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8-18 岁儿科重症监护病房幸存者的长期疼痛症状。

Long-term Pain Symptomatology in PICU Survivors Aged 8-18 Years.

机构信息

Division of Pediatric Psychology, Department of Pediatrics.

Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon.

出版信息

Hosp Pediatr. 2023 Jul 1;13(7):641-655. doi: 10.1542/hpeds.2022-007027.

Abstract

BACKGROUND AND OBJECTIVES

Children discharged from the PICU often experience long-term physical, psychological, social and cognitive challenges, described as postintensive care syndrome. This study fills a critical gap by describing the long-term pain symptoms many children experience using child self-report.

METHODS

Participants in this cross-sectional study were children aged 8 to 18 years (and 1 parent, n = 64 dyads) who were 8 to 24 months post-PICU discharge. Participants completed measures assessing pain, psychosocial function, and treatment utilization. Health information relevant to the PICU admission was obtained from the electronic medical record.

RESULTS

Children were an average age of 14.3 years and 50% female. Average pain intensity in the past month was 3.65 (0-10 numeric rating scale), with 36% of children reporting pain ≥2 to 3 days a week. Youth with higher intensity (≥4) and more frequent pain (≥2-3 days a week) had greater pain catastrophizing, pain-related fear, anxiety, and sleep disturbance than those with less frequent and intense pain. Higher pain frequency was also associated with greater pain-related disability and depressive symptoms. Pain was not associated with any PICU-related variables abstracted from the electronic medical record. Parents reported children frequently accessed pain treatment services postdischarge; however, 37.5% reported the coronavirus disease 2019 pandemic impacted access to recommended services.

CONCLUSIONS

A significant portion of children experience pain post-PICU discharge. For many of these children, pain is frequent and is associated with impairments in psychosocial function. Future prospective research studies can be used to identify risk factors of poor pain outcomes so children can receive targeted interventions.

摘要

背景和目的

从 PICU 出院的儿童经常经历长期的身体、心理、社会和认知挑战,被描述为重症监护后综合征。本研究通过描述许多儿童使用儿童自我报告所经历的长期疼痛症状,填补了这一关键空白。

方法

本横断面研究的参与者为年龄在 8 至 18 岁(和 1 名家长,n = 64 对)之间的 PICU 出院后 8 至 24 个月的儿童。参与者完成了评估疼痛、心理社会功能和治疗利用的措施。与 PICU 入院相关的健康信息从电子病历中获得。

结果

儿童的平均年龄为 14.3 岁,50%为女性。过去一个月的平均疼痛强度为 3.65(0-10 数字评分量表),36%的儿童报告疼痛≥2 至 3 天/周。与疼痛强度较低(<4)和疼痛频率较低(<2-3 天/周)的儿童相比,疼痛强度较高(≥4)和疼痛频率较高(≥2-3 天/周)的儿童有更大的疼痛灾难化、疼痛相关恐惧、焦虑和睡眠障碍。较高的疼痛频率也与更大的疼痛相关残疾和抑郁症状有关。疼痛与从电子病历中提取的任何与 PICU 相关的变量均无关联。家长报告说,儿童在出院后经常接受疼痛治疗服务;然而,37.5%的家长报告说,2019 年冠状病毒病大流行影响了获得推荐服务的机会。

结论

很大一部分儿童在 PICU 出院后会经历疼痛。对于这些儿童中的许多人来说,疼痛是频繁的,并与心理社会功能受损有关。未来的前瞻性研究可以用于确定不良疼痛结局的风险因素,以便为儿童提供有针对性的干预措施。

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