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儿童疼痛的评估和处理

Authors
Julie Hauer, MD
Barbara L Jones, PhD, MSW
Section Editor
David G Poplack, MD
Deputy Editor
Melanie S Kim, MD
Translators
陈幼芬, 副主任医师

引言

疼痛的评估和处理是儿科保健的基本组成部分。在儿童尤其是幼儿中，识别是否存在疼痛及疼痛的严重程度并对疼痛进行治疗是一种挑战。为确保所有年龄段的儿童均能获得充分的疼痛控制，根据儿童的认知能力使用评估工具是很重要的。

儿童疼痛的评估和疼痛处理的概述将总结在此。新生儿的评估和疼痛处理将单独讨论。 (参见“新生儿疼痛评估”和“新生儿疼痛的预防和治疗”)

评估

小儿疼痛的评估包括：确定疼痛的基础类型、来源和部位以及严重程度。

疼痛的类型 — 疼痛是指不愉快的躯体或内脏感觉，伴有真实的、潜在的或感知到的组织损伤。根据基础病理生理学，将疼痛分为伤害性疼痛和神经病理性疼痛。确定疼痛的类型有助于识别疼痛的病因，而病因可指导治疗的选择。 (参见“癌症疼痛的评估”，关于‘推断性病理生理机制(癌症疼痛的类型)’一节)

●伤害性疼痛是由组织损伤和炎症刺激完整的疼痛感受器引起的疼痛(图 1)。伤害性疼痛可分为感受器在皮肤、软组织、骨骼肌和骨的躯体痛和感受器在内脏器官如肾脏和胃肠道的内脏痛。躯体痛定位明确，被描述为锐痛、持续钝痛、挤压痛、刀刺痛或跳痛。内脏痛通常定位不明确，常常被描述为钝痛、绞痛或持续的钝绞痛。

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-03.
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References
Top
  1. Hauer JM, Wical BS, Charnas L. Gabapentin successfully manages chronic unexplained irritability in children with severe neurologic impairment. Pediatrics 2007; 119:e519.
  2. Hauer J. Identifying and managing sources of pain and distress in children with neurological impairment. Pediatr Ann 2010; 39:198.
  3. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002; 347:1094.
  4. Beyer JE, Denyes MJ, Villarruel AM. The creation, validation, and continuing development of the Oucher: a measure of pain intensity in children. J Pediatr Nurs 1992; 7:335.
  5. Wong DL, Hockenberry-Eaton M, Wilson D, et al. Wong's Essentials of Pediatric Nursing, Mosby, St Louis 2001. Vol 6.
  6. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988; 14:9.
  7. Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126:e1168.
  8. Breau LM, Camfield C, McGrath PJ, et al. Measuring pain accurately in children with cognitive impairments: refinement of a caregiver scale. J Pediatr 2001; 138:721.
  9. Breau LM, McGrath PJ, Camfield CS, Finley GA. Psychometric properties of the non-communicating children's pain checklist-revised. Pain 2002; 99:349.
  10. Malviya S, Voepel-Lewis T, Burke C, et al. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth 2006; 16:258.
  11. Voepel-Lewis T, Merkel S, Tait AR, et al. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg 2002; 95:1224.
  12. Hunt AM. A survey of signs, symptoms and symptom control in 30 terminally ill children. Dev Med Child Neurol 1990; 32:341.
  13. Hunt A, Burne R. Medical and nursing problems of children with neurodegenerative disease. Palliat Med 1995; 9:19.
  14. Solodiuk J, Curley MA. Pain assessment in nonverbal children with severe cognitive impairments: the Individualized Numeric Rating Scale (INRS). J Pediatr Nurs 2003; 18:295.
  15. Voepel-Lewis T, Malviya S, Tait AR, et al. A comparison of the clinical utility of pain assessment tools for children with cognitive impairment. Anesth Analg 2008; 106:72.
  16. Beyer JE, McGrath PJ, Berde CB. Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. J Pain Symptom Manage 1990; 5:350.
  17. Berde C, Wolfe J. Pain, anxiety, distress, and suffering: interrelated, but not interchangeable. J Pediatr 2003; 142:361.
  18. Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatr Clin North Am 2007; 54:645.
  19. McGrath PA. Development of the World Health Organization Guidelines on Cancer Pain Relief and Palliative Care in Children. J Pain Symptom Manage 1996; 12:87.
  20. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. p.37. http://apps.who.int/medicinedocs/documents/s19116en/s19116en.pdf. (Accessed on July 07, 2013).
  21. Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2013; :CD005179.
  22. Dart RC, Rumack BH. Intravenous acetaminophen in the United States: iatrogenic dosing errors. Pediatrics 2012; 129:349.
  23. Greco C, Berde C. Pain management for the hospitalized pediatric patient. Pediatr Clin North Am 2005; 52:995.
  24. Williams DG, Patel A, Howard RF. Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. Br J Anaesth 2002; 89:839.
  25. Bruera E, Sweeney C. Methadone use in cancer patients with pain: a review. J Palliat Med 2002; 5:127.
  26. Moryl N, Coyle N, Foley KM. Managing an acute pain crisis in a patient with advanced cancer: "this is as much of a crisis as a code". JAMA 2008; 299:1457.
  27. Murphy EJ. Acute pain management pharmacology for the patient with concurrent renal or hepatic disease. Anaesth Intensive Care 2005; 33:311.
  28. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manage 2004; 28:497.
  29. Portenoy RK, Sibirceva U, Smout R, et al. Opioid use and survival at the end of life: a survey of a hospice population. J Pain Symptom Manage 2006; 32:532.
  30. Hauer J. Improving comfort in children with severe neurological impairment. Prog Palliat Care 2012; 20:349.