儿童手术后疼痛指标的临床和实验室变化

Semkovych Ya.V
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Inclusion criteria: age 7-18 years; indication for surgery for acute appendicitis; American Society of Anesthesiologists (ASA) Anesthesia Risk Score I and II; parental consent for the children to participate in the study.Acute pain intensity was measured using the Visual Analog Scale (VAS) and the Face, Legs, Activity, Cry, Consolability(FLACC) scale. Key vital signs assessed included heart rate, respiratory rate, systolic and diastolic blood pressure, and oxygen saturation (SpO2). In addition, laboratory indicators including leukocyte count, blood glucose level, erythrocyte sedimentation rate, and TLR-4 and CD40L levels were determined. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki«Ethical Principles for Medical Research Involving Human Subjects» (Minutes of the Ethics Committee No. 2, dated February 24, 2002). Statistical analysis was performed on a personal computer using Statistica 10 software, using parametric and nonparametric statistical methods. The study is a part of the research project of the Department of Children’s Diseases of the Postgraduate Medical Education Faculty of the Ivano- Frankivsk National Medical University «Health Status and Adaptation of Children from the Precarpathian  Region with Somatic Diseases, Their Prevention» 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results. The mean age of the children was 13.8±0.23 years, while the mean body weight was 40.9±1.6 kg. Gender assessment showed no diff erences between boys and girls (55.4 % and 44.6 %, respectively, р>0.05).The study showed very strong positive correlations (r=0.9-1.0) between acute pain assessment scores on the VAS and FLACCscale and heart rate, blood glucose levels; strong positive correlations (r=0.7-0. 9) with total leukocyte count and erythrocytesedimentation rate; moderate positive correlations (r=0.5-0.7) with serum TLR4 and CD40L levels; weak positive correlations(r<0.5) with diastolic blood pressure, SpO2, and opioid and non-opioid analgesic administration.Conclusions. The observed positive correlations between acute pain scores on the VAS and FLACC scale and proinflammatory indicators may support the theory of involvement of these markers in the generation of acute pain in pediatricpatients. 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引用次数: 0

摘要

儿童术后疼痛仍是儿科重症监护中的一个重要问题,这可能与管理方法不完善有关。长期的术后疼痛会延迟康复和复健,增加治疗成本,并延长阿片类药物的使用时间。围手术期疼痛处理不当会导致各种术后并发症,尽管使用了公认的临床、实验室和仪器指标,但对这些并发症的预测仍然难以实现。本研究旨在评估腹部手术后儿童的临床和实验室变化及其与急性疼痛量表的相关性。研究纳入了 83 名在阿片类药物麻醉下接受腹部手术的 7-18 岁儿童。纳入标准:7-18 岁;急性阑尾炎手术指征;美国麻醉医师协会(ASA)麻醉风险评分 I 级和 II 级;家长同意儿童参与研究。评估的主要生命体征包括心率、呼吸频率、收缩压和舒张压以及血氧饱和度(SpO2)。此外,还测定了白细胞计数、血糖水平、红细胞沉降率、TLR-4 和 CD40L 水平等实验室指标。所有临床和实验室研究均按照世界医学协会赫尔辛基宣言 "涉及人类受试者的医学研究伦理原则"(2002 年 2 月 24 日伦理委员会第 2 号会议记录)进行。统计分析在个人电脑上使用 Statistica 10 软件,采用参数和非参数统计方法进行。本研究是伊万诺-弗兰科夫斯克国立医科大学医学教育研究生院儿童疾病系研究项目 "前喀尔巴阡地区患有躯体疾病儿童的健康状况和适应性及其预防"(2021-2026 年)的一部分,国家注册号为 0121U111129;作者为共同研究者。儿童的平均年龄为(13.8±0.23)岁,平均体重为(40.9±1.6)公斤。性别评估显示,男孩和女孩之间没有差异(分别为 55.4 % 和 44.6 %,р>0.05)。研究显示,VAS 和 FLACCscale 的急性疼痛评估得分与心率、血糖水平之间存在很强的正相关性(r=0.9-1.0);与白细胞总数之间存在很强的正相关性(r=0.7-0.9)。7-0.9);与血清TLR4和CD40L水平呈中度正相关(r=0.5-0.7);与舒张压、SpO2、阿片类和非阿片类镇痛药用量呈弱正相关(r<0.5)。所观察到的 VAS 和 FLACC 量表上的急性疼痛评分与促炎指标之间的正相关性可能支持这些指标参与儿科患者急性疼痛产生的理论。不过,还需要进一步研究术后急性疼痛的产生机制,确定与慢性疼痛中痛觉相关的标记物,并制定儿童这些病症的预防策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CLINICAL AND LABORATORY CHANGES IN POSTSURGICAL PAIN MARKERS IN CHILDREN
Pos toperative pain in children remains a signifi cant problem in pediatric intensive care, possibly related to an imperfectalgorithm for its management. Prolonged postoperative pain delays recovery and rehabilitation, increases treatment costs,and prolongs opioid use. Inadequate perioperative pain management can lead to a variety of postoperative complications, the prediction of which remains elusive despite the use of commonly accepted clinical, laboratory, and instrumental indicators. The aim of this study was to evaluate clinical and laboratory changes in children after abdominal surgery and their correlation with acute pain scales.Material and Methods. The study included 83 children aged 7-18 years who underwent abdominal surgery under opioid anesthesia. Inclusion criteria: age 7-18 years; indication for surgery for acute appendicitis; American Society of Anesthesiologists (ASA) Anesthesia Risk Score I and II; parental consent for the children to participate in the study.Acute pain intensity was measured using the Visual Analog Scale (VAS) and the Face, Legs, Activity, Cry, Consolability(FLACC) scale. Key vital signs assessed included heart rate, respiratory rate, systolic and diastolic blood pressure, and oxygen saturation (SpO2). In addition, laboratory indicators including leukocyte count, blood glucose level, erythrocyte sedimentation rate, and TLR-4 and CD40L levels were determined. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki«Ethical Principles for Medical Research Involving Human Subjects» (Minutes of the Ethics Committee No. 2, dated February 24, 2002). Statistical analysis was performed on a personal computer using Statistica 10 software, using parametric and nonparametric statistical methods. The study is a part of the research project of the Department of Children’s Diseases of the Postgraduate Medical Education Faculty of the Ivano- Frankivsk National Medical University «Health Status and Adaptation of Children from the Precarpathian  Region with Somatic Diseases, Their Prevention» 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results. The mean age of the children was 13.8±0.23 years, while the mean body weight was 40.9±1.6 kg. Gender assessment showed no diff erences between boys and girls (55.4 % and 44.6 %, respectively, р>0.05).The study showed very strong positive correlations (r=0.9-1.0) between acute pain assessment scores on the VAS and FLACCscale and heart rate, blood glucose levels; strong positive correlations (r=0.7-0. 9) with total leukocyte count and erythrocytesedimentation rate; moderate positive correlations (r=0.5-0.7) with serum TLR4 and CD40L levels; weak positive correlations(r<0.5) with diastolic blood pressure, SpO2, and opioid and non-opioid analgesic administration.Conclusions. The observed positive correlations between acute pain scores on the VAS and FLACC scale and proinflammatory indicators may support the theory of involvement of these markers in the generation of acute pain in pediatricpatients. However, further research is needed to investigate the mechanisms of acute postoperative pain generation, to identify markers related to nociception in chronic pain, and to develop preventive strategies for these conditions in children.
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