非药物干预缓解新生儿足跟采血所致疼痛的网状Meta分析

Non-drug intervention in relieving pain caused by neonatal heel blood collection in newborns: a network Meta-analysis

目的:评价不同非药物干预缓解新生儿足跟采血所致疼痛的效果,为临床工作者提供循证依据。方法:计算机检索PubMed、EMbase、Web of Science、the Cochrane Library、中国知网(CNKI)、维普数据库(VIP)、万方数据库(WanFang Database)、中国生物医学文献数据库(CBM)、CINAHL数据库,检索时限均为建库至2021年12月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行网状Meta分析。结果:共纳入67项随机对照试验,涉及非营养吮吸、抚触按摩、音乐疗法、体位干预、母乳吮吸、口服甜味剂、袋鼠护理、常规护理8种非药物干预方法,包括新生儿疼痛评估量表(NIPS)得分、疼痛面容持续时间、啼哭持续时间、心率、血氧饱和度5个结局指标。网状Meta分析结果显示:在降低NIPS疼痛得分方面,体位干预、非营养吮吸、母乳吮吸、袋鼠护理、口服甜味剂均优于常规护理(P<0.05),体位干预累积排序曲线下面积(SUCRA)最大(92.0%);在缩短疼痛面容持续时间方面,音乐疗法、体位干预优于常规护理,音乐疗法SUCRA最大(100%);在缩短啼哭持续时间方面,抚触按摩、母乳吮吸、非营养吮吸、口服甜味剂均优于常规护理(P<0.05),抚触按摩SUCRA最大(94.4%);在稳定新生儿足跟采血的心率时,抚触按摩、袋鼠护理优于常规护理,抚触按摩SUCRA最大(96.7%);在稳定新生儿血氧饱和度方面,袋鼠护理优于常规护理,非营养吮吸SUCRA最大(84.3%)。结论:现有证据表明,体位干预降低新生儿疼痛最有效;音乐疗法能缩短疼痛面容持续时间;抚触按摩对缩短新生儿啼哭持续时间最有效;在稳定新生儿心率、血氧饱和度方面,抚触按摩、袋鼠护理、非营养吮吸都可能是有效的干预方式。

Objective:To evaluate the effect of different non-drug interventions on relieving pain caused by neonatal heel blood collection in newborns, and to provide evidence-based basis for clinicians.Methods:PubMed, EMbase, Web of Science, the Cochrane Library, CNKI,VIP,WanFang Database, CBM and CINAHL databases were searched from inception to December, 2021.Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies.Network Meta-analysis was performed using Stata 16.0 software.Results:A total of 67 RCTs were included, involving non-nutritional sucking, touch massage, music therapy, posture intervention, breast milk sucking, oral sweeteners, kangaroo care, routine care 8 non-drug interventions, and NIPS duration of pain, crying duration, heart rate, oxygen saturation 5 outcome indicators.Meta-analysis results showed that position intervention, non-nutritive sucking, breast milk sucking, kangaroo care and oral sweeteners were superior to conventional care in reducing NIPS scores(P<0.05).The sort table showed the SUCRA of the body position intervention was the largest, which was 92.0%.In terms of shortening pain face duration, music therapy, posture intervention, outperforms routine care, The sort table showed the SUCRA of music was the largest, which was 100%.In terms of shortening the duration of crying, touching massage, breast milk sucking, non-nutritional sucking, oral sweeteners were superior to routine nursing(P<0.05).The sort table showed the SUCRA of massage was the largest, which was 94.4%.When the heart rate of neonatal heel blood was stabilized, touching massage and kangaroo care were superior to routine care.The sort table showed the SUCRA of touch massage was the largest, which was 96.9%.The kangaroo nursing was better than routine nursing in stabilizing the blood oxygen saturation of heel blood collection of newborns.The sorting table showed the SUCRA of non-nutrient sucking was the lorgest, which was 84.3%.Conclusions:Current evidence shows that postural intervention is the most effective way to reduce neonatal pain.Music therapy can significantly shorten the duration of painful face;Touch massage is the most effective way to shorten the duration of newborn crying.touching massage, kangaroo care and non-nutritional sucking may be effective intervention methods in stabilizing neonatal heart rate and oxygen saturation.