Stevens Bonnie, McGrath Patrick, Gibbins Sharyn, Beyene Joseph, Breau Lynn, Camfield Carol, Finley Allen, Franck Linda, Howlett Alixe, McKeever Patricia, O'Brien Karel, Ohlsson Arne, Yamada Janet
Faculties of Nursing and Medicine, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Room 4734c, Toronto, Ontario, Canada M5G 1X8.
Pain. 2003 Sep;105(1-2):27-35. doi: 10.1016/s0304-3959(03)00136-2.
In the past decade, our knowledge of pain in newborn infants has advanced considerably. However, infants at significant risk for neurologic impairment (NI) have been systematically excluded from almost all research on pain in neonates. The objectives of this study were to compare: (a). the nature, frequency and prevalence of painful procedures, (b). analgesics and sedatives administered, and (c). the relationship between painful procedures and analgesia for neonates at risk for NI. One hundred and ninety-four infants at high (cohort A, n=67), moderate (cohort B, n=59) and low (cohort C, n=68) risk for NI from two tertiary level Neonatal Intensive Care Unit's in Canada were included in a retrospective cohort study on the first 7 days of life. Data were collected from medical records and analyzed using chi-square, ANOVA and regression approaches. All cohorts had a mean of >10 painful procedures per day during the first 2 days of life. There was an interaction effect between cohort group and day of life (F(5,188)=2.13, P<0.06) with cohort A having significantly more painful procedures on day 1 (F(2,191)=4.79, P<0.009). There was no statistical difference in the number of infants who received continuous infusion (F(2,20)=1.9, P=0.13) or bolus (F(2,20)=1.3, P=0.25) opioids or sedatives (F(2,20)=0.45, P=0.84) by cohort over the 7 day period. There was a statistical difference in bolus opioid administration for days 1 (P<0.05) and 2 (P<0.001) with less than 10% of infants in cohort A receiving bolus opioids compared with approximately 22-33% of infants in cohorts B and C. There was a statistically significant correlation between painful procedures and analgesic use (r=0.29, P<0.001), although significant associations existed for cohorts B and C only. The number of painful procedures and study site primarily accounted for the variance (61% in cohort B and 35% in cohort C) in analgesic use, while in cohort A, only study site contributed to the variance (16%). Neonates at the highest risk for NI had the greatest number of painful procedures and the least amount of opioids administered during the first day of life. There was no relationship between painful procedures and analgesic use in this group. As these infants are vulnerable to pain and its consequences, the rational underlying health professional strategies regarding painful procedures and analgesic use for procedural pain in this population urgently awaits exploration.
在过去十年中，我们对新生儿疼痛的了解有了显著进展。然而，几乎所有关于新生儿疼痛的研究都系统性地排除了有严重神经功能损害（NI）风险的婴儿。本研究的目的是比较：（a）疼痛性操作的性质、频率和发生率；（b）所使用的镇痛药和镇静剂；（c）有NI风险的新生儿疼痛性操作与镇痛之间的关系。来自加拿大两家三级新生儿重症监护病房的194名NI风险高（队列A，n = 67）、中（队列B，n = 59）和低（队列C，n = 68）的婴儿被纳入一项关于出生后前7天的回顾性队列研究。数据从医疗记录中收集，并采用卡方检验、方差分析和回归方法进行分析。所有队列在出生后头两天每天平均有超过10次疼痛性操作。队列组和出生天数之间存在交互作用（F(5,188)=2.13，P<0.06），队列A在第1天的疼痛性操作显著更多（F(2,191)=4.79，P<0.009）。在7天期间，各队列接受持续输注（F(2,20)=1.9，P = 0.13）或推注（F(2,20)=1.3，P = 0.25）阿片类药物或镇静剂（F(2,20)=0.45，P = 0.84）的婴儿数量没有统计学差异。在第1天（P<0.05）和第2天（P<0.001）推注阿片类药物存在统计学差异，队列A中接受推注阿片类药物的婴儿不到10%，而队列B和C中约22 - 33%的婴儿接受推注阿片类药物。疼痛性操作与镇痛药物使用之间存在统计学显著相关性（r = 0.29，P<
