肿瘤患儿疼痛管理现状的单中心调查

A single center survey on pain management in pediatric patients with tumors

目的了解目前血液肿瘤患儿疼痛管理现状及存在的阻碍。方法以2018年1月8日—2018年1月26日期间血液肿瘤科实体瘤及淋巴瘤病房住院患儿、家长及医生为研究对象,对年龄大于4岁的住院患儿进行连续地疼痛评估,对23名医生及28名患儿家长进行问卷调查。结果有97名患儿接受了多次疼痛评估,其中20人发生中重度疼痛(20.6%)。共计评估367人次,67人次为中重度疼痛(占18.3%),其中70.2%的疼痛未向医生报告,予以镇痛治疗的仅占17.9%,其中阿片类药物占8.3%。针对家长和医师的问卷调查显示:有5/23的医生选择偶尔或从不对患儿评估疼痛,21/28的家长选择医生偶尔或从不评估患儿疼痛,差异具有显著性。当被问及开具镇痛药物依据时,有11/23的医生选择依据疼痛评分;当被问及最有助于缓解晚期癌症患儿中到重度疼痛方法时,有17/23的医生选择阿片类药物;而当被问及实际推荐首选药物时仅6/23的选择阿片类药物,差异具有显著性。结论肿瘤患儿的镇痛治疗尚未被充分重视,甚至中重度疼痛都仍被忽视。疼痛评估不足、家长及医生缺失疼痛相关知识是目前疼痛管理关键阻碍。完善疼痛评估是开展儿童癌痛管理的关键。

Objective To learn the status quo of pain management in children with tumors and to find out the barriers to pain management.Methods Pediatric inpatients,their parents,and physicians in the Department of Hematological Oncology from January 8,2008 to January 26,2018 were enrolled as the subjects.Pain assessment was performed for pediatric inpatients older than 4 years.A questionnaire-based survey on pain relief was performed in 23 physicians and 28 parents.The status quo of pain management in children with tumors was evaluated.Results A total of 97 children were assessed,among whom 20(20.6%)had moderate-to-severe pain.A total of 367 times were assessed,among whom 67(18.3%)had moderate-to-severe pain,among which 70.2%were not reported to the physicians and 17.9%were treated with analgesics,among which opioids accounted for 8.3%.For pain assessment,our survey showed that 5/23 of physicians responded that they“occasionally or never assess pain in children”,the difference with statistical significance.while up to 21/28 of parents responded that“The doctors occasionally or never assess pain of children”.Only 11/23 of the physicians prescribed analgesics based on pain scores.When asked about the best way to relieve moderate-to-severe pain in children with advanced cancer,17/23 of the physicians chose opioids;when asked about the actual recommended analgesics for moderate-to-severe pain,however,only 6/23 of the doctors recommended strong opioids,the difference with statistical significance.Conclusions The value of analgesic treatment in pediatric patients with tumors has not been fully recognized,and moderate-to-severe pain is still neglected.Inadequate pain assessment and poor pain-related knowledge by medical staff and parents are currently the major barriers to pain management.The improvement of pain assessment is the key to the management of cancer pain in children.