粘膜炎疼痛及其与白细胞计数的时间关系。

IF 1.7 4区 医学 Q2 ANESTHESIOLOGY
Pediatric Anesthesia Pub Date : 2025-04-01 Epub Date: 2025-01-06 DOI:10.1111/pan.15063
Claire Douglas, James D Morse, Brian J Anderson
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引用次数: 0

摘要

背景:接受化疗和/或放疗导致中性粒细胞减少的儿童可能会患上疼痛性粘膜炎。我们探讨了因免疫抑制而患粘膜炎的儿童的疼痛评分与白细胞计数之间的关系,并评估了阿片类药物和氯胺酮镇痛的影响:方法:儿科肿瘤学和血液学病房护理的粘膜炎患儿在转诊至儿科疼痛服务部门进行静脉镇痛后,被邀请参加这项观察性研究。每天记录疼痛评分、白细胞计数、中性粒细胞计数和镇痛需求,直到静脉镇痛停止或过渡到口服镇痛为止。使用非线性混合效应模型对数据进行分析,该模型使用乙叉最大效应(EMAX)模型寻求白细胞计数与疼痛评分之间的关系。确定了镇痛剂的使用对疼痛评分的影响。白细胞计数与疼痛评分之间的时间关系采用具有平衡半衰期的延迟效应模型:从 2022 年 1 月到 2023 年 12 月,50 名儿童参加了研究。白细胞计数上升与疼痛反应之间的平衡半衰期为 0.29 天。初始疼痛评分(已开始接受扑热息痛和曲马多治疗的儿童的估计值)为 6.3(最大疼痛为 10)。疼痛的最大减轻幅度是初始疼痛评分的 59%。吗啡和氯胺酮可进一步减轻疼痛;阿片类药物的最大缓解率为 38%,氯胺酮的最大缓解率为 11%:结论:粘膜炎疼痛的缓解与严重中性粒细胞减少期后白细胞计数的增加有关,而白细胞计数是中性粒细胞计数的代用指标。镇痛反应延迟约 1 天。与使用阿片类药物或氯胺酮的镇痛效果相比,白细胞计数增加所带来的镇痛效果更为显著。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mucositis Pain and Its Temporal Relationship to White Cell Count.

Background: Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.

Methods: Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (EMAX) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half-time.

Results: Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half-time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.

Conclusion: Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.

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来源期刊
Pediatric Anesthesia
Pediatric Anesthesia 医学-麻醉学
CiteScore
3.20
自引率
11.80%
发文量
222
审稿时长
3-8 weeks
期刊介绍: Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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