烧伤操作痛管理策略研究进展
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摘要
烧伤创面换药是严重烧伤患者治疗过程中必不可少的重要环节,其所带来的烧伤操作性疼痛(procedural pain)最常见、痛苦最大,并可造成机体过度应激反应,对机体产生不良影响;且长期不受控制的疼痛不仅使患者情绪恶化,产生恐惧、焦虑和抑郁等问题,还可直接影响创面的愈合速度与质量,从而在一定程度上影响烧伤患者的预后与转归。医护人员对烧伤操作痛的管理具有重要意义,但是由于部分操作者对烧伤操作性疼痛认识不足,重视度不高,烧伤操作痛的管理现状不容乐观。本文综述了烧伤操作痛的药物管理、非药物管理两方面的临床发展现状,以期为临床烧伤操作痛的管理提供参考。
Addressing burn wound is an indispensable procedure of treating severely burned patients. The procedural pain is common but hard to bear,which can cause adverse effects on the body as well as making it overreacting. More worse,patients will not only become emotional,but also feared,anxious and depressed if the uncontrollable pain lasts too long,thus reducing the cure speed and quality of burned area and affecting the prognosis and outcomes of patients. Healthcare staff actually play a significant role in treating the pain caused by addressing burn wound,however,due to that some of the staff haven't taken the procedural pain seriously or haven't mastered enough knowledge in this field,the current situation of managing the procedural pain caused by addressing burn wound is not optimistic. In this article,the clinical development of drug and non-drug management of the procedural pain caused by addressing burn wound is reviewed in the hope of providing some references when treating it.
Addressing burn wound is an indispensable procedure of treating severely burned patients. The procedural pain is common but hard to bear,which can cause adverse effects on the body as well as making it overreacting. More worse,patients will not only become emotional,but also feared,anxious and depressed if the uncontrollable pain lasts too long,thus reducing the cure speed and quality of burned area and affecting the prognosis and outcomes of patients. Healthcare staff actually play a significant role in treating the pain caused by addressing burn wound,however,due to that some of the staff haven't taken the procedural pain seriously or haven't mastered enough knowledge in this field,the current situation of managing the procedural pain caused by addressing burn wound is not optimistic. In this article,the clinical development of drug and non-drug management of the procedural pain caused by addressing burn wound is reviewed in the hope of providing some references when treating it.
引文
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[2]de Jong AEE,Middelkoop E,Faber AW,et al.Non-pharmacological nursing interventions for procedural pain relief in adults with burns:a systematic literature review[J].Burns,2007,33(7):811-827.
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[8]Retrouvey H,Shahrokhi S.Pain and the thermally injured patient-a review of current therapies[J].J Burn Care Res,2015,36(2):315-323.
[9]Bidwell KL,Miller SF,Coffey R,et al.Evaluation of the safety and efficacy of a nursing-driven midazolam protocol for the management of procedural pain associated with burn injuries[J].J Burn Care Res,2013,34(1):176-182.
[10]Holtman JJ,Jellish WS.Opioid-induced hyperalgesia and burn pain[J].J Burn Care Res,2012,33(6):692-701.
[11]Rimaz S,Alavi CE,Sedighinejad A,et al.Effect of gabapentin on morphine consumption and pain after surgical debridement of burn wounds:a double-blind randomized clinical trial study[J].Arch Trauma Res,2012,1(1):38-43.
[12]Andrews RM,Browne AL,Wood F,et al.Predictors of patient satisfaction with pain management and improvement 3 months after burn injury[J].J Burn Care Res,2012,33(3):442-452.
[13]Yang CL,Wei ZR.Advances in the research of burn pain[J].Zhonghua Shao Shang Za Zhi,2017,33(1):61-64.
[14]刘旭丽,秦爱玲,王建.烧伤疼痛多模式护理干预疗效分析[J].中国疼痛医学杂志,2016,22(9):719-720.
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[18]Pardesi O,Fuzaylov G.Pain management in pediatric burn patients:review of recent literature and future directions[J].J Burn Care Res,2017,38(6):335-347.
[19]Latarjet J,Choinere M.Pain in burn patients[J].Burns,1995,21(5):344-348.
[20]Taal LA,Faber AW.Post-traumatic stress,pain and anxiety in adult burn victims[J].Burns,1997,23(7-8):545-549.
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[25]Choiniere M,Auger FA,Latarjet J.Visual analogue thermometer:a valid and useful instrument for measuring pain in burned patients[J].Burns,1994,20(3):229-235.
[26]Melzack R.The Mc Gill Pain Questionnaire:major properties and scoring methods[J].Pain,1975,1(3):277-299.
[27]Abbey J,Piller N,De Bellis A,et al.The Abbey pain scale:a 1-minute numerical indicator for people with end-stage dementia[J].Int J Palliat Nurs,2004,10(1):6-13.
[28]Merkel SI,Voepel-Lewis T,Shayevitz JR,et al.The FLACC:a behavioral scale for scoring postoperative pain in young children[J].Pediatr Nurs,1997,23(3):293-297.
[29]Elmasry M,Steinvall I,Thorfinn J,et al.Treatment of children with scalds by xenografts:report from a swedish burn centre[J].J Burn Care Res,2016,37(6):e586-e591.
[30]Linneman PK,Terry BE,Burd RS.The efficacy and safety of fentanyl for the management of severe procedural pain in patients with burn injuries[J].J Burn Care Rehabil,2000,21(6):519-522.
[31]Tosun Z,Esmaoglu A,Coruh A.Propofol-ketamine vs propofolfentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes[J].Paediatr Anaesth,2008,18(1):43-47.
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[33]Prakash S,Fatima T,Pawar M.Patient-controlled analgesia with fentanyl for burn dressing changes[J].Anesth Analg,2004,99(2):552-555.
[34]Le Floch R,Naux E,Pilorget A,et al.Use of remifentanil for analgesia during dressing change in spontaneously breathing non-intubated burn patients[J].Ann Burns Fire Disasters,2006,19(3):136-139.
[35]Rashaan ZM,Krijnen P,van den Akker-Van MM,et al.Clinical effectiveness,quality of life and cost-effectiveness of Flaminal(R)versus Flamazine(R)in the treatment of partial thickness burns:study protocol for a randomized controlled trial[J].Trials,2016,17(1):122.
[36]Mangano A,Albertin A,La Colla L.Patient controlled sedation using a standard protocol for dressing changes in burns:patients'preference,procedural details and a preliminary safety evaluation.Are studies always adequately powered and analyzed[J].Burns,2010,36(6):948,948-950.
[37]Nilsson A,Steinvall I,Bak Z,et al.Patient controlled sedation using a standard protocol for dressing changes in burns:patients'preference,procedural details and a preliminary safety evaluation[J].Burns,2008,34(7):929-934.
[38]Wilinski J,Lechowicz M,Kameczura T,et al.Non-steroidal antiinflammatory drugs and paracetamol in self-therapy of various disorders in students of different fields of study[J].Folia Med Cracov,2015,55(2):49-59.
[39]Childs C,Little RA.Acetaminophen(paracetamol)in the management of burned children with fever[J].Burns Incl Therm Inj,1988,14(5):343-348.
[40]Marret E,Kurdi O,Zufferey P,et al.Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects:meta-analysis of randomized controlled trials[J].Anesthesiology,2005,102(6):1249-1260.
[41]Visser E,Schug SA.The role of ketamine in pain management[J].Biomed Pharmacother,2006,60(7):341-348.
[42]Tawfic QA.A review of the use of ketamine in pain management[J].J Opioid Manag,2013,9(5):379-388.
[43]Williams PI,Sarginson RE,Ratcliffe JM.Use of methadone in the morphine-tolerant burned paediatric patient[J].Br J Anaesth,1998,80(1):92-95.
[44]Clark JD.Understanding methadone metabolism:a foundation for safer use[J].Anesthesiology,2008,108(3):351-352.
[45]周湘桂.烧伤创面换药操作痛控制性镇痛治疗的研究[D].南昌大学,2008.
[46]Alexander M,Daniel T,Chaudry IH,et al.Opiate analgesics contribute to the development of post-injury immunosuppression[J].J Surg Res,2005,129(1):161-168.
[47]Kohut SA,Stinson J.Psychological therapies for the management of chronic and recurrent pain in children and adolescents[J].Paediatr Child Health,2016,21(5):258-259.
[48]Li J,Zhou L,Wang Y.The effects of music intervention on burn patients during treatment procedures:a systematic review and metaanalysis of randomized controlled trials[J].BMC Complement Altern Med,2017,17(1):158.
[49]Protacio J.Patient-directed music therapy as an adjunct during burn wound care[J].Crit Care Nurse,2010,30(2):74-76.
[50]Tan X,Yowler CJ,Super DM,et al.The efficacy of music therapy protocols for decreasing pain,anxiety,and muscle tension levels during burn dressing changes:a prospective randomized crossover trial[J].J Burn Care Res,2010,31(4):590-597.
[51]Son JT,Kim SH.The effects of self-selected music on anxiety and pain during burn dressing changes[J].Taehan Kanho Hakhoe Chi,2006,36(1):159-168.
[52]Prensner JD,Yowler CJ,Smith LF,et al.Music therapy for assistance with pain and anxiety management in burn treatment[J].J Burn Care Rehabil,2001,22(1):83-88,82-83.
[53]Fratianne RB,Prensner JD,Huston MJ,et al.The effect of musicbased imagery and musical alternate engagement on the burn debridement process[J].J Burn Care Rehabil,2001,22(1):47-53.
[54]Christenberry EB.The use of music therapy with burn patients[J].J Music Ther,1979,16(3):138-148.
[55]Li J,Zhou L,Wang Y.The effects of music intervention on burn patients during treatment procedures:a systematic review and metaanalysis of randomized controlled trials[J].BMC Complement Altern Med,2017,17(1):158.
[56]Hoffman HG,Meyer WR,Ramirez M,et al.Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients[J].Cyberpsychol Behav Soc Netw,2014,17(6):397-401.
[57]Kipping B,Rodger S,Miller K,et al.Virtual reality for acute pain reduction in adolescents undergoing burn wound care:a prospective randomized controlled trial[J].Burns,2012,38(5):650-657.
[58]Hoffman HG,Chambers GT,Meyer WR,et al.Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures[J].Ann Behav Med,2011,41(2):183-191.
[59]Patterson DR,Wiechman SA,Jensen M,et al.Hypnosis delivered through immersive virtual reality for burn pain:a clinical case series[J].Int J Clin Exp Hypn,2006,54(2):130-142.
[60]Hoffman HG,Patterson DR,Carrougher GJ.Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy:a controlled study[J].Clin J Pain,2000,16(3):244-250.
[61]Baudoin J,Jafari P,Meuli J,et al.Topical negative pressure on burns:an innovative method for wound exudate collection[J].Plast Reconstr Surg Glob Open,2016,4(11):e1117.
[62]Mercado A,Pérez I,Sánchez V.Effect of a combined continuous and intermittent transcutaneous electrical nerve stimulation on pain perception of burn patients evaluated by visual analog scale:a pilot study[J].Local and Regional Anesthesia,2015(8):119-122.
[63]Sari Z,Polat MG,Ozgul B,et al.The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes[J].Burns,2014,40(5):909-914.
[64]Bikmoradi A,Harorani M,Roshanaei G,et al.The effect of inhalation aromatherapy with damask rose(Rosa damascena)essence on the pain intensity after dressing in patients with burns:a clinical randomized trial[J].Iran J Nurs Midwifery Res,2016,21(3):247-254.
[65]Fisher E,Law E,Palermo TM,et al.Psychological therapies(remotely delivered)for the management of chronic and recurrent pain in children and adolescents[J].Cochrane Database Syst Rev,2015(3):D11118.
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[2]de Jong AEE,Middelkoop E,Faber AW,et al.Non-pharmacological nursing interventions for procedural pain relief in adults with burns:a systematic literature review[J].Burns,2007,33(7):811-827.
[3]Edwards RR,Smith MT,Klick B,et al.Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury[J].Ann Behav Med,2007,34(3):313-322.
[4]Choiniere M,Melzack R,Girard N,et al.Comparisons between patients'and nurses'assessment of pain and medication efficacy in severe burn injuries[J].Pain,1990,40(2):143-152.
[5]Myers R,Lozenski J,Wyatt M,et al.Sedation and analgesia for dressing change:a survey of american burn association burn centers[J].J Burn Care Res,2017,38(1):e48-e54.
[6]Wibbenmeyer L,Eid A,Kluesner K,et al.An Evaluation of factors related to postoperative pain control in burn patients[J].J Burn Care Res,2015,36(5):580-586.
[7]Wibbenmeyer L,Oltrogge K,Kluesner K,et al.An evaluation of discharge opioid prescribing practices in a burn population[J].J Burn Care Res,2015,36(2):329-335.
[8]Retrouvey H,Shahrokhi S.Pain and the thermally injured patient-a review of current therapies[J].J Burn Care Res,2015,36(2):315-323.
[9]Bidwell KL,Miller SF,Coffey R,et al.Evaluation of the safety and efficacy of a nursing-driven midazolam protocol for the management of procedural pain associated with burn injuries[J].J Burn Care Res,2013,34(1):176-182.
[10]Holtman JJ,Jellish WS.Opioid-induced hyperalgesia and burn pain[J].J Burn Care Res,2012,33(6):692-701.
[11]Rimaz S,Alavi CE,Sedighinejad A,et al.Effect of gabapentin on morphine consumption and pain after surgical debridement of burn wounds:a double-blind randomized clinical trial study[J].Arch Trauma Res,2012,1(1):38-43.
[12]Andrews RM,Browne AL,Wood F,et al.Predictors of patient satisfaction with pain management and improvement 3 months after burn injury[J].J Burn Care Res,2012,33(3):442-452.
[13]Yang CL,Wei ZR.Advances in the research of burn pain[J].Zhonghua Shao Shang Za Zhi,2017,33(1):61-64.
[14]刘旭丽,秦爱玲,王建.烧伤疼痛多模式护理干预疗效分析[J].中国疼痛医学杂志,2016,22(9):719-720.
[15]Twycross A.Educating nurses about pain management:the way forward[J].J Clin Nurs,2002,11(6):705-714.
[16]Schafheutle EI,Cantrill JA,Noyce PR.Why is pain management suboptimal on surgical wards[J].J Adv Nurs,2001,33(6):728-737.
[17]Shen J,Giles SA,Kurtovic K,et al.Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face,Legs,Activity,Cry,Consolability(FLACC)Scale[J].Burns,2017,43(1):114-120.
[18]Pardesi O,Fuzaylov G.Pain management in pediatric burn patients:review of recent literature and future directions[J].J Burn Care Res,2017,38(6):335-347.
[19]Latarjet J,Choinere M.Pain in burn patients[J].Burns,1995,21(5):344-348.
[20]Taal LA,Faber AW.Post-traumatic stress,pain and anxiety in adult burn victims[J].Burns,1997,23(7-8):545-549.
[21]Connor-Ballard PA.Understanding and managing burn pain:Part 2[J].Am J Nurs,2009,109(5):54-62,63.
[22]Connor-Ballard PA.Understanding and managing burn pain:part 1[J].Am J Nurs,2009,109(4):48-56,57.
[23]孙颖,唐洪泰,王光毅,等.烧伤患者康复期疼痛护理的循证研究[J].解放军护理杂志,2016,33(12):14-18.
[24]Girtler R,Gustorff B.Pain management of burn injuries[J].Anaesthesist,2011,60(3):243-250.
[25]Choiniere M,Auger FA,Latarjet J.Visual analogue thermometer:a valid and useful instrument for measuring pain in burned patients[J].Burns,1994,20(3):229-235.
[26]Melzack R.The Mc Gill Pain Questionnaire:major properties and scoring methods[J].Pain,1975,1(3):277-299.
[27]Abbey J,Piller N,De Bellis A,et al.The Abbey pain scale:a 1-minute numerical indicator for people with end-stage dementia[J].Int J Palliat Nurs,2004,10(1):6-13.
[28]Merkel SI,Voepel-Lewis T,Shayevitz JR,et al.The FLACC:a behavioral scale for scoring postoperative pain in young children[J].Pediatr Nurs,1997,23(3):293-297.
[29]Elmasry M,Steinvall I,Thorfinn J,et al.Treatment of children with scalds by xenografts:report from a swedish burn centre[J].J Burn Care Res,2016,37(6):e586-e591.
[30]Linneman PK,Terry BE,Burd RS.The efficacy and safety of fentanyl for the management of severe procedural pain in patients with burn injuries[J].J Burn Care Rehabil,2000,21(6):519-522.
[31]Tosun Z,Esmaoglu A,Coruh A.Propofol-ketamine vs propofolfentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes[J].Paediatr Anaesth,2008,18(1):43-47.
[32]Nilsson A,Steinvall I,Bak Z,et al.Patient controlled sedation using a standard protocol for dressing changes in burns:patients'preference,procedural details and a preliminary safety evaluation[J].Burns,2008,34(7):929-934.
[33]Prakash S,Fatima T,Pawar M.Patient-controlled analgesia with fentanyl for burn dressing changes[J].Anesth Analg,2004,99(2):552-555.
[34]Le Floch R,Naux E,Pilorget A,et al.Use of remifentanil for analgesia during dressing change in spontaneously breathing non-intubated burn patients[J].Ann Burns Fire Disasters,2006,19(3):136-139.
[35]Rashaan ZM,Krijnen P,van den Akker-Van MM,et al.Clinical effectiveness,quality of life and cost-effectiveness of Flaminal(R)versus Flamazine(R)in the treatment of partial thickness burns:study protocol for a randomized controlled trial[J].Trials,2016,17(1):122.
[36]Mangano A,Albertin A,La Colla L.Patient controlled sedation using a standard protocol for dressing changes in burns:patients'preference,procedural details and a preliminary safety evaluation.Are studies always adequately powered and analyzed[J].Burns,2010,36(6):948,948-950.
[37]Nilsson A,Steinvall I,Bak Z,et al.Patient controlled sedation using a standard protocol for dressing changes in burns:patients'preference,procedural details and a preliminary safety evaluation[J].Burns,2008,34(7):929-934.
[38]Wilinski J,Lechowicz M,Kameczura T,et al.Non-steroidal antiinflammatory drugs and paracetamol in self-therapy of various disorders in students of different fields of study[J].Folia Med Cracov,2015,55(2):49-59.
[39]Childs C,Little RA.Acetaminophen(paracetamol)in the management of burned children with fever[J].Burns Incl Therm Inj,1988,14(5):343-348.
[40]Marret E,Kurdi O,Zufferey P,et al.Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects:meta-analysis of randomized controlled trials[J].Anesthesiology,2005,102(6):1249-1260.
[41]Visser E,Schug SA.The role of ketamine in pain management[J].Biomed Pharmacother,2006,60(7):341-348.
[42]Tawfic QA.A review of the use of ketamine in pain management[J].J Opioid Manag,2013,9(5):379-388.
[43]Williams PI,Sarginson RE,Ratcliffe JM.Use of methadone in the morphine-tolerant burned paediatric patient[J].Br J Anaesth,1998,80(1):92-95.
[44]Clark JD.Understanding methadone metabolism:a foundation for safer use[J].Anesthesiology,2008,108(3):351-352.
[45]周湘桂.烧伤创面换药操作痛控制性镇痛治疗的研究[D].南昌大学,2008.
[46]Alexander M,Daniel T,Chaudry IH,et al.Opiate analgesics contribute to the development of post-injury immunosuppression[J].J Surg Res,2005,129(1):161-168.
[47]Kohut SA,Stinson J.Psychological therapies for the management of chronic and recurrent pain in children and adolescents[J].Paediatr Child Health,2016,21(5):258-259.
[48]Li J,Zhou L,Wang Y.The effects of music intervention on burn patients during treatment procedures:a systematic review and metaanalysis of randomized controlled trials[J].BMC Complement Altern Med,2017,17(1):158.
[49]Protacio J.Patient-directed music therapy as an adjunct during burn wound care[J].Crit Care Nurse,2010,30(2):74-76.
[50]Tan X,Yowler CJ,Super DM,et al.The efficacy of music therapy protocols for decreasing pain,anxiety,and muscle tension levels during burn dressing changes:a prospective randomized crossover trial[J].J Burn Care Res,2010,31(4):590-597.
[51]Son JT,Kim SH.The effects of self-selected music on anxiety and pain during burn dressing changes[J].Taehan Kanho Hakhoe Chi,2006,36(1):159-168.
[52]Prensner JD,Yowler CJ,Smith LF,et al.Music therapy for assistance with pain and anxiety management in burn treatment[J].J Burn Care Rehabil,2001,22(1):83-88,82-83.
[53]Fratianne RB,Prensner JD,Huston MJ,et al.The effect of musicbased imagery and musical alternate engagement on the burn debridement process[J].J Burn Care Rehabil,2001,22(1):47-53.
[54]Christenberry EB.The use of music therapy with burn patients[J].J Music Ther,1979,16(3):138-148.
[55]Li J,Zhou L,Wang Y.The effects of music intervention on burn patients during treatment procedures:a systematic review and metaanalysis of randomized controlled trials[J].BMC Complement Altern Med,2017,17(1):158.
[56]Hoffman HG,Meyer WR,Ramirez M,et al.Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients[J].Cyberpsychol Behav Soc Netw,2014,17(6):397-401.
[57]Kipping B,Rodger S,Miller K,et al.Virtual reality for acute pain reduction in adolescents undergoing burn wound care:a prospective randomized controlled trial[J].Burns,2012,38(5):650-657.
[58]Hoffman HG,Chambers GT,Meyer WR,et al.Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures[J].Ann Behav Med,2011,41(2):183-191.
[59]Patterson DR,Wiechman SA,Jensen M,et al.Hypnosis delivered through immersive virtual reality for burn pain:a clinical case series[J].Int J Clin Exp Hypn,2006,54(2):130-142.
[60]Hoffman HG,Patterson DR,Carrougher GJ.Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy:a controlled study[J].Clin J Pain,2000,16(3):244-250.
[61]Baudoin J,Jafari P,Meuli J,et al.Topical negative pressure on burns:an innovative method for wound exudate collection[J].Plast Reconstr Surg Glob Open,2016,4(11):e1117.
[62]Mercado A,Pérez I,Sánchez V.Effect of a combined continuous and intermittent transcutaneous electrical nerve stimulation on pain perception of burn patients evaluated by visual analog scale:a pilot study[J].Local and Regional Anesthesia,2015(8):119-122.
[63]Sari Z,Polat MG,Ozgul B,et al.The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes[J].Burns,2014,40(5):909-914.
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