早期反复操作性疼痛对足月新生儿疼痛反应的影响

Impact of early repetitive painful procedures on pain response in full - term infants

目的探讨新生儿期反复疼痛刺激对足月儿近期疼痛行为的影响。方法选择2009年3月至5月在南京医科大学附属南京儿童医院新生儿医学中心普通病房的62例足月儿为研究对象，男36例，女26例，应用数码摄像机记录新生儿在住院期间经历所有致痛性操作过程中的面部表情和肢体动作，依此进行新生儿疼痛行为评分[新生儿面部编码系统（NFCS）评分和新生儿疼痛评估量表（NIPS）评分]。结果足月新生儿在住院期间平均经历致痛性操作次数56．5次（12—249次），平均每天5．9次（4～26次）。NFCS评分和NIPS评分结果均显示，与第1次相比，足月儿经历10次以上疼痛刺激后，致痛操作时的疼痛评分持续下降（NFCS评分：P10=0．012，P20=0．015，P30=0．041；NIPS评分：P10=0．006，P20=0．015，P30=0．049）；在致痛性操作准备阶段表现出疼痛评分短暂上升（NFCS评分：P2〈0．001，P，〈0．001，P4=0．004，P5：0．009；NIPS评分：P2〈0．001，P3〈0．001，P4=0．045，P5=0．031）；在致痛性操作恢复阶段疼痛评分无变化。多次疼痛刺激对新生儿哭声的潜伏期和哭声持续时间无影响，但显著增加致痛性操作准备阶段哭泣的比例（P=0．032）。结论足月新生儿在经历反复多次疼痛刺激后，对后续的疼痛刺激表现出疼痛敏感性下降，在随后的应激刺激时反应增强。

Objective To explore the impact of early repetitive painful procedures on subsequent pain beha- viors and physiological indicators in full - term infants. Methods Sixty - two full - term neonates were enrolled （ male 36 cases ,female 26 cases） from the medical center of neonatal care at Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from March to May in 2009. The data of all painful procedures were performed on those neonates and their responses to them were collected by using digital video recording were collected. The Neonatal Facial Coding Sys- tem C （NFCS） and Neonatal Infant Pain Scale （NIPS） were used prospectively to evaluate the pain response to painful procedures. Results The average experience of pain caused by operation on newborn at the hospital was 56.5 times （ 12 -249 times） , and the daily average was 5.9 times （4 -26 times）. After they were exposed to more than 10 repe- titive pain procedures,the full -term neonates showed the declining pain response assessed by NFCS and NIPS during the subsequent painful procedures （ NFCS ： P10 = 0. 012, P20 = 0. 015, P30= 0. 041 ; NIPS ： Pl0 = 0. 006, P2o = 0. 015, P3o = 0. 049） , and the temporarily enhanced pain response was observed in the preparation phase of the subsequent painful procedures（ NFCS ： P2 〈 0. 001, P3 〈 0. 001, P4 = 0. 004, P5 = 0. 009 ; NIPS ： P2 〈 0.00l, P3 〈 0. 001, P4 = 0. 045 ,P5 =0. 031 ）. But there was no difference in preparation phase. There was no alternation in latency and crying time after repetitiing painful procedures, but the proportion of crying neonates in the preparation phase of the painful procedures was increased（P = 0. 032 ）. Conclusions After exposed to repetitive pain, full - term neonates expressed hypoalgesia during subsequent painful procedures, but the temporary irritation was enhanced during the following phases exposed to stress.