非药物干预方法在早产儿眼底筛查中的镇痛效果研究

doi:10.3877/cma.j.issn.1673-5250.2015.03.019

目的

探讨不同非药物干预方法对早产儿眼底筛查的镇痛效果。

方法

选择2013年12月至2014年3月在成都市妇女儿童中心医院新生儿科住院，并且需首次进行眼底筛查的160例早产儿为研究对象。将其按照入院顺序号随机分为4组：非营养性吸吮(NNS)组、宫内体位支持组、联合组及对照组，每组各40例。分别在早产儿眼底筛查前、后2 min采用新生儿疼痛量表(NIPS)对受试者进行疼痛评分，并比较各组评分差异。本研究遵循的程序符合成都市妇女儿童中心医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人知情同意，并与监护人签署临床研究知情同意书。各组患儿胎龄、出生体质量及首次眼底筛查纠正胎龄比较，差异均无统计学意义(P>0.05)。

结果

各组早产儿在接受筛查前，NIPS评分结果均为0分。在筛查后，各组NIPS评分结果均为正值。对照组早产儿筛查后NIPS评分显著高于筛查前，且差异有统计学意义(P<0.05)；在筛查后2 min时，对照组NIPS评分分别较NNS组、宫内体位支持组及联合组高，且差异均有统计学意义(P<0.05)；联合组NIPS评分分别较NNS组及宫内体位支持组低，且差异均有统计学意义(P<0.05)；而NNS组与宫内体位支持组NIPS评分比较，差异无统计学意义(P>0.05)。

结论　'

早产儿对疼痛敏感，NNS及宫内体位支持对早产儿均有明显镇痛作用，二者联合的干预方法具有协同镇痛作用。对进行眼底筛查的早产儿需进行疼痛管理。

关键词: 疼痛, 眼底, 婴儿吸吮用假奶头, 体位, 早产儿

Objective

To study the analgesic effects of different nonpharmacological pain-relieving interventions for fundus oculi screening of premature infants.

Methods

A total of 160 premature infants who were hospitalized and need to be done fundus oculi screening for the first time in department of Neonatal, Chengdu Women's & Children's Central Hospital from December 2013 to March 2014 were chosen as study subjects.They were randomly divided into four groups according to the order of admission: non-nutritive sucking(NNS) group, intrauterine position support group, combination group of both and control group, each group had forty premature infants. According to Neonatal Infant Pain Scale (NIPS), pain scores were got 2 min before and after each fundus oculi screening with different nonpharmacological pain-relieving interventions, and NIPS scores differences were compared among different groups.This study followed the Ethics Standards of Human Trial Committee of Chengdu Women's & Children's Central Hospital, and was approved by the Human Trial Committee. All parents signed the informed consent.There were no significant differences among 4 groups of infants in gestational age, birth weight and corrected gestational age when tested of fundus oculi screening for the first time(P>0.05).

Results

ALL the NIPS scores were zero before screening and positive value after screening. NIPS score in control group after fundus oculi screening was higher than that before screening, and the difference was significant(P<0.05). After 2 min of screening: NIPS score in control group was higher than that in NNS group, intrauterine position support group and combination group, respectively, and the differences were significant(P<0.05); NIPS score in combination group was lower than that in NNS group and intrauterine position support group, respectively, and the differences were significant(P<0.05); But, there was no significant difference between NNS group and intrauterine position support group in NIPS score(P>0.05).

Conclusions

Premature infants are sensitive to pain.NNS and intrauterine position support interventions have analgesic effect to premature infants and the combination intervention of both has synergism analgesic effect.It is necessary to take pain management when doing fundus oculi screening for premature infant.

Key words: Pain, Fundus oculi, Pacifiers, Posture, Infant, premature

表1 4组早产儿一般临床资料比较(±s)

Table 1 Comparison of general clinical data among 4 groups(±s)

组别	例数	胎龄(周)	出生体质量(g)	首次眼底筛查胎龄(周)
NNS组	40	29.4±1.4	1 946±44	34.1±1.4
宫内体位支持组	40	29.8±1.5	1 985±40	33.9±1.5
联合组	40	29.7±1.5	1 987±40	33.8±1.6
对照组	40	30.3±1.3	1 976±43	34.7±1.4
F值	?	0.68	1.88	2.10
P值	?	0.56	0.14	0.31

表1 4组早产儿一般临床资料比较(±s)

Table 1 Comparison of general clinical data among 4 groups(±s)

组别	例数	胎龄(周)	出生体质量(g)	首次眼底筛查胎龄(周)
NNS组	40	29.4±1.4	1 946±44	34.1±1.4
宫内体位支持组	40	29.8±1.5	1 985±40	33.9±1.5
联合组	40	29.7±1.5	1 987±40	33.8±1.6
对照组	40	30.3±1.3	1 976±43	34.7±1.4
F值	?	0.68	1.88	2.10
P值	?	0.56	0.14	0.31

表2 4组早产儿NIPS评分比较(分，±s)

Table 2 Comparison of NIPS score among 4 groups(score，±s)

组别	例数	筛查后2 min评分
NNS组	40	2.6±0.6
宫内体位支持组	40	2.7±0.5
联合组	40	1.6±0.5
对照组	40	5.2±0.3
F值	?	97.99
P值	?	<0.05

表2 4组早产儿NIPS评分比较(分，±s)

Table 2 Comparison of NIPS score among 4 groups(score，±s)

组别	例数	筛查后2 min评分
NNS组	40	2.6±0.6
宫内体位支持组	40	2.7±0.5
联合组	40	1.6±0.5
对照组	40	5.2±0.3
F值	?	97.99
P值	?	<0.05

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Study on analgesic effects of nonpharmacologic interventions in fundus oculi screening of premature infants

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Study on analgesic effects of nonpharmacologic interventions in fundus oculi screening of premature infants