【摘要】目的 本研究观察学龄前儿童在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 本研究为前瞻性队列研究，纳入108名1-6岁行开颅肿瘤切除术的患儿（ASA分级为I-II级）。术后分别采用Face, Legs, Activity, Cry and Consolability (FLACC) 评分 和 Wong-Baker Faces Scale (WBFS)评分两种不同的疼痛评分方法，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。结果108名学龄前行开颅肿瘤切除术的患儿，大部分的患儿（FLACC法62%、WBFS法82%）患在术后1小时的疼痛评分超过4分。开颅部位（PFLACC=0.035; PWBFS=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; PWBFS=0.002）均为术后疼痛的相关因素。结论 大部分学龄前儿童在行开颅肿瘤切除术后48小时内经历了中到重度的疼痛，尤其是某些1-2岁小儿。在可以控制的因素中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和术后使用静脉镇痛泵可以明显减轻患儿的术后疼痛。
【Abstract】Objective: The study observed the status of postoperative pain in preschoolers after craniotomy and analyzed the factors affecting postoperative pain. Methods: This prospective cohort study included 108 patients aged 1-6 years 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 PCIA （PFLACC=0.000; PWBFS=0.002）are related factors of postoperative pain. Discussion: In our study, the majority of preschoolers after craniotomy within 48 hours experienced moderate to severe pain, especially in some of 1-2 year-old children. Using analgesics before the end of surgery, receiving PCIA and earlier comfort from their parents soon after neurosurgery significantly relieved postoperative pain in preschoolers after craniotomy.
Cited
)
