综合疼痛干预在急性脑膜炎患儿中应用效果

Effect of comprehensive pain intervention in the acute meningitis children

目的探讨综合疼痛干预在儿科重症监护病房（PICU）急性脑膜炎患儿疼痛管理中的应用效果。方法选取在PICU住院的急性脑膜炎患儿及家属各140例，采用随机数字表法随机分为两组，每组70例，在干预开始前应用幼儿面部编码系统（NFCS）评分，比较两组患儿疼痛分度，入院当日分别进行疼痛干预，对照组患儿家属学习PICU护理手册，观察组患儿家属学习疼痛信息手册、幼儿缓解疼痛相关方法及PICU护理手册。两组患儿分别在入院当天、脑脊液穿刺时、入院后第3、5、7天对患儿疼痛程度进行评估，入院第7天对家属满意度进行评估。结果疼痛缓解程度上，人院第3天时观察组患儿轻度疼痛28．57％，中度疼痛42．86％，重度疼痛25．71％；对照组轻度疼痛11．43％，中度疼痛54．29％，重度疼痛34．29％，两组差异有统计学意义（x^2=6．91，P=0．03）。人院时，两组患儿间心理状态差异无统计学意义（P〉0．05）；入院第7天，对照组患儿心理状态较观察组不稳定，不愉悦居多，差异有统计学意义（P〈0．05）。入院第7天观察组和对照组患儿家长对疼痛管理的平均满意度分别为（87．42±6．88）％，（73．10±10．12）％，两组差异有统计学意义（t=8．21，P〈0．01）。结论综合疼痛干预可帮助PICU急性脑膜炎患儿更好地缓解脑脊液穿刺及疾病本身带来的疼痛。

Objective To investigate the efficacy of comprehensive pain intervention in the pain management of child in the pediatric intensive care unit with Acute Meningitis. Methods A total of 280 parents and children at the PICU of Maternal and Child Care Service Centre of Tangshan were enrolled in the study. All the parents and children were randomly divided into observation group and control group （child was in same group with his/her parents）, with 70 parents/children in each group. The pain scales of the two groups were compared using the neonatal facial coding system （NFCS） before the study. Pain intervention began at the first day of admission. Parents in the observation group learned the handbook of pain information, methods for pain alleviation in children and handbook of nursing in PICU. Parents in the control group only learned the handbook of nursing in PICU. The efficacies of the pain management methods of the two groups were assessed by pain alleviation rate and the satisfaction rates of the parents. Results The pain alleviation rate of the observation group was higher than that of the control group at admission day 3. The result of children were as followed, observation group： mild pain 28.57% ,moderate pain 42.86% ,severe pain 25.71% ;control group mild pain 11.43%, moderate pain 54.29%, severe pain 34.29%, differences between the two groups have statistical significance （ x^2 = 6.91, P = 0. 03 ）. On admission, psychological status differences between two groups of children had no statistical significance （P 〉0. 05）. The seventh day of admission, the control group with mental state is not stable in the observation group, not pleasure, the difference was statistically significant （P 〈 0. 05）. Parents in the observation group showed greater satisfactions than parents in the control group [ （ 87.42 ± 6. 88）%, （73. 10 ± 10. 12）% ], the difference was statistically significant （t = 8. 21 ,P 〈 0. 01 ）. Conclusions Comprehensive pain intervention in the pain management of child in the pediatric intensive care unit with acute meningitis could alleviate pain in children.