%). Before rehabilitation, the most common medication were opioids (61.8%), relieving pain in 82.4%, followed by acetaminophen (47.3%) alleviating pain in 84.6%. Heat treatment was the most common nonpharmacologic modality (20.0%) relieving pain in 81.8%, followed by massage therapy (14.5%) alleviating pain in 75.0%. During the rehabilitation program, antidepressants were the most common medication (74.5%), relieving pain in 22.0%, followed by nonsteroidal antiinflammatory drugs (61.8%), alleviating pain in 70.6%. Massage therapy was the most common nonpharmacologic modality (60.0%), alleviating pain in 75.8%, and then cognitive behavioral therapy (54.5%), alleviating pain in 40.0%. There were pain improvements in all anatomic locations after rehabilitation except for the back torso, where pain increased 0.7 +/- 2.9 points. Opioids were more commonly used in high voltage (P < .05), and cognitive behavioral therapy in low-voltage injuries (P < .05). Opioids were used in both electrical flash and electrical contact injuries. Pain in electrically injured patients remains an important issue and should continue to be addressed in a multimodal way. It is hoped that this study will guide us to design future interventions for pain control after electrical injury.
本研究的目的是评估电损伤后疼痛管理的效果。对一家康复医院门诊烧伤科出院的电损伤患者（1999年7月1日至2008年7月31日）进行了回顾性病历审查。收集了人口统计学数据、初始评估和出院时的数字疼痛评分（NPRs）、药物、非药物治疗方式及其入院前和康复后的效果。使用Student's t检验和卡方检验比较高电压（≥1000伏）和低电压（<1000伏）以及电接触和电弧烧伤患者之间的疼痛管理效果，P<0.05被认为具有统计学意义。在研究期间出院的82例电损伤患者中，27例因数据不完整被排除，剩下55例患者，其平均年龄±标准差为40.7±11.3岁，烧伤总面积为19.2±22.7%，治疗时间为16.5±15.7个月。大多数为男性（90.9%），大多数损伤发生在工作中（98.2%），主要由低电压引起（n = 32，58.2%），其余由高电压引起（n = 18，32.7%）。电接触比电弧烧伤更常见（54.5%对45.5%）。疼痛是主要主诉（92.7%），手部受影响最严重（61.8%），其次是头颈部（38.2%）、肩部（38.2%）和背部躯干（38.2%）。康复前，最常用的药物是阿片类药物（61.8%），82.4%的患者疼痛得到缓解，其次是对乙酰氨基酚（47.3%），84.6%的患者疼痛得到缓解。热疗是最常见的非药物治疗方式（20.0%），81.8%的患者疼痛得到缓解，其次是按摩疗法（14.5%），75.0%的患者疼痛得到缓解。在康复计划期间，抗抑郁药是最常用的药物（74.5%），22.0%的患者疼痛得到缓解，其次是非甾体抗炎药（61.8%），70.6%的患者疼痛得到缓解。按摩疗法是最常见的非药物治疗方式（60.0%），75.8%的患者疼痛得到缓解，然后是认知行为疗法（54.5%），40.0%的患者疼痛得到缓解。除背部躯干疼痛增加0.7±2.9分之外，康复后所有解剖部位的疼痛均有改善。阿片类药物在高电压损伤中更常用（P<0.05），认知行为疗法在低电压损伤中更常用（P<0.05）。阿片类药物在电弧烧伤和电接触损伤中均有使用。电损伤患者的疼痛仍然是一个重要问题，应继续采用多模式方法进行处理。希望本研究将指导我们设计未来电损伤后疼痛控制的干预措施。
