CAJ | 학술논문

目的设计多感官型分心装置(MMD),观察其在烧伤换药和其他医疗过程中减轻患儿焦虑和疼痛的效果.方法设计3项前瞻性、随机对照临床试验.选择澳大利亚布里斯班皇家儿童医院烧伤中心和骨折整形外科患儿182例,共计354个医疗过程,分别应用标准分心法、手握电子游戏机和MMD(前MMD-D型、MMD-D型及MMD-PP型).采用改良面部表情评分法、面部疼痛评分法、视觉模拟评分法及Wong-Baker面部表情疼痛评分法,记录患儿报告的疼痛分数、父母和护理人员报告的患儿焦虑和疼痛分数以及换药时间.结果与标准分心法组和电子游戏机组[(3.60±0.25)、(3.83±1.49)分]比较,MMD-D组与MMD-PP组患儿首次换药时的疼痛分数[(2.13±0.23)、(2.15±0.17)分]显著降低(P<0.01),换药时间明显缩短(P<0.01),且MMD在连续3次换药过程中均能发挥缓解疼痛的作用.此外,MMD-PP组患儿在换药前由焦虑引起的疼痛分数也较其他组显著降低(P<0.01).结论 MMD较标准分心法和手握电子游戏机更能有效减轻患儿伤口处理过程中的焦虑和疼痛.该装置仍在临床试验中,且继续显示其有效性.
목적 설계다감관형분심장치(MMD),관찰기재소상환약화기타의료과정중감경환인초필화동통적효과.방법 설계3항전첨성、수궤대조림상시험.선택오대리아포리사반황가인동의원소상중심화골절정형외과환인182례,공계354개의료과정,분별응용표준분심법、수악전자유희궤화MMD(전MMD-D형、MMD-D형급MMD-PP형).채용개량면부표정평분법、면부동통평분법、시각모의평분법급Wong-Baker면부표정동통평분법,기록환인보고적동통분수、부모화호리인원보고적환인초필화동통분수이급환약시간.결과 여표준분심법조화전자유희궤조[(3.60±0.25)、(3.83±1.49)분]비교,MMD-D조여MMD-PP조환인수차환약시적동통분수[(2.13±0.23)、(2.15±0.17)분]현저강저(P<0.01),환약시간명현축단(P<0.01),차MMD재련속3차환약과정중균능발휘완해동통적작용.차외,MMD-PP조환인재환약전유초필인기적동통분수야교기타조현저강저(P<0.01).결론 MMD교표준분심법화수악전자유희궤경능유효감경환인상구처리과정중적초필화동통.해장치잉재림상시험중,차계속현시기유효성.
Objective Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, com-bined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effec-tiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Methods Three separate prospective randomized control tri-als involving 182 children having 354 dressing changes were conducted in the burns and orthopedic depart-ments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregivcr and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. Results MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain daring proce-dures compared to standard care and video games (P<0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. Conclusions MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show positive clinical outcomes.