疼痛综合管理策略在儿童日间全麻下口腔治疗中应用的随机对照研究

doi:10.12016/j.issn.2096-1456.2022.06.007

口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (6): 427-432.DOI: 10.12016/j.issn.2096-1456.2022.06.007

疼痛综合管理策略在儿童日间全麻下口腔治疗中应用的随机对照研究

刘冰¹(), 王沛娟¹, 张亚秋¹, 冯彩华¹, 王军², 张惠¹()

1.军事口腔医学国家重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔生物工程技术研究中心,第四军医大学口腔医院麻醉科,陕西西安（710032）
2.武警陕西省总队医院麻醉科,陕西西安（710054）

收稿日期:2021-12-06 修回日期:2022-02-04 出版日期:2022-06-20 发布日期:2022-04-15
通讯作者: 张惠
作者简介:刘冰,主治医师,硕士,Email： adalb729@163.com
基金资助:
国家自然科学基金项目(81971076)

A holistic approach for postoperative pain management in children receiving dental treatment under general anesthesia: a randomized clinical trial

LIU Bing¹(), WANG Peijuan¹, ZHANG Yaqiu¹, FENG Caihua¹, WANG Jun², ZHANG Hui¹()

1. State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, Fourth Military Medical University, Xi’an 710032, China
2. Department of Anesthesiology, Shaanxi Provincial General Hospital of Armed Police, Xi’an 710054, China

Received:2021-12-06 Revised:2022-02-04 Online:2022-06-20 Published:2022-04-15
Contact: ZHANG Hui
Supported by:
grants from National Natural Science Foundation of China(81971076)

摘要/Abstract

摘要：

目的探讨疼痛综合管理策略在儿童日间全麻下口腔治疗中的应用效果。方法 2020年1月至8月某院接受日间全身麻醉下口腔治疗儿童,年龄3~7周岁,按美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级为Ⅰ~Ⅱ级,治疗牙齿数 ≥ 10颗。120名儿童被随机分配到2组,综合策略组（H组,n=60）采用疼痛综合管理策略,包括超前镇痛、疼痛管理指导、微信评估（在术后4、6、24 h通过扫描二维码进行疼痛评估）三项内容;对照组（C组,n=60）无超前镇痛及疼痛管理指导,仅进行微信评估疼痛。术后2 h采用表情、下肢、活动、哭闹、可安慰性（face,legs,activity,cry and consolability,FLACC）量表对2组进行疼痛评估。术后4、6、24 h采用父母疼痛测量量表（parents postoperative pain measure,PPPM）对2组进行疼痛评估。结果与C组相比,H组术后2 h FLACC得分显著降低,差异有统计学意义（P <0.05）。H组在术后4、6、24 h三个时间点显著疼痛（PPPM ≥ 6分）发生率均低于C组（P <0.05）,且PPPM得分较C组显著降低（P<0.05）。H组91.7%的家长及时进行疼痛评估,而C组71.6%的家长及时评估疼痛,H组父母依从性更高（P <0.05）。结论疼痛综合管理策略可降低儿童日间全麻下口腔治疗后疼痛的发生率,是安全有效的日间口腔治疗后疼痛管理方法。

关键词: 儿童, 口腔治疗, 日间全麻, 术后疼痛, 术后疼痛管理, 超前镇痛, 疼痛管理指导, 微信评估, 无痛治疗, 舒适化治疗, 随机对照研究

Abstract:

Objective To investigate the efficacy of a holistic approach for postoperative pain management in children receiving dental treatment under general anesthesia in day-surgery operating room. Methods A total of 120 children, aged 3-7 years, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with ≥ 10 treated teeth, receiving comprehensive dental treatment under general anesthesia from January 2020 to August 2020 were enrolled in this trial and randomly allocated into the holistic approach group (group H, n=60) and including preemptive analgesia, instructions to parents for pain management and web-based assessment system (assessment pain by scanning the quick response code 4, 6, and 24 hours postoperatively) and the control group (group C, n=60) only scanning the quick response code. Pain, face, legs, activity, cry and consolability (FLACC) scale was used to assess the level of pain 2 h postoperatively and the parents postoperative pain measure (PPPM) was used to assess the level of pain 4, 6, and 24 h postoperatively in two groups. Results The FLACC scores of group H 2 h postoperatively were significantly lower than group C (P <0.05). The incidences of significant pain (PPPM scores ≥ 6) 4, 6 and 24 h postoperatively in group H were lower than group C (P <0.05). Altogether, 91.7% of parents in group H and 71.6% in group C assessed the level of pain of children over time. The compliance rate of parents in group H was significantly higher than group C (P <0.05). Conclusion The holistic approach had a positive effect on reducing postoperative pain for children receiving dental treatment under general anesthesia in the day-surgery operating room.

Key words: children, dental treatment, ambulatory anesthesia, postoperative pain, postoperative pain management, preemptive analgesia, instructions to parents for pain management, web-based assessment system, painless treatment, comfort therapy, randomized controlled trial

中图分类号:

刘冰, 王沛娟, 张亚秋, 冯彩华, 王军, 张惠. 疼痛综合管理策略在儿童日间全麻下口腔治疗中应用的随机对照研究[J]. 口腔疾病防治, 2022, 30(6): 427-432.

LIU Bing, WANG Peijuan, ZHANG Yaqiu, FENG Caihua, WANG Jun, ZHANG Hui. A holistic approach for postoperative pain management in children receiving dental treatment under general anesthesia: a randomized clinical trial[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(6): 427-432.

图/表 4

参考文献 22

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Items		Group H（n=55）	Group C（n=43）	c²/t	P
Male:female		32:23（58.18%）	26:17（60.47%）	0.05	0.819
Age/months		51.00 ± 10.06	50.09 ± 12.34	0.98	0.689
Weight/kg		16.64 ± 2.50	17.02 ± 3.16	0.26	0.497
ASA-PS1/ASA-PS2		53/2	42/1	0.05	0.828
Anesthesia-related data	Fentanyl/μg	33.95 ± 4.80	35.72 ± 6.87	4.33	0.136
	Propofol/mg	50.84 ± 7.43	50.51 ± 7.80	0.05	0.835
	Cisatracurium/mg	1.67 ± 0.25	1.68 ± 0.42	1.73	0.974
	Duration of anesthesia/min	146.64 ± 31.17	140.53 ± 30.22	0.35	0.332
Dental treatment-related data	Teeth treated（n）	16.04 ± 2.73	16.47 ± 2.67	0.04	0.438
	Number of teeth extracted ≥ 3（%）	12（21.81%）	8（18.60%）	0.15	0.695
	Local anesthetic/mL	0.96 ± 0.36	1.08 ± 0.46	2.92	0.134

Items		Group H（n=55）	Group C（n=43）	c²/t	P
Male:female		32:23（58.18%）	26:17（60.47%）	0.05	0.819
Age/months		51.00 ± 10.06	50.09 ± 12.34	0.98	0.689
Weight/kg		16.64 ± 2.50	17.02 ± 3.16	0.26	0.497
ASA-PS1/ASA-PS2		53/2	42/1	0.05	0.828
Anesthesia-related data	Fentanyl/μg	33.95 ± 4.80	35.72 ± 6.87	4.33	0.136
	Propofol/mg	50.84 ± 7.43	50.51 ± 7.80	0.05	0.835
	Cisatracurium/mg	1.67 ± 0.25	1.68 ± 0.42	1.73	0.974
	Duration of anesthesia/min	146.64 ± 31.17	140.53 ± 30.22	0.35	0.332
Dental treatment-related data	Teeth treated（n）	16.04 ± 2.73	16.47 ± 2.67	0.04	0.438
	Number of teeth extracted ≥ 3（%）	12（21.81%）	8（18.60%）	0.15	0.695
	Local anesthetic/mL	0.96 ± 0.36	1.08 ± 0.46	2.92	0.134

	Score	Group H （n=55）	Group C （n=43）	c²	P
FLACC score	0	4（7.27）	0（0）		0.032
	1-3	40（72.73）	27（62.79）	6.90
	4-7	11（20.00）	16（37.21）
PPPM score≥6	T₁	13（23.64）	20（46.51）	5.65	0.017
	T₂	11（20.00）	18（41.86）	5.54	0.019
	T₃	3（5.45）	12（27.91）	9.38	0.002

	Score	Group H （n=55）	Group C （n=43）	c²	P
FLACC score	0	4（7.27）	0（0）		0.032
	1-3	40（72.73）	27（62.79）	6.90
	4-7	11（20.00）	16（37.21）
PPPM score≥6	T₁	13（23.64）	20（46.51）	5.65	0.017
	T₂	11（20.00）	18（41.86）	5.54	0.019
	T₃	3（5.45）	12（27.91）	9.38	0.002

疼痛综合管理策略在儿童日间全麻下口腔治疗中应用的随机对照研究

A holistic approach for postoperative pain management in children receiving dental treatment under general anesthesia: a randomized clinical trial

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