| BackgroundNowadays, the phenomenon of burned children (1～17years old) is very common. Pediatric burn patients’wound dressing is the important premise of wound healing, and pain along with wound surface dressing change may cause persistent physiological and psychological harm to pediatric burn patients. So the pain remission during wound surface dressing change on pediatric burn patients is a multiple problem related to both children’s wound repair and the stabilization of their families and the society. Opioids are recognized as the cornerstone of pain remission in the world. However, using Opioids as a routine in pediatric burn patients during wound surface dressing change for pain remission has not been reported in relevant literature in our country at present; meanwhile, the theme about pediatric burn patients’ pain remission during wound surface dressing change is rarely reported in our country now either. Therefore, to relieve the pain of pediatric burn patients’ wound surface dressing change is a way to effectively promote one focuses of the quality of nursing service for domestic pediatric burn patients.50% nitrous oxide also has another name "Entonox". It has being used a lot in inpatient and outpatient departments for pain remission (including burn wound surface dressing change), it is also using for pre-hospital first aid pain remission in many Europe countries and America. The qualified doctors and nurses who have been trained and have passed the examination can practice the analgesic device.50% nitrous oxide is usually used for conscious operation analgesia, such as painless labor, endoscopy and so on. The literature of 50% nitrous oxide using in adult burn patients during wound surface dressing change for pain remission is published by our research team before, and there are not any reports about its use in pediatric burn patients for analgesia in the literature we have searched.Objectives1、To investigate the doctors’ and nurses’ understanding in scientific, feasibility and acceptability of current pain remission during wound surface dressing change among pediatric burn patients and their attitudes toward the application of 50% nitrous oxide in pain remission;2、To verify the pain remission effect of 50% nitrous oxide in pediatric burn patients during and after wound surface dressing change; and to definite the pain remission satisfaction of inhaling 50% nitrous oxide during and after wound surface dressing change in pediatric burn patients;3、To establish a primary pain remission scheme of 50% nitrous oxide for pediatric burn patients wound surface dressing change, then to propagandize and generalize the using of 50% nitrous oxide.MethodCase study, literature research, qualitative Interviews and randomized controlled trial.1、To investigate the situation of pain remission of 268 pediatric burn patients during wound surface dressing change in department of burn, a university-affiliated hospital on the basis of case study. To explore the pain remission method at home and abroad in pediatric burn patients during wound surface dressing change through the literature review, and combining them with the previous results of our research group of using 50% nitrous oxide in adult burn patients during and after wound surface dressing change, to explore a method which has strong operability, good effect, and convenient to relieve pain during wound surface dressing change for Chinese pediatric burn patients.2、Based on the literature review and qualitative research, a phenomenological research method was used in this part. A qualitative research "doctors’ and nurses’ cognition of inhaling 50% nitrous oxide in pediatric burn patients for wound surfac e dressing pain remission" in department of burn, a university-affiliated hospital was conducted. Before the interview, the author set up a Semi-structured interview outli ne, then sent the outline to 2 senior experts for examination, after that the author d id verify and perfect the outline, and then carried out it by depth interviews. After obtained the information, two members of our research group did the analysis.3、After obtained the qualification of Clinical Trials and the Ethics Committee of The hospital. According to inclusion and exclusion criteria, the research "50% nitrous oxide inhaling in 120 pediatric burn patients during wound surface dressing change for pain remission" was conducted in department of burn, the hospital of Second Military Medical University of Chinese PLA. The observation target includes heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), oxygen saturation (SPO2), the score of Changhai Pain Rating Scale, and negative-effect, and the method’s satisfaction of pediatric burn patients.Results1. Study on the case study, the existing literature and the previous study results of our research group indicates that there is a gap between our country and European countries and America, where the medical system is relatively wholesome in pediatric burn patients during wound dressing change pain remission. Because of anesthetist do not guide the use of Opioids in clinic, and the relatives worrying about the negative effect to the body of pediatric burn patients. All of these reasons limited the development of burn dressing management.2. The qualitative study on perception of doctors and nurses about 50% nitrous oxide inhaling using in pediatric burn patients for pain remission showed that:①Doctors and nurses felt sympathy for pediatric burn patients and believed that a gap existed between current situation and expected one in pain remission. And to prescribe analgesics during wound surface dressing change for pediatric burn patients was unfavorable; Given the fact that 50% nitrous oxide was effective in pain remission for adult burn patients, doctors and nurses tended to apply it to pediatric burn patients during wound surface dressing change after provided the literature concerning children using 50% nitrous oxide; Guidelines of the application of 50% nitrous oxide during wound surface dressing change for pediatric burn patients render further modification.②Doctors and nurses were unsatisfactory with pain remission for pediatric burn patients.③Doctors and nurses supported the application of 50% nitrous oxide during wound surface dressing change for pediatric burn patients. Meanwhile, they hoped that administrators would also support it.3. A randomized, simple-blind controlled study.(1)①There was no statistical differences on the proportion of gender and age between two groups. There were no statistical differences between control group and experimental group in the levels of HR, SBP, DBP, and SPO2 before dressing change (P>0.05). Compared with those of control group, the levels of HR, SBP, DBP, and SPO2 in experimental group were significantly ameliorated during dressing change (P<0.01). After dressing change, the levels of DBP in the two groups were close (P>0.05), but the levels of HR, SBP, and SPO2 showed statistical differences (P<0.01). Before dressing change, the pain scores were approximate between control group and experimental group (P>0.05). Compared with those in control group, the pain scores were significantly lowered in experimental group during and after dressing change (P<0.01), and the result of the covariance analysis of pain scores during dressing change showed statistical significance differences (F=867.956, P<0.001).(2) Negative effects and satisfactory degree there were no obvious negative effects in two groups during and after wound surface dressing change. The control group was not satisfied with the pain remission effect, while the experimental group was all satisfied with the pain remission effect.4. Handbook of 50% nitrous oxide inhaling in pediatric burn patients during wound surface dressing change pain remission for people’s practice was set up on the bases of the literature review and clinic.Conclusion1. Nowadays domestic pediatric burn patients’pain remission during wound surface dressing change develops slowly; there is a gap between developed countries.2.50% nitrous oxide has been used in pediatric burn patients during wound surface dressing change for pain remission in a routine in many developed countries, while such literature sporadically reported in our country.3. Doctors and nurses supported the application of 50% nitrous oxide during wound surface dressing change for burn children.4. Pediatric burn patients inhaling 50% nitrous oxide during wound surface dressing change for pain remission has obvious effects in our country. |
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