中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2013年
4期
216-221
,共6页
陈银花%钱丽冰%陈梦莹%曹兆兰%徐玉香%程锐%卢官明%李晓南
陳銀花%錢麗冰%陳夢瑩%曹兆蘭%徐玉香%程銳%盧官明%李曉南
진은화%전려빙%진몽형%조조란%서옥향%정예%로관명%리효남
插管法,气管内%静脉切开术%疼痛%疼痛测定%面部表情%婴儿,新生
插管法,氣管內%靜脈切開術%疼痛%疼痛測定%麵部錶情%嬰兒,新生
삽관법,기관내%정맥절개술%동통%동통측정%면부표정%영인,신생
Intubation,intratracheal%Phlebotomy%Pain%Pain measurement%Facial expression%Infant,newborn
目的 评估不同致痛性操作对新生儿疼痛评分和生理指标的影响. 方法 2009年3月1日至5月31日入住南京医科大学附属南京儿童医院新生儿医疗中心的新生儿108例,其中早产儿46例,足月儿62例.通过实时床边观察和数码录像收集新生儿从入院到出院期间所有诊疗需要所致的疼痛性操作过程,应用新生儿面部编码系统(Neonatal Facial Coding System,NFCS)、新生儿疼痛评估量表(Neonatal Infant Pain Scale,NIPS)及早产儿疼痛量表(Premature Infant Pain Profile,PIPP)评估新生儿的疼痛反应,同时记录操作前后患儿心率和血氧饱和度变化.采用Student-t检验、x2检验和重复测量方差分析比较不同致痛性操作对新生儿疼痛评分和生理指标的影响. 结果 早产儿共接受不同类型致痛性操作6966例次,经历最多的前3种致痛性操作分别为气管内吸引(23.6％,1645/6966)、口鼻腔吸引(18.3％,1278/6966)和外周静脉穿刺置管(17.2％,1195/6966),而足月儿经历最多的前3种致痛性操作分别为外周静脉穿刺置管(27.0％,989/3667)、拔除留置针(20.5％,751/3667)和去除胶布(18.4％,675/3667).早产儿致痛性操作疼痛评分较高的前3种分别是气管插管[NFCS(7.00±1.66)分,PIPP(14.08±3.54)分]、股静脉穿刺[NFCS(6.52±1.66)分,PIPP(12.15±3.11)分]和腋静脉穿刺[NFCS(5.75±1.89)分,PIPP(11.75±4.19)分]；足月儿致痛性操作疼痛评分较高的前3种分别是股静脉穿刺[NFCS(6.68±1.34)分,NIPS(5.58±1.32)分]、去除胶布[NFCS(6.00±1.41)分,NIPS(5.67±0.58)分]及腹壁静脉穿刺[NFCS(6.00±0.00)分,NIPS(5.50±0.71)分].不同类型的致痛性操作引起的足月儿心率(F=0.186,P=0.836)及血氧饱和度(F=1.672,P=0.198)变化差异无统计学意义. 结论 住院新生儿经历反复多次的致痛性操作,其中气管插管和股静脉穿刺可引起重度操作性疼痛,应加强新生儿的疼痛管理.
目的 評估不同緻痛性操作對新生兒疼痛評分和生理指標的影響. 方法 2009年3月1日至5月31日入住南京醫科大學附屬南京兒童醫院新生兒醫療中心的新生兒108例,其中早產兒46例,足月兒62例.通過實時床邊觀察和數碼錄像收集新生兒從入院到齣院期間所有診療需要所緻的疼痛性操作過程,應用新生兒麵部編碼繫統(Neonatal Facial Coding System,NFCS)、新生兒疼痛評估量錶(Neonatal Infant Pain Scale,NIPS)及早產兒疼痛量錶(Premature Infant Pain Profile,PIPP)評估新生兒的疼痛反應,同時記錄操作前後患兒心率和血氧飽和度變化.採用Student-t檢驗、x2檢驗和重複測量方差分析比較不同緻痛性操作對新生兒疼痛評分和生理指標的影響. 結果 早產兒共接受不同類型緻痛性操作6966例次,經歷最多的前3種緻痛性操作分彆為氣管內吸引(23.6％,1645/6966)、口鼻腔吸引(18.3％,1278/6966)和外週靜脈穿刺置管(17.2％,1195/6966),而足月兒經歷最多的前3種緻痛性操作分彆為外週靜脈穿刺置管(27.0％,989/3667)、拔除留置針(20.5％,751/3667)和去除膠佈(18.4％,675/3667).早產兒緻痛性操作疼痛評分較高的前3種分彆是氣管插管[NFCS(7.00±1.66)分,PIPP(14.08±3.54)分]、股靜脈穿刺[NFCS(6.52±1.66)分,PIPP(12.15±3.11)分]和腋靜脈穿刺[NFCS(5.75±1.89)分,PIPP(11.75±4.19)分]；足月兒緻痛性操作疼痛評分較高的前3種分彆是股靜脈穿刺[NFCS(6.68±1.34)分,NIPS(5.58±1.32)分]、去除膠佈[NFCS(6.00±1.41)分,NIPS(5.67±0.58)分]及腹壁靜脈穿刺[NFCS(6.00±0.00)分,NIPS(5.50±0.71)分].不同類型的緻痛性操作引起的足月兒心率(F=0.186,P=0.836)及血氧飽和度(F=1.672,P=0.198)變化差異無統計學意義. 結論 住院新生兒經歷反複多次的緻痛性操作,其中氣管插管和股靜脈穿刺可引起重度操作性疼痛,應加彊新生兒的疼痛管理.
목적 평고불동치통성조작대신생인동통평분화생리지표적영향. 방법 2009년3월1일지5월31일입주남경의과대학부속남경인동의원신생인의료중심적신생인108례,기중조산인46례,족월인62례.통과실시상변관찰화수마록상수집신생인종입원도출원기간소유진료수요소치적동통성조작과정,응용신생인면부편마계통(Neonatal Facial Coding System,NFCS)、신생인동통평고량표(Neonatal Infant Pain Scale,NIPS)급조산인동통량표(Premature Infant Pain Profile,PIPP)평고신생인적동통반응,동시기록조작전후환인심솔화혈양포화도변화.채용Student-t검험、x2검험화중복측량방차분석비교불동치통성조작대신생인동통평분화생리지표적영향. 결과 조산인공접수불동류형치통성조작6966례차,경력최다적전3충치통성조작분별위기관내흡인(23.6％,1645/6966)、구비강흡인(18.3％,1278/6966)화외주정맥천자치관(17.2％,1195/6966),이족월인경력최다적전3충치통성조작분별위외주정맥천자치관(27.0％,989/3667)、발제류치침(20.5％,751/3667)화거제효포(18.4％,675/3667).조산인치통성조작동통평분교고적전3충분별시기관삽관[NFCS(7.00±1.66)분,PIPP(14.08±3.54)분]、고정맥천자[NFCS(6.52±1.66)분,PIPP(12.15±3.11)분]화액정맥천자[NFCS(5.75±1.89)분,PIPP(11.75±4.19)분]；족월인치통성조작동통평분교고적전3충분별시고정맥천자[NFCS(6.68±1.34)분,NIPS(5.58±1.32)분]、거제효포[NFCS(6.00±1.41)분,NIPS(5.67±0.58)분]급복벽정맥천자[NFCS(6.00±0.00)분,NIPS(5.50±0.71)분].불동류형적치통성조작인기적족월인심솔(F=0.186,P=0.836)급혈양포화도(F=1.672,P=0.198)변화차이무통계학의의. 결론 주원신생인경력반복다차적치통성조작,기중기관삽관화고정맥천자가인기중도조작성동통,응가강신생인적동통관리.
Objective To assess the effects of different types of painful procedures on neonatal pain scores and physiological changes.Methods A prospective study was conducted in neonatal intensive care unit of Nanjing Children's Hospital from March 1,2009 to May 31,2009.Around-theclock bedside data of all painful procedures performed on 108 neonates (46 premature and 62 termbirth infants) from admission to discharge for diagnosis or treatment were collected through video,along with cardiac monitoring.Neonatal Facial Coding System (NFCS),Neonatal Infant Pain Scale (NIPS),Premature Infant Pain Profile (PIPP) and physiological changes (heart rate and blood oxygen saturation) were used to evaluate the pain that neonates experienced.Data were analyzed by Student-t test,Chi-square test and analysis of variance.Results There were 6966 painful procedures on preterm neonates,among which tracheal aspiration (23.6 ％,1645/6966),nasal aspiration (18.3％,1278/6966) and intravenous cannulation (17.2％,1195/6966) were the most frequently used.There were 3667 painful procedures on term neonates,among which,intravenous cannulation (27.0％,989/3667),removal of indwelling needle (20.5％,751/3667) and tape removal (18.4％,675/3667)were the most frequently used painful procedures on term ones.For preterm neonates,both NFCS and PIPP showed that tracheal intubation (7.00± 1.66 and 14.08±3.54),femoral venous puncture (6.52±1.66 and 12.15±3.11) and axillary vein puncture (5.75± 1.89 and 11.75±4.19) caused much more pain than other procedures.For term neonates,both NFCS and NIPS indicated that femoral venous puncture (6.68±1.34 and 5.58±1.32),tape removal (6.00±1.41 and 5.67±0.58)and abdominal wall vein puncture (6.00 ± 0.00 and 5.50 ± 0.71) were the top three painful procedures.No differences were found in heart rate and blood oxygen saturation changes caused by different types of painful procedures in term neonates (F=0.186,P=0.836; F=1.672,P=0.198).Conclusions Better pain management is important because neonates in neonatal intensive care unit were exposed to numerous types of invasive painful procedures,and tracheal intubations and femoral venous puncture are severe painful procedures.
