van Aken M A, Heezen T J, van Lieshout C F
Tijdschr Kindergeneeskd. 1986 Aug;54(4):112-8.
The development and reduction of distress in children with leukemia was studied during a frequently recurring medical procedure, i.e., a bone marrow aspiration (BMA). The role of a number of factors in the development of distress display in children during this procedure was studied. The intensity of distress display was assessed with a behavioral rating scale. The intensity of distress display was found to be independent of the physician who performed the punction, the part of the body to which the punction was administered, the number of previously administered BMA'S, whether the child had to undergo a lumbar puncture after the BMA, and whether the child was sedated. The intensity of distress display varied with age and sex of the child. The intensity of distress display was weaker in older children, but this age effect was stronger for boys than for girls. An experimental program was developed and administered in order to reduce distress display during medical treatment. This program consisted of three parts (relaxation, imagination of a pleasant situation and arousal of the concomitant feelings, as well as watching a model). The experimental program was found to be effective in reducing distress display in children. The amount of reduction was dependent of the number of prior BMA'S (the fewer the prior BMA'S, the greater the decrease) and of the level of pretreatment display of distress (the higher the level, the smaller the decrease.
在一项频繁进行的医疗程序，即骨髓穿刺术（BMA）期间，对白血病患儿痛苦的产生与减轻情况进行了研究。研究了多种因素在该程序中对患儿痛苦表现产生过程中的作用。采用行为评定量表对痛苦表现的强度进行评估。结果发现，痛苦表现的强度与实施穿刺的医生、穿刺部位、既往接受BMA的次数、患儿在BMA后是否必须接受腰椎穿刺以及患儿是否接受了镇静处理无关。痛苦表现的强度因患儿的年龄和性别而异。年龄较大的患儿痛苦表现的强度较弱，但这种年龄效应在男孩中比在女孩中更明显。为了减少医疗过程中的痛苦表现，制定并实施了一个实验方案。该方案包括三个部分（放松、想象愉快情境并唤起相应感受以及观察榜样）。结果发现该实验方案在减少患儿痛苦表现方面是有效的。减少的程度取决于既往BMA的次数（既往BMA次数越少，减少幅度越大）以及治疗前痛苦表现的水平（水平越高，减少幅度越小）。
