Gibbins Sharyn, Stevens Bonnie, Hodnett Ellen, Pinelli Janet, Ohlsson Arne, Darlington Gerarda
Faculty of Nursing, Health Scoences Center, Sunnybrook and Women's College Hospital, 76 Grenville Street, Rm 445, Toronto, Ontario, Canada M5A 1B2.
Nurs Res. 2002 Nov-Dec;51(6):375-82. doi: 10.1097/00006199-200211000-00005.
Preterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines.
To compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses.
In a randomized controlled trial, 190 neonates were stratified by gestational age and then randomized to receive (a) sucrose and nonnutritive sucking (n = 64), (b) sucrose alone (n = 62), or (c) sterile water and nonnutritive sucking (control) (n = 64) to evaluate the efficacy (pain response as measured using the Premature Infant Pain Profile) (Stevens, Johnson, Petryshen, & Taddio, 1996) and safety (adverse events) following a scheduled heel lance during the first week of life. Stratification was used to control for the effects of age on pain response.
Significant differences in pain response existed among treatment groups (F = 22.49, p <.001), with the lowest mean Premature Infant Pain Profile scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Intervention group and sex explained 12% of the variance in Premature Infant Pain Profile scores. Few adverse events occurred (n = 6), and none of them required medical or nursing interventions.
The combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. Research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose is required.
入住新生儿重症监护病房的早产儿和急病足月儿要接受多项频繁的侵入性和疼痛性操作，目的是改善其预后。尽管已开展了多项试验来确定蔗糖对处理早产儿和急病足月儿操作疼痛的疗效，但这些试验总体上缺乏方法学的严谨性，也未为临床医生提供明确的实践指南。
比较三种干预措施缓解早产儿和足月儿足跟采血相关操作疼痛的疗效和安全性，并探讨包括性别、疾病严重程度和既往疼痛性操作等背景因素对疼痛反应的影响。
在一项随机对照试验中，190名新生儿按胎龄分层，然后随机分为三组，分别接受：(a)蔗糖加非营养性吸吮（n = 64）；(b)仅蔗糖（n = 62）；或(c)无菌水加非营养性吸吮（对照组）（n = 64），以评估出生后第一周内按计划进行足跟采血后的疗效（使用早产儿疼痛量表测量疼痛反应）（史蒂文斯、约翰逊、佩特里申和塔迪奥，1996年）和安全性（不良事件）。采用分层法控制年龄对疼痛反应的影响。
各治疗组之间的疼痛反应存在显著差异（F = 22.49，p <.001），蔗糖加非营养性吸吮组的平均早产儿疼痛量表得分最低。足跟采血后蔗糖的疗效不受疾病严重程度、出生后年龄或疼痛性操作次数的影响。干预组和性别解释了早产儿疼痛量表得分变异的12%。不良事件很少发生（n = 6），且均无需医疗或护理干预。
蔗糖与非营养性吸吮联合使用是单次足跟采血最有效的干预措施。需要研究胎龄对重复剂量蔗糖疗效和安全性的影响。
