非营养性吸吮缓解侵入性护理操作所致新生儿疼痛效果的系统评价

The Efficacy of Non-Nutritive Sucking Interventions for Alleviating Neonatal Pain Caused by Invasive Nursing Procedures:A Systematic Review

目的系统评价非营养性吸吮缓解侵入性护理操作所致新生儿疼痛的效果,为临床新生儿疼痛的管理提供循证护理证据。方法计算机检索PubMed/MEDLINE、EBSCO、OVID、EMBase、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国知网(CNKI),并辅助手工检索和引文检索,全面获取相关内容资料。根据纳入、排除标准,由两名研究者独立筛选文献、方法学质量评价和资料提取。采用RevMan5.0.25统计软件进行Meta分析。结果经筛选共纳入8篇临床对照试验文献进行系统评价。非营养性吸吮较常规护理更能稳定新生儿足跟采血期间和采血后恢复期的心率、足跟采血后恢复期的血氧饱和度,差异均有统计学意义(P<0.01),但新生儿足跟采血期间和采血后恢复期的呼吸频率和血压、足跟采血期间的血氧饱和度比较,差异均无统计学意义(P>0.05);可缩短新生儿足跟采血时啼哭和疼痛面容的持续时间、减小足跟采血后恢复期啼哭新生儿所占的比例,差异均有统计学意义(P<0.01);可减少新生儿侵入性护理操作时的早产儿疼痛简表(PIPP)评分、新生儿面部编码系统(NFCS)评分、新生儿急性疼痛行为量表(DAN)评分、新生儿疼痛量表(NIPS)评分,差异均有统计学意义(P<0.05)。结论非营养性吸吮能有效缓解新生儿疼痛时行为反应,减少新生儿侵入性护理操作时疼痛量表的评分,但并不能有效减轻新生儿疼痛时的生理反应。

Objective To systematically evaluate the efficacy of non - nutritive sucking in alleviating neonatal pain caused by invasive nursing so as to provide evidence for clinical management of neonatal pain. Methods Data in PubMed/MED- LINE, EBSCO, OVID, EMBase, Cochrane Library, CBM and CNKI were retrieved in computer, at the same time, reference retrieval and manual searching were conducted to comprehensively acquire related data. According to inclusion and exclusion crite- ria, documents screening, quality assessment of methodology and data extraction were done by two researchers respectively. RevMan5.0. 25 statistical software was adopted to do Meta - analysisl Results Eight literatures of CCTs were includ- ed in the systematic review. Compared with usual care, non - nutritive sucking （NNS） could better stabilize heart rate （HR） during and after heel lance and better stabilize blood oxygen saturation after heel lance （P 〈0.01 ） . However, the difference of respiratory rate （RR） and blood pressure （BP） during and after heel lance, blood oxygen saturation during heel lance was not statistically significant （ P 〉0. 05 ）. NNS can shorten crying and grimacing duration time in heel lance and reduce crying proportion after heel lance （ P 〈 0. 01 ） . It can also reduce PIPP score, NIPS score, DAN score and NFCS score during invasive nursing procedures （ P 〈 0. 05 ） . Conclusion NNS compared with usual care could relieve behavioral response of neonatal pain and could decrease neonatal pain scale score. But NNS could not effectively reduce physiological response of neonatal pain.