Wang Y Q, Huang J Q, Wu Z H, Chen J J
Department of Burns, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Shao Shang Za Zhi. 2021 Mar 20;37(3):237-242. doi: 10.3760/cma.j.cn501120-20200210-00048.
To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in children with burns. From November 2018 to December 2019, 196 children with burns who were admitted to West China Hospital of Sichuan University and met the inclusion criteria were enrolled in the prospective randomized controlled study. The children were divided into traditional pain management group (97 children, 51 males and 46 females, aged 1 to 6 years) and stepwise pain management group (96 children, 55 males and 41 females, aged 1 to 6 years) according to the random number table. Children in traditional pain management group were treated with traditional acute pain care, while the children in stepwise pain management group were treated with stepped acute pain management (moderate pain was treated with oral administration of acetaminophen sustained-release dry suspension at the dose of 10 to 15 mg/kg once every 4 to 6 hours, and severe pain was treated with morphine intravenous injection at the dose of 0.1 to 0.2 mg/kg once every 4 hours) on the basis of traditional acute pain care after admission. The COMFORT behavior scale was applied to compare the resting pain levels of children in the two groups within post injury day (PID) 3 (1, 9, and 17 o'clock each day). The adverse reactions of children in the stepwise pain management group during the treatment period were recorded. The occurrence of PTSD within one month after injury was evaluated in both groups by the revised PTSD scale. Data were statistically analyzed with independent sample test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. The pain scores of children in stepwise pain management group were significantly lower than traditional pain management group at 1, 9, and 17 o'clock on PID 1, 1, 9, and 17 o'clock on PID 2, and 1, 9, and 17 o'clock on PID 3 (=2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71, <0.05 or <0.01). The pain scores of children in both groups showed a decreasing trend over time. Of the 96 children in stepwise pain management group, 84 children were treated with oral administration of acetaminophen sustained-release dry suspension, and 12 children were treated with morphine intravenous injection. No adverse reaction occurred during the treatment period. The incidence of PTSD of children in stepwise pain management group within 1 month after injury was 3.12% (3/96), which was significantly lower than 14.43% (14/97) in traditional pain management group, <0.05. The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in children with burns.
探讨逐步急性疼痛管理对烧伤患儿急性疼痛及创伤后应激障碍（PTSD）的影响。2018年11月至2019年12月，选取四川大学华西医院收治的196例符合纳入标准的烧伤患儿，纳入前瞻性随机对照研究。根据随机数字表将患儿分为传统疼痛管理组（97例，男51例，女46例，年龄1至6岁）和逐步疼痛管理组（96例，男55例，女41例，年龄1至6岁）。传统疼痛管理组患儿采用传统急性疼痛护理，逐步疼痛管理组患儿在入院后传统急性疼痛护理基础上采用逐步急性疼痛管理（中度疼痛采用口服对乙酰氨基酚缓释干混悬剂，剂量为10至15mg/kg，每4至6小时1次，重度疼痛采用吗啡静脉注射，剂量为0.1至0.2mg/kg，每4小时1次）。应用COMFORT行为量表比较两组患儿伤后第3天（每天1、9、17时）的静息疼痛水平。记录逐步疼痛管理组患儿治疗期间的不良反应。两组均采用修订的PTSD量表评估伤后1个月内PTSD的发生情况。数据采用独立样本t检验、Bonferroni校正、重复测量方差分析、卡方检验、Wilcoxon秩和检验及Fisher确切概率检验进行统计学分析。逐步疼痛管理组患儿在伤后第1天的1、9、17时，伤后第2天的1、9、17时，伤后第3天的1、9、17时的疼痛评分均显著低于传统疼痛管理组（t=2.71、3.44、4.05、4.18、4.08、4.19、4.25、3.69、3.71，P<0.05或P<0.01）。两组患儿疼痛评分均随时间呈下降趋势。逐步疼痛管理组96例患儿中，84例采用口服对乙酰氨基酚缓释干混悬剂治疗，12例采用吗啡静脉注射治疗。治疗期间未发生不良反应。逐步疼痛管理组患儿伤后1个月内PTSD发生率为3.12%（3/96），显著低于传统疼痛管理组的14.43%（14/97），P<0.05。逐步急性疼痛管理可缓解烧伤患儿的急性疼痛并降低PTSD的发生率。
