新生儿重症监护病房新生儿疼痛的评估及其干预措施的临床研究

摘要

Objective To study the pain controlling effects of non-pharmaceutical interventions in neonatal intensive care unit (NICU) setting. Methods Infants who received radial artery puncture were assigned into control group, non-nutritive sucking (NNS) group and NNS plus glucose (NNS + GS) group according to their admission sequences. Each group contained 20 patients. Heart rate ( HR), respiratory rate (RR) and oxygen saturation (SpO2 ) before and after the procedure were monitored using Multi-Parameter Monitor ECG. Neonatal pain was evaluated using the preterm infant pain profile (PIPP). Results Among all three groups, after radial artery puncture, HR and RR were significantly increased, and SpO2 was significantly decreased (P < 0. 01). HR, RR and SpO2 variations in NNS group and NNS + GS group were less significant than the control group (P < 0. 05), and recovered to baseline more quickly. During the radial artery puncture, PIPP scores of infants in NNS and NNS + GS group were significantly lower than the control group (P < 0. 01), with NNS + GS group lower than NNS group (P <0. 05). Conclusions HR, RR and SpO2 can be used as physiological indicators of neonatal pain. PIPP score is simple and practical to be used in NICU setting. Both NNS and NNS + GS can partially relieve neonatal pain, and NNS + GS works better.%目的：通过对新生儿重症监护病房(NICU)接受桡动脉穿刺的新生儿进行疼痛评分,观察其非药物干预的止痛效果。方法将接受桡动脉穿刺的新生儿按入院顺序随机分为3组：(1)对照组；(2)非营养性吸吮组(NNS 组)；(3)非营养性吸吮＋葡萄糖组(NNS ＋ GS 组)。应用多参数心电监护仪监测各组新生儿穿刺前后经皮血氧饱和度(SpO2)、心率和呼吸频率变化及应用新生儿疼痛评分简表(PIPP)对各组新生儿疼痛进行评分。结果各组新生儿在遭受桡动脉穿刺时的心率、呼吸频率均增快,SpO2降低(P 均＜0.01),其中 NNS 组及 NNS ＋ GS 组干预后心率、呼吸频率、SpO2的变化较对照组小(P ＜0.05),且可较快恢复至穿刺前。桡动脉穿刺后行 PIPP 评分,NNS组、NNS ＋ GS 组明显低于对照组,差异有显著统计学意义(P ＜0.01)。 NNS ＋ GS 组 PIPP 评分低于NNS 组,差异有统计学意义(P ＜0.05)。结论(1)心率、呼吸频率、SpO2可作为评价新生儿疼痛的生理指标,PIPP 疼痛评分简便、实用,可在临床推广应用。(2)非营养性吸吮及非营养性吸吮联合葡萄糖均能缓解新生儿疼痛,但非营养性吸吮联合葡萄糖止痛效果更好。