Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in children with burns: a prospective randomized controlled study
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摘要:
目的 探讨阶梯式急性疼痛管理对减轻烧伤患儿急性疼痛及创伤后应激障碍（PTSD）的效果。 方法 2018年11月—2019年12月，四川大学华西医院收治的196例烧伤患儿符合入选标准，纳入本前瞻性随机对照研究。采用随机数字表法将患儿分为常规疼痛管理组97例（男51例、女46例，年龄1~6岁）和阶梯疼痛管理组96例（男55例、女41例，年龄1~6岁）。常规疼痛管理组患儿入院后采取常规急性疼痛管理方法；阶梯疼痛管理组患儿入院后在常规急性疼痛管理的基础上，采取阶梯式急性疼痛管理方案（即中度疼痛口服对乙酰氨基酚缓释干混悬剂，每次10~15 mg/kg，每4~6小时1次；重度疼痛予吗啡静脉注射，每次0.1~0.2 mg/kg，每4小时1次）。采用舒适行为量表评估2组患儿伤后3 d内（每天1：00、9：00、17：00）的静息疼痛水平，记录阶梯疼痛管理组患儿用药期间不良反应情况，采用PTSD修订版量表评估2组患儿伤后1个月内的PTSD发生情况。对数据行独立样本
t 检验、Bonferroni校正、重复测量方差分析、
χ 2检验、Wilcoxon秩和检验、Fisher确切概率法检验。 结果 伤后1 d的1：00、9：00、17：00，伤后2 d的1：00、9：00、17：00，伤后3 d的1：00、9：00、17：00，阶梯疼痛管理组患儿疼痛评分均明显低于常规疼痛管理组（
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）。2组患儿疼痛评分均随时间推移呈下降趋势。阶梯疼痛管理组96例患儿中有84例患儿口服了对乙酰氨基酚缓释干混悬剂，12例患儿静脉注射了吗啡，在用药期间均未发生任何不良反应。阶梯疼痛管理组患儿伤后1个月内PTSD发生率为3.12%（3/96），明显低于常规疼痛管理组的14.43%（14/97），
P <0.05。 结论 阶梯式急性疼痛管理可减轻烧伤患儿伤后急性疼痛程度，降低PTSD的发生率。
Abstract:Objective To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in children with burns. Methods 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
t test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. Results 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 (
t =2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71,
P <0.05 or
P <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,
P <0.05. Conclusions The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in children with burns.
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Key words:
- Burns /
- Pain /
- Stress disorders, post-traumatic /
- Child
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