母亲心音录音对早产儿足跟采血时行为和生理反应的影响

The effects of recorded maternal heart sound on premature infants'behavior and physiological response during the heel-prick procedure

目的探讨母亲心音录音对早产儿足跟穿刺采血时行为和生理反应的影响。方法选择2018年1~12月深圳市南山区妇幼保健院新生儿重症监护病房收治的胎龄32~36周早产儿进行前瞻性研究,基于交叉设计方法计算样本量为52例。入组早产儿均需经历2次足跟穿刺采血,2次采血间隔24~72 h。采血前用密封信封随机选择第1次采血时干预还是第2次采血时干预(播放母亲心音录音)。采血前10 min至结束后10 min进行录像。采用新生儿疼痛评分(neonatal infant pain score,NIPS)、心率、氧饱和度、灌注指数、NIPS和心率恢复至基线的时间评估疼痛程度。将所有观察指标按是否干预分为干预组和对照组,进行自身对照,应用SPSS 25.0统计软件进行分析。结果共纳入52例早产儿,其中47例完成了研究。干预组采血后2~6 min的NIPS均低于对照组,分别为(0.3±1.3)分比(1.3±2.3)分、(0.4±1.3)分比(1.3±2.1)分、(0.1±0.9)分比(1.0±1.7)分、(0.3±1.1)分比(1.0±2.0)分、(0.0±0.0)分比(1.1±2.3)分;3~7 min的心率也均低于对照组,分别为(141.2±19.9)次/min比(147.3±19.8)次/min、(139.3±16.2)次/min比(144.8±16.6)次/min、(138.8±17.2)次/min比(145.8±17.8)次/min、(136.8±17.2)次/min比(147.0±18.0)次/min、(138.7±16.0)次/min比(142.5±17.0)次/min,差异均有统计学意义(P<0.05)。两组之间和组内不同时间点比较,血氧饱和度和灌注指数差异均无统计学意义(P>0.05)。干预组NIPS和心率返回基线的时间分别为2 min和3 min,对照组分别为7 min和8 min,差异有统计学意义(P<0.05)。结论播放母亲心音录音可以减轻早产儿足跟采血时的疼痛。

Objective To study the effects of recorded maternal heart sound on premature infants'behavior and physiological response during the heel-prick procedures.Method From January to December 2018,premature infants with gestational age between 32 and 36 weeks admitted to the neonatal intensive care unit of our hospital were selected for this prospective study.Based on the crossover design method,the sample size was calculated as 52 cases.Premature infants enrolled in the study were required to receive 2 heel-prick procedures with an interval of 24 to 72 hours.Before the first heel-prick procedure,a sealed envelope was used determining the timing of intervention(playing the maternal heart sound)as during the first blood collection or the second blood collection.The infants were videotaped 10 minutes before the procedure to 10 minutes after the procedure.The level of pain was assessed using the neonatal infant pain score(NIPS),heart rate,oxygen saturation,perfusion index and the duration for NIPS and heart rate returning to baseline.Self-control before-after intervention method was used.The data were analyzed using SPSS 25.0.Result A total of 52 premature infants were included and 47 completed the study.NIPS at 2~6 minute after heel-prick in the intervention group were lower than the control group and the heart rates at 3~7 minute after heel-prick procedures in the intervention group were lower than the control group,the differences were statistically significant(P<0.05).No differences of oxygen saturation and perfusion index between or within the two groups were found.The duration of NIPS and heart rate returning to baseline in the intervention group were 2 and 3 minutes,respectively,and 7 and 8 minutes in the control group,the differences were statistically significant(P<0.05).Conclusion Recorded maternal heart sound may alleviate pain during heel-prick procedures in premature infants.