四分之一定位触摸法对新生儿桡动脉采血中疼痛程度及生命体征稳定性的影响

Application effect of quarter positioning combined touch method on the degree of pain in neonatal radial artery blood sampling and its influence and the stability of vital signs

目的探讨四分之一定位联合触摸法应用于新生儿桡动脉采血中对其生命体征稳定性和疼痛程度的影响。方法选取2019-08-12-2021-07-12郑州大学附属儿童医院103名新生儿作为研究对象。采用随机数字表法分组,对照组51名给予触摸法行桡动脉采血,观察组52名给予四分之一定位联合触摸法行桡动脉采血。对比2组新生儿穿刺效果,包括首次采血成功率、采血时间、皮下出血情况,采用新生儿疼痛评估量表(NIPS)评分和面部编码系统(NFCS)评分评估新生儿疼痛程度,采用心电监护仪记录2组新生儿的心率、呼吸频率及血氧饱和度水平。采用SPSS 23.0对数据进行统计学分析。结果观察组首次采血成功率为88.46%,高于对照组70.59%,皮下出血率为13.46%,低于对照组37.25%,差异有统计学意义,χ^(2)值分别为5.067和7.724,P值分别为0.024和0.005;观察组采血时间为(2.03±0.36)min,低于对照组(4.95±0.45)min,差异有统计学意义,t=36.400,P<0.001;观察组穿刺结束时新生儿NIPS评分、NFCS评分分别为(2.55±0.54)分和(2.81±0.70)分,均低于对照组(3.42±0.60)分和(4.22±0.78)分,差异有统计学意义,t值分别为7.738和9.660,均P<0.001;观察组穿刺结束时新生儿呼吸频率、心率分别为(46.20±1.85)次/min和(134.65±3.42)次/min,均低于对照组(50.50±2.03)次/min和(138.67±3.55)次/min,血氧饱和度为(97.32±0.88)%,高于对照组(96.53±0.60)%,差异有统计学意义,t值分别为11.240、5.853和5.332,均P<0.001。结论触摸法联合四分之一定位在新生儿桡动脉采血过程中具有显著效果,能够有效提高首次采血成功率,降低皮下出血率、疼痛程度和采血时间,保持新生儿生命体征平稳,具有临床推广价值。

Objective To investigate the influence of the combination of the quartile position and touch method on the stability of vital signs and pain degree of neonates in radial artery blood sampling.Methods Totally 103 newborns from the cChildren’s Hospital Affiliated to Zhengzhou University from August 12,2019 to July 12,2021 were selected as the research objects.51 patients in the control group were given radial artery blood collection by touch method,and 52 patients in the observation group were given radial artery blood collection by quarter positioning combined with touch method.The puncture effects of the two groups of newborns were compared,including the success rate of the first blood collection,the time of blood collection,and the subcutaneous hemorrhage,Neonatal pain assessment scale(NIPS)score and NeonatalFacial Coding System(NFCs)score were used to evaluate the degree of neonatal pain.Ecg monitor was used to record the heart rate,respiratory rate and oxygen saturation level of neonates in the two groups.SPSS 23.0 was used for statistical analysis of the data.Results The success rate of first blood collection in the observation group was 88.46%,higher than that in the control group(70.59%).The subcutaneous bleeding rate was 13.46%,lower than that in the control group(37.25%),the difference was statistically significant(χ^(2)=5.067,7.724,P=0.024,0.005).The blood collection time of observation group was(2.03±0.36)min,which was lower than that of control group(4.95±0.45)min,and the difference was statistically significant(t=36.400,P<0.001).NIPS scores and NFCS scores of neonates in the observation group at the end of puncture were(2.55±0.54)points and(2.81±0.70)points,respectively,lower than those in the control group(3.42±0.60)points and(4.22±0.78)points,with statistically significant differences(t=7.738,9.660,all P<0.001);at the end of puncture,the respiratory rate and heart rate of neonates in the observation group were(46.20±1.85)times/min and(134.65±3.42)times/min,respectively,lower than(50.50±2.03)times/min and(138.67±3.55)times/min in the control group.The blood oxygen saturation was(97.32±0.88)%,higher than that of the control group(96.53±0.60)%,and the difference was statistically significant(t=11.240,5.853,5.332,all P<0.001).Conclusion The touch method combined with quarter positioning has significant effect in the process of neonatal radial artery blood collection,which can effectively improve the success rate of initial blood collection,reduce the rate of subcutaneous bleeding,pain degree and blood collection time,and keep the vital signs of neonates stable,which has clinical popularization value.