不同类型致痛性操作对新生儿疼痛的影响

Effects of different types of painful procedures on neonatal pain scores and physiological changes

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 In fant Pain Scale，NIPS）及早产儿疼痛量表（PrematureInfantPainProfile，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、7。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ENFCS（7．00±1．66）分，PIPP（14．08±3．54）分]、股静脉穿刺ENFCS（6．52±1．66）分，PIPP（12．15±3．11）分]和腋静脉穿刺ENFCS（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ENFCS（6．68±1．34）分，NIPS（5．58土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ENFCS（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。

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-the clock 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.