| Objective To evaluate the clinical effect of nitrous oxide inhalation technique(NOIT)on analgesia and sedation of dressing change in children with moderate and severe burns,and to investigate its optimal usage and pain management mode of dressing change in burns.Methods A retrospective non-randomized controlled study was conducted.From December 2019 to November 2021,140 hospitalized burn children who were admitted to the Department of Burns and Plastic Surgery of the Jinan Central Hospital met the inclusion criteria of this study.There were 82 males and 58 females,with age of(1.51±0.76)years,body mass of(12.32±2.33)kg,total burn area of(11.80±5.10)%TBSA and third degree burn area of(0.94±1.12)%TBSA.In the course of dressing change,42 cases were treated with NOIT for analgesia and sedation,which were set as the test group,98 cases were treated without analgesia and sedation,the total burn area was stratified by 5%,and 42 cases were randomly selected as the control group.In the two group,a dressing change during 3-14 days after burn was selected for the study.Face,legs,activity,cry and consolability(FLACC)scale scores which representing pain intensity and Ramsay Sedation Scale scores which representing the degree of sedation were collected before,during and after dressing change.The analgesia satisfaction scores of doctors and parents after dressing change,the duration of dressing change and the healing time of deep second degree wound were collected.Heart rate(HR),transcutaneous oxygen saturation(SpO2)and adverse events such as nausea and vomiting were collected before,during and after dressing change.Data were statistically analyzed with Mann-Whitney U test,chi-square test,analysis of variance for repeated measurement,independent samples t test and Bonferroni correction.Results There were no significant differences in pain intensity score and sedation score between the two groups before and after dressing change(t=0.145,0.281,-0.361,-0.161,P>0.05).At the immediate time after wound debridement,the pain intensity score of the test group was(2.48±0.67)score,which was significantly lower than(7.57±1.04)score in the control group(t=-26.689,P<0.001),the sedation degree in test group was(1.83±0.38)score,which was significantly higher than(1.21±0.42)score in control group(t=7.151,P<0.001).After dressing change,the satisfaction score of surgeons in the test group was(8.45±0.80)score,which was significantly higher than(6.26±1.08)score in the control group(t=10.529,P<0.001),the satisfaction score of parents in the test group was(8.38±0.94)score,which was higher than(7.90±1.01)score in the control group(t=2.244,P<0.05).The dressing change duration of test group was(20.43±5.33)minute,which was significantly less than(26.83±5.68)minute in control group(t=-5.326,P<0.001).The healing time of deep second degree wound between the two groups was similar,and there was no significant difference(t=-0.428,P>0.05).There were no significant differences in HR and SpO2 between the two groups before and after dressing change(t=0.750,-0.477,0.761,0.422,P>0.05).During dressing change,HR in test group was(120.36±14.72)beats per minute,which was significant lower than(151.40±6.83)beats per minute in control group(t=-12.395,P<0.001),SpO2 in test group was(99.02±0.81)%,which was significant higher than(97.29±1.70)%in control group(t=5.978,P<0.001).During dressing change,2 patients in the test group showed nausea and 1 patient showed euphoria,while HR in the control group continued to be higher than the normal range.Conclusions In the process of dressing change in children with moderate and severe burns,standardized use of NOIT for analgesia and sedation is safe and effective,and can effectively control the pain of dressing change.It is feasible and efficient to adopt nurse-centered management mode of burn dressing change pain. |
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