摘要
目的观察低龄儿童（1岁～6岁）开颅术后的疼痛现状，并探讨影响其术后疼痛的相关因素。方法应用前瞻性队列研究，入选择期开颅肿瘤切除术1岁-6岁患儿135例，其中15例因为术后不能即刻拔除气管导管被排除，11例因为术后1h内未清醒不能配合术后评分也被排除，另有1例因术后2日血肿行二次手术也被排除。最终共108例能够配合术后疼痛评分的患儿纳入研究。美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级。测量和记录每名患儿的人口统计学资料、手术的变量及术后疼痛及相关变量，术后分别采用Face、Legs、Activity、Cryand Consolability（FLACC）评分和Wong-BakerFacesScale（WBFS）评分两种方法进行疼痛评分。结果108名患儿中大部分的患儿（FLACC法62％、WBFS法82％）在术后1h的疼痛评分超过4分。开颅部位（PFLACC=0．035；RWBFS=0．039）、手术结束前末次镇痛药的使用（PFLACC=0．026，PWBFS=0．015）、手术结束后患儿的去向（PWBFS=0．022）及术后是否使用静脉镇痛泵（PFLACC=0．000，RWBFS=0．002）均为术后疼痛的相关因素。结论大部分低龄儿童在行开颅肿瘤切除术后48h内经历了中到重度的疼痛，尤其是某些1岁～2岁小儿。在可以控制的因素中手术，手术结束前镇痛药的使用，术后及时得到父母的安抚与关怀，术后使用静脉镇痛泵等可以明显减轻患儿的术后疼痛。
Objective The study observed the status of postoperative pain in preschoolers after craniotomy and analyzed the related factors affecting postoperative pain. Methods This prospective cohort study included 108 patients aged 1 y-6 y old children experienced craniotomy （ASA classification as Class Ⅰ～Ⅱ）. Postoperative pain was measured by two different scoring methods including Face, Legs, Activity, Cry and Consolability （FLACC） score and Wong-Baker Faces Scale （WBFS） score. The children＇s demographics, biomedical, surgical and postoperative variables were measured. Results The most postoperative pain value （FLACC 62%, WBFS 82%） of 108 preschoolers was more than 4 points within the first hour following neurosurgery. Specially, Craniotomy site （PFLACC=0.035, PWBFS=0.039）, before the end of surgery last analgesic use （PFLACC=0.026, PWBFS=0.015）, children＇s whereabouts after the end of surgery （PWBFS=0.022） and patient controlled intravenous analgesia （PCIA）（PFLACC=0.000, PWBFS=0.002） are related factors of postoperative pain. Conclusions In our study, the majority of preschoolers experience moderate to severe pain within the first hour after craniotomy, especially in some of 1 y-2 y. Using analgesics before the end of surgery, receiving PCIA and earlier comfort from their parents soon after surgery may significantly relieve postoperative pain in neurosurgery pediatric patients. [ Key words ] Postoperative pain; Neurosurgery ; Preschoolers; Related factors
出处
《国际麻醉学与复苏杂志》
CAS
2015年第7期605-609,共5页
International Journal of Anesthesiology and Resuscitation
关键词
术后疼痛
神经外科
学龄前儿童
相关因素
Postoperative pain
Neurosurgery
Preschoolers
Related factors
