Grunau R E, Holsti L, Whitfield M F, Ling E
Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Vancouver, Canada.
Clin J Pain. 2000 Mar;16(1):37-45. doi: 10.1097/00002508-200003000-00007.
The goal of this study was to examine whether body activity such as postural, trunk, and limb movements may be potential pain cues in preterm infants.
Convenience sample.
Level III neonatal intensive care unit (NICU).
Extremely low birth weight (< or = 1,000 g) preterm infants (n = 64) undergoing routine NICU medical care.
Procedures likely to differ in evoking distress (i.e., endotracheal suctioning, chest physical therapy, diaper change, or nasogastric feed) were observed. Behaviors were recorded at bedside using the Neonatal Individualized Developmental Care and Assessment Program system.
Changes in heart rate and sleep/waking state were related to the procedures, supporting the assumption of differing relative disruption to the infant. Arching, squirming, startles, and twitching were not observed significantly more during procedures than at baseline. After controlling for background variables, finger splay and leg extension were significantly related to ongoing procedures. Facial brow raising was a function of the number of invasive procedures in the past 24 hours; thus, it may be a useful cue of sensitization.
Some extensor movements seemed to be distress signals, whereas tremors, startles, and twitches were not related to discomfort during the observation period. These behaviors may differ qualitatively during longer lasting tissue invasive events. The results of this study indicate the need for more in-depth study of patterns of motor activity in preterm infants over longer observation periods to evaluate potential signs of stress and pain in babies undergoing NICU medical care.
本研究旨在探讨诸如姿势、躯干和肢体运动等身体活动是否可能是早产儿潜在的疼痛线索。
便利样本。
三级新生儿重症监护病房（NICU）。
接受NICU常规医疗护理的极低出生体重（≤1000克）早产儿（n = 64）。
观察可能在引起痛苦方面存在差异的操作（即气管内吸痰、胸部物理治疗、更换尿布或鼻饲）。使用新生儿个体化发育护理与评估计划系统在床边记录行为。
心率和睡眠/清醒状态的变化与操作有关，支持了对婴儿造成不同程度相对干扰的假设。在操作过程中，未观察到拱背、扭动、惊吓和抽搐比基线时明显增多。在控制背景变量后，手指张开和腿部伸展与正在进行的操作显著相关。皱眉是过去24小时内侵入性操作次数的函数；因此，它可能是敏化的一个有用线索。
一些伸展运动似乎是痛苦信号，而震颤、惊吓和抽搐在观察期内与不适无关。在持续时间更长的组织侵入性事件中，这些行为可能在性质上有所不同。本研究结果表明，需要在更长的观察期内对早产儿的运动活动模式进行更深入的研究，以评估接受NICU医疗护理的婴儿的潜在应激和疼痛迹象。
