3组非药物干预镇痛法在新生儿疼痛中的应用效果比较

目的分析非药物干预镇痛法在新生儿疼痛中的应用效果。方法将96例新生儿随机分为A组、B组和C组,均给予非药物镇痛,A组为襁褓包裹、音乐和非营养性吮吸联合法,B组为口服甜味剂联合非营养吮吸,C组为襁褓包裹。对比3组新生儿穿刺操作中及穿刺后新生儿面部编码系统(NFCS)分值和新生儿疼痛评分量表(NIPS)分值、采血前后心率(HR)变化、疼痛性啼哭发生率。结果 3组新生儿在穿刺操作中及操作完毕后NFCS分值、NIPS分值均有明显差异,且均以A组最低,C组最高;3组新生儿操作完毕后NFCS分值、NIPS分值均明显降低。采血结束时A组HR最低,采血前后A组HR上升程度最小。A组、B组、C组新生儿疼痛性啼哭发生率分别为54.29%、77.14%、90.62%,3组比较有显著差异,P均0.05。结论襁褓包裹、音乐联合非营养性吮吸在3种非药物镇痛干预中效果最佳,能减小穿刺性操作中新生儿心率波动,降低啼哭发生率。     

口服25％葡萄糖缓解足跟采血所致新生儿疼痛的研究

目的探讨口服25％葡萄糖对足跟采血所致新生儿疼痛的影响。方法选取25例需足底采血测血糖两次以上的新生儿,自身对照,选取任一次给予干预,即在足底采血前2min给予口服1ml25％葡萄糖。采用新生儿面部编码系统（NFCS）、新生儿急性疼痛行为评分量表（DAN）、哭泣时长及心率变化作为疼痛评估指标。结果干预组新生儿NFCS评分在针刺和挤捏阶段分值明显低于常规组（均P〈0．01）;干预组新生儿DAN评分在面部表情、肢体运动、声音表现三方面分值均明显低于常规组（均P〈0．01）;干预组回复阶段哭泣时长显著短于常规组（P〈0．05）;干预组心率均值高于常规组,在0S、15s心率差异有显著意义（P〈0．05）。结论足底采血时,给予25％葡萄糖1ml可以显著降低新生儿哭吵和疼痛评分分数,但不能阻止心率增加。     

桡动脉采血在新生儿护理中的价值分析

目的 探究桡动脉采血在新生儿护理中的应用效果.方法 我院2022年6月1日至2022年12月1日接收的58例新生儿,随机分为对照组和观察组,每组各29例.对照组实施肱动脉采血法,观察组实施桡动脉采血法.对比两组的一次采血成功率、不良反应发生率、NIPS评分、NFCS评分.结果 观察组新生儿一次采血成功率高于对照组新生儿,不良反应发生率、NIPS评分、NFCS评分低于对照组新生儿(P<0.05).结论 新生儿采血实施桡动脉采血法,能够提高一次采血成功率,减少新生儿不良反应及疼痛程度.     

非营养性吸吮对缓解足跟采血所致新生儿疼痛的效果观察

目的:探讨非营养性吸吮对有效缓解新生儿足跟采血所致疼痛的效果。方法:选择我院进行足跟采血检验的新生儿作为研究对象并随机等分为对照组和研究组,对照组给予口中滴注葡萄糖溶液,研究组新生儿给予葡萄糖溶液吸吮后进行非营养性吸吮。采用新生儿疼痛评分量表(NIPS)和新生儿面部编码系统评分简表(NFCS)评估两组新生儿疼痛情况。结果:采血中及采血后研究组新生儿NIPS评分以及NFCS评分均低于对照组,差异具有统计学意义(P0.05)。结论:针对接受足跟采血新生儿予以非营养性吸吮,可以有效缓解其足跟采血所至的疼痛刺激,减轻新生儿痛苦。     

视听转移配合轻柔手法在新生儿足跟采血镇痛中的应用

目的:探讨视听转移配合轻柔手法在新生儿足跟采血镇痛中的应用效果。方法:将2019年1月1日～2020年2月1日儿科接收的114例新生儿根据简单随机法分为观察组59例和对照组55例,两组新生儿均进行足跟采血,对照组给予常规镇痛护理,观察组在常规镇痛基础上给予视听转移配合轻柔手法。比较两组一针采血成功率、采血情况、采血前中后疼痛程度[采用新生儿面部编码系统(NFCS)]、心率及血氧饱和度的变化。结果:观察组一针采血成功率高于对照组(P0.05);观察组疼痛面容出现时间及啼哭开始时间均晚于对照组(P0.01),疼痛面容持续时间、啼哭持续时间及采血时间均短于对照组(P0.01);采血中,两组NFCS评分、心率均高于采血前(P0.05);采血后3 min,两组NFCS评分、心率均低于采血中(P0.05),且观察组均低于对照组(P0.01);采血中,两组血氧饱和度均低于采血前(P0.05),且观察组高于对照组(P0.01);采血后3 min,两组血氧饱和度均高于采血中(P0.05),且观察组高于对照组(P0.01)。结论:将视听转移配合轻柔手法应用于新生儿足跟采血镇痛护理中,采血成功率较高,不仅能缩短患儿疼痛面容、啼哭时间及采血时间,还能减轻采血过程中疼痛程度,对快速恢复心率及血氧饱和度具有明显优势。     

吸吮配方奶缓解早产儿穿刺疼痛的效果

[目的]通过与非营养性吸吮对比,探讨吸吮早产儿配方奶缓解早产儿静脉穿刺疼痛的效果。[方法]将80例早产儿随机分为非营养性吸吮(对照组)和棉签吸吮早产儿配方奶水组(观察组)各40例。采用新生儿疼痛评分量表(NIPS)、早产儿疼痛量表(PIPP)、心率上升幅度、血氧饱和度下降幅度、疼痛面容持续时间、啼哭例数作为观察指标。[结果]观察组较对照组发生啼哭例数较少、疼痛面容持续时间较短、心率上升、血氧饱和度下降幅度均较低及NIPS、30s后PIPP评分分值较低(均P0.05)。[结论]与非营养性吸吮相比,棉签吸吮早产儿配方奶止痛效果更明显,且操作简便、取材容易。     

不同护理干预方法对减轻足月新生儿足跟采血疼痛的影响

目的探讨不同护理干预方法对减轻足月新生儿足跟采血疼痛的影响。方法将183例接受足跟采血的足月新生儿随机分为对照组、拥抱组和母乳吸吮组各61例。对照组采用常规足跟采血方法,拥抱组母亲抱着新生儿采血,母乳吸吮组在足跟采血前2min由母亲给新生儿哺乳。比较3组新生儿啼哭出现时间与持续时间、新生儿面部编码系统(NFCS)评分及新生儿急性疼痛行为量表(DAN)评分。结果母乳吸吮组足跟针刺后啼哭出现时间与持续时间晚于/短于拥抱组和对照组,采血过程中、采血后1min和2min的NFCS评分明显低于拥抱组和对照组,采血过程中3个维度的DAN评分均明显低于拥抱组和对照组;而拥抱组和对照组上述指标比较,差异均无统计学意义。结论母乳吸吮能有效减轻足月新生儿足跟采血所致的疼痛,而拥抱对其无效。     

口服蔗糖加非营养性吸吮对新生儿疼痛的影响

目的探讨口服24%蔗糖溶液加非营养性吸吮缓解新生儿疼痛的效果。方法将患有高胆红素血症的足月新生儿100例按入院时间、性别随机分为对照组和干预组,各50例。干预组在接受静脉穿刺前2 min口服24%蔗糖溶液2 mL,同时给予非营养性吸吮;对照组在穿刺过程中不给予任何缓解疼痛的干预措施。观察2组新生儿静脉穿刺时的疼痛程度,并记录啼哭持续时间以及心率、呼吸和血氧饱和度的变异率。结果干预组的新生儿面部编码系统(NFCS)和新生儿疼痛评估量表(NIPS)评分和啼哭时间显著小于对照组,差异有统计学意义(P<0.01),干预组的心率、呼吸及血氧饱和度变异率显著小于对照组,差异有统计学意义(P<0.01)。结论口服蔗糖加非营养性吸吮可显著缓解新生儿疼痛。     

口服葡萄糖缓解新生儿疼痛效果的研究

目的探讨口服25％葡萄糖缓解新生儿疼痛的效果。方法新生儿106例分为对照组和实验组各53例。在股静脉穿刺前2min治疗组舌尖滴入温的25％葡萄糖液2ml,对照组滴入温开水2ml。股静脉穿刺后1min和5min,应用新生儿疼痛评分量表（NIPS）对53例对照组和实验组患儿进行疼痛评分。结果刺激后1min和5minNIPS评分实验组低于对照组,两组间的疼痛评分差异有显著性（P=0．000）。结论口服25％的葡萄糖水2ml能显著缓解新生儿的疼痛。     

不同葡萄糖喂服方式对减轻新生儿足跟采血所致疼痛的影响

目的探讨葡萄糖喂服方式对足跟采血所致新生儿疼痛的影响,为临床干预减轻新生儿操作性疼痛提供一种方便可行的葡萄糖喂服途径。方法将70例健康足月新生儿随机分为观察组和对照组各35例,脱落6例,最终入组各32例。观察组在足跟采血前用婴儿奶嘴喂服25%葡萄糖,对照组用注射器滴注葡萄糖于婴儿口中。观察足跟采血时和采血结束后2min各组新生儿疼痛量表(NIPS)得分、心率和氧饱和度变化。结果足跟采血过程中和结束后2min,两组NIPS评分、心率及氧饱和度差异均无统计学意义(P>0.05)。结论用奶嘴喂服葡萄糖与传统的注射器喂服方法对减轻新生儿足跟采血所致疼痛反应的效果无差异,但前者更接近自然吸吮行为,且方便易行。     

Differences in pain expression between male and female newborn infants

The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 and 42 weeks and with 25-120 h of life were studied. Healthy term neonates required a capillary puncture for PKU screening and clinically stable premature infants needed a capillary puncture for glucose dosage. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were evaluated at bedside prior to the puncture, when patients were at rest, during foot heating; during capillary puncture; and at 1, 3, and 5 min after heel lancing. Results were analyzed by repeated-measures ANOVA followed by the Multiple Comparison Method of Bonferroni. A significant difference among the mean NFCS scores during the six study periods was noted for the whole group of neonates (P<0.000001). Also, a significant interaction between the NFCS score profile in female and male neonates at the different study periods was observed (P=0.025). Regarding NIPS, ANOVA showed only a significant difference among the mean NIPS scores during the six study periods for the whole group of neonates (P<0.000001). No significant interactions between gestational age and time, nor between gestational age and gender were noted, for both NFCS and NIPS. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.     

非营养性吸吮和吸吮8%葡萄糖水对缓解新生儿疼痛的效果观察

目的探索非药物治疗缓解新生儿疼痛的有效方法。方法将130例住院新生儿随机分为非营养性吸吮组和吸吮8%葡萄糖水组,各65例,在采足跟血疼痛刺激前30s、穿刺后20s、1min、3min分别记录心率、呼吸、经皮血氧饱和度和哭声持续时间,并在穿刺1min后根据新生儿面部编码系统、新生儿疼痛评估量表进行疼痛评分。结果穿刺后20s两组新生儿心率加快(P0.01),1min时恢复到穿刺前水平;穿刺后20s、1min两组新生儿呼吸频率均加快(P0.05),3min时恢复到穿刺前水平;两组新生儿穿刺前后经皮血氧饱和度均无明显变化(P0.05);穿刺后吸吮8%葡萄糖水组新生儿哭声持续时间少于非营养性吸吮组(P0.01);吸吮8%葡萄糖水组新生儿面部编码系统和新生儿疼痛评估量表评分均低于非营养性吸吮组(P0.05或P0.01)。结论新生儿对急性疼痛很敏感,吸吮8%葡萄糖水对新生儿有相对较好的止痛作用,在临床护理中,可应用非药物治疗干预措施。     

小儿经桡动脉采集血气分析3种方法的比较

目的 探讨小儿经桡动脉采集血气分析的不同方法.方法 选取小儿经桡动脉采集血气分析207例,按时间顺序分为3组.A组69例,采用1 ml血气针经小儿桡动脉采集血气分析.B组69例,采用1 ml注射器接5.5号头皮针(以1 ∶ 1 000的肝素抗凝)经小儿桡动脉采集血气分析.C组69例,采用1 ml血气针接无菌技术下将塑料管剪至2 cm的5.5号头皮针经小儿动脉采集血气分析.结果 A组操作针头易滑脱,穿刺成功率低.B组操作由于抗凝剂混合不均匀,易发生凝血.C组操作针头不易滑脱,穿刺成功率高,不易发生凝血,检验结果准确.结论 采用1 ml血气针接剪短的5.5号头皮针经小儿桡动脉采集血气分析,是一种较为理想的方法,值得临床推广.     

经桡动脉径路冠状动脉介入术后气囊压迫器不同压迫时间的止血效果比较

目的 观察桡动脉压迫器(TR-Band止血气囊)在桡动脉径路介入术后的止血效果并探讨最适止血时间.方法 将266例经桡动脉行冠状动脉造影术并用TR-Band止血气囊压迫止血的患者,按压迫时间随机分为A、B、C3组.A组90例压迫8h,B组87例压迫10h,C组89例压迫12h,比较3组出血情况、血氧饱和度的变化情况和手部肿胀情况.结果 A、B、C3组出血率分别为16.7％、3.4％、9.0％,3组比较差异显著;术后手部肿胀发生率A、B、C3组分别为27.8％、12.6％、21.3％,3组比较差异显著;3组术后末梢血氧饱和度比较差异无统计学意义.结论 桡动脉径路冠状动脉介入术后应用气囊压迫器止血效果较好,以压迫10h效果最好,且不良反应少.     

Pain and tactile stimuli during arterial puncture in preterm neonates

The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.     

Clinical, Physiologic, and Biologic Impact of Environmental and Behavioral Interventions in Neonates During a Routine Nursing Procedure

The aim of this randomized crossover study was to evaluate the impact of environmental and behavioral interventions (EBI) on behavioral, physiologic, and biologic stress response during a weighing procedure in neonates. Three groups of 15 neonates included (A) gestational age (GA), < or =32 weeks; (B) GA, 32 weeks, 1 day to 36 weeks, 6 days; and (C) GA, > or =37 weeks. Each neonate experienced 2 weighing procedures with and without EBI. Pain was evaluated by using the Neonatal Infant Pain Scale (NIPS) and the Neonatal Pain and Discomfort Scale (EDIN). Heart rate and oxygen saturation were recorded. Salivary samples were obtained for cortisol assay. Cerebral tissue oxygenation index (TOI) was recorded with near-infrared spectroscopy. A significant decrease of NIPS and EDIN was observed with EBI versus control. Mean heart rate was lower with EBI. No difference in cortisol level changes was observed. For groups A and B, a trend of increased TOI was observed with EBI. We concluded that EBI during a nursing procedure provides a decrease in pain scores in preterm and term neonates with changes in heart rate. PERSPECTIVE: This study evaluates the impact of combined environmental and behavioral interventions on pain responses in neonates during a weighing procedure. The results indicate a decrease in behavioral pain scores and in heart rate for preterm and term neonates and a trend in increased brain oxygenation depending on gestational age.     

口服葡萄糖耐量试验采血方法的探讨

目的 探讨一种适宜口服葡萄耐量试验的采血方法。方法 于上臂用留置针穿刺置管后随机分成肝素封管组（A1）和0．9％NS封管组（B1）,分别于空腹、服药后0．5h,1h,2h,3h在留置针采血1.5ml,并同时在对侧上臂直接穿刺采血1.5ml作对照组（A2、B2）,标本配对后测血糖并作统计学处理。此外,用问卷调查30例志愿者对二种采血方法的主观接受程度。结果 经留置针采血与单次穿刺采血的血糖值无显著差异,二种封管液均可使用。30例志愿者全部愿意选择留置针采血法。结论 留置针采血可替代传统的反复直接穿刺采血行OGTT试验。     

不同护理干预方法对新生儿桡动脉采血时疼痛和生命体征的影响

目的 探讨非药物干预,包括非营养性吸吮和葡萄糖糖水口服,对新生儿桡动脉采血时疼痛及生命体征的影响.方法 106例住院新生儿随机分为非营养性吸吮(non-nutritive sucking,NNS)组、糖水组和对照组,分别于采血时给予安慰奶嘴吸吮、10%葡萄糖10～20 ml 口服以及不给予任何干预方法.各组在进行桡动脉穿刺采血时应用"新生儿急性疼痛行为评分量表"进行疼痛评分,并应用多功能监护仪动态记录穿刺前、穿刺中及穿刺后的生命体征和经皮血氧饱和度等指标的变化.结果 在进行桡动脉穿刺采血时,3组新生儿疼痛评分差异有统计学意义(F=47.847,P=0.000),其中对照组明显高于NNS组和糖水组,而NNS组和糖水组之间差异无统计学意义.3组新生儿的生命体征参数变异率差异有统计学意义,其中NNS组和糖水组的变异率均低于对照组(P=0.000),NNS组和糖水组之间无统计学意义.结论 新生儿在进行桡动脉穿刺时,给予非营养性吸吮或喂食糖水可以减轻其疼痛反应,同时减少生命体征的波动.