复合镇痛在超脉冲点阵二氧化碳激光治疗小儿烧伤后增生性瘢痕中的应用效果的前瞻性随机对照研究  

A prospective randomized controlled study on the effects of compound analgesia in ultra-pulsed fractional carbon dioxide laser treatment of post-burn hypertrophic scars in children

作　　者：杨姣 石珊 王玲 李娜 韩军涛 胡大海 Yang Jiao;Shi Shan;Wang Ling;Li Na;Han Juntao;Hu Dahai(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院烧伤与皮肤外科,全军烧伤中心,西安710032

出　　处：《中华烧伤与创面修复杂志》2022年第7期683-690,共8页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金青年科学基金项目(81901965)。

摘　　要：目的探讨复合镇痛在超脉冲点阵二氧化碳激光(UFCL)治疗小儿烧伤后增生性瘢痕中的应用效果。方法采用前瞻性随机对照研究方法。2018年4月—2020年3月,将空军军医大学第一附属医院收治的169例烧伤后增生性瘢痕患儿按照随机数字表法分为单纯全身麻醉组[39例,男19例、女20例,年龄35(21,48)个月]、全身麻醉+利多卡因组[41例,男23例、女18例,年龄42(22,68)个月]、全身麻醉+布洛芬栓组[41例,男25例、女16例,年龄38(26,52)个月]以及应用全身麻醉+利多卡因+布洛芬栓的三联用药组[48例,男25例、女23例,年龄42(25,60)个月],各组患儿在行UFCL治疗瘢痕时分别采用对应的镇痛方案,并针对患儿治疗过程进行全程综合护理。分别于首次麻醉清醒后0(即刻)、1、2、4 h,采用儿童疼痛行为量表FLACC对患儿瘢痕进行疼痛程度评估。首次麻醉清醒后4 h疼痛评估结束后,采用自制的镇痛满意度调查表对患儿或其家属对镇痛效果的满意度进行评估并计算满意率。首次术后2 h内,观察并记录患儿不良反应,如恶心呕吐、头痛头晕、嗜睡等发生情况。首次治疗前和末次治疗结束后1个月,选用温哥华瘢痕量表(VSS)对患儿瘢痕情况进行评估并计算两者的差值。对数据行LSD检验、Kruskal-Wallis H检验、χ^(2)检验或Fisher确切概率法检验。结果首次麻醉清醒0 h,全身麻醉+利多卡因组、全身麻醉+布洛芬栓组和三联用药组患儿的FLACC评分均明显低于单纯全身麻醉组(P<0.01),全身麻醉+布洛芬栓组和三联用药组患儿的FLACC评分均明显低于全身麻醉+利多卡因组(P<0.01),三联用药组患儿的FLACC评分明显低于全身麻醉+布洛芬栓组(P<0.01)。首次麻醉清醒1、2 h,全身麻醉+布洛芬栓组和三联用药组患儿的FLACC评分均明显低于单纯全身麻醉组和全身麻醉+利多卡因组(P<0.01),三联用药组患儿的FLACC评分明显低于全身麻醉+布洛芬栓组(P<0.01Objective To investigate the effects of compound analgesia on ultra-pulsed fractional carbon dioxide laser(UFCL)treatment of post-burn hypertrophic s in children.Methods A prospective randomized controlled study was conducted.From April 2018 to March 2020,169 pediatric patients with post-burn hypertrophic s admitted to the First Affiliated Hospital of Air Force Medical University were randomly divided into general anesthesia alone group(39 cases,19 males and 20 females,aged 35(21,48)months),general anesthesia+lidocaine group(41 cases,23 males and 18 females,aged 42(22,68)months),general anesthesia+ibuprofen suppository group(41 cases,25 males and 16 females,aged 38(26,52)months),and three-drug combination group with general anesthesia+lidocaine+ibuprofen suppository(48 cases,25 males and 23 females,aged 42(25,60)months),and the pediatric patients in each group were treated with corresponding analgesic regimens when UFCL was used to treat s,and the pediatric patients were given comprehensive care throughout the treatment process.The pain degree of pediatric patients scar was evaluated by facial expression,legs,activity,cry,and consolability(FLACC)of children's pain behavior scale at 0(immediately),1,2,and 4 h after awakening from the first anesthesia,respectively.At 4 h after awakening from the first anesthesia of postoperative pain assessment,the self-made analgesia satisfaction questionnaire was used to evaluate the satisfaction for the analgesic effect of the pediatric patients or their families,and the satisfaction rate was calculated.Within 2 h after the first operation,the occurrences of adverse reactions of the pediatric patients,such as nausea and vomiting,headache,dizziness,drowsiness,etc,were observed and recorded.Before the first treatment and 1 month after the last treatment,the Vancouver scar scale(VSS)was used to evaluate the pediatric patients scar,and the difference value between the two was calculated.Data were statistically analyzed with least significant difference test,Kruskal-Wallis H test,chi

关 键 词：瘢痕 疼痛 激光疗法 围手术期护理 布洛芬 复合镇痛 

分 类 号：R726.5[医药卫生—儿科]