小儿镇静状态下牙科治疗中与疼痛/不适相关的伤害感受：一项采用客观和主观测量方法的临床研究。

Nociception associated with pain/distress in young children sedated for dental treatment: a clinical study with objective and subjective measures.

机构信息

Dentistry Post-Graduate Programme, Universidade Federal de Goiás, Goiânia, GO, Brazil.

Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil.

出版信息

Eur Arch Paediatr Dent. 2023 Apr;24(2):255-262. doi: 10.1007/s40368-023-00782-6. Epub 2023 Jan 27.

DOI:10.1007/s40368-023-00782-6

PMID:36705850

Abstract

PURPOSE

To evaluate the association between children's pain/distress levels and patient characteristics (age, sex, history of dental pain), sedation type (level of sedation, sedative regimen), nociception and pain intensity reported by the parents in sedated children undergoing minimally invasive dental treatment.

METHODS

This clinical study evaluated secondary outcomes of an RCT that evaluated the efficacy of dexmedetomidine sedation with or without ketamine. Only children who had nociception levels recorded using the Analgesia Nociception Index (ANI) were included (0-100; 0 = highest nociception). FLACC scale (Face, Legs, Activity, Cry and Consolability) was used to assess children's pain/distress (0-10; 0 = no pain/distress). Parental proxy report of the child's pain intensity during the treatment was performed using the Visual Analogue Scale (VAS; 0-100; 0 = no pain). The association between ANI, children's age and sex, dental pain history, sedation level, sedative regimen, and VAS with the FLACC was verified using the generalised estimation equation analysis (alpha 0.05).

RESULTS

Participants were 31 children (51.6% boys) and their parents (90.3% mothers). Median FLACC was 3.3 (25th-75th percentiles 1.7-8.2), ANI 80.9 (74.7-85.8), and VAS 10 (1-23). FLACC associated with ANI (OR 0.96; 95% CI 0.93-0.99; p = 0.02), moderate sedation (0.13; 0.03-0.50; p = 0.003), and VAS (1.05; 1.01-1.10; p = 0.01).

CONCLUSION

Pain/distress was generally low and more prominent with minimal (versus moderate) sedation and higher nociception.

摘要

目的

评估儿童疼痛/不适水平与患者特征（年龄、性别、牙科疼痛史）、镇静类型（镇静水平、镇静方案）、父母报告的伤害感受和疼痛强度之间的关联，这些特征与接受微创牙科治疗的镇静儿童有关。

方法

本临床研究评估了一项 RCT 的次要结果，该 RCT 评估了右美托咪定镇静联合或不联合氯胺酮的疗效。仅纳入了使用镇痛伤害感受指数（ANI）记录伤害感受水平的儿童（0-100；0=最高伤害感受）。FLACC 量表（面部、腿部、活动、哭闹和安抚性）用于评估儿童的疼痛/不适（0-10；0=无疼痛/不适）。父母通过视觉模拟量表（VAS；0-100；0=无疼痛）报告孩子在治疗过程中的疼痛强度。使用广义估计方程分析（alpha 0.05）验证了 ANI、儿童年龄和性别、牙科疼痛史、镇静水平、镇静方案以及 VAS 与 FLACC 之间的关系。

结果

参与者为 31 名儿童（51.6%为男孩）及其父母（90.3%为母亲）。FLACC 的中位数为 3.3（25 至 75 百分位数为 1.7-8.2），ANI 为 80.9（74.7-85.8），VAS 为 10（1-23）。FLACC 与 ANI（OR 0.96；95%CI 0.93-0.99；p=0.02）、中度镇静（0.13；0.03-0.50；p=0.003）和 VAS（1.05；1.01-1.10；p=0.01）相关。