Rush Ryan, Rush Sloan, Nicolau John, Chapman Karen, Naqvi Mubariz
Department of Pediatrics, Texas Tech University Health Sciences Center and Northwest Texas Healthcare Systems, Amarillo, TX 79106, USA.
Retina. 2004 Apr;24(2):242-5. doi: 10.1097/00006982-200404000-00009.
To determine whether adverse effects manifested via vital sign changes during the screening examination for retinopathy of prematurity (ROP) are due to the pharmacologic properties of the eye drops or to physical manipulation of the eyes. The authors also investigated the relationship between distress during the screening process and the severity of prematurity of the infant.
A prospective observational study was designed that enrolled all infants either weighing < or =1500 g or who were < or =32 weeks gestational age at birth who were admitted to the neonatal intensive care unit (NICU) at Northwest Texas Hospital or Baptist St. Anthony's Hospital from June 2002 to February 2003. Thirty participants were enrolled in this study. Blood pressure, pulse, temperature, respiratory rate, and O2 saturation were recorded at different time intervals during the examination. Infants were excluded from the study if they were on the ventilator, considered acutely ill, born with significant birth defects, or currently taking inotropic drugs, or had received albuterol 2 hours before the examination.
Oxygen saturation and pulse rate following physical manipulation of the eyes significantly varied from baseline values and the values obtained during the three instillations of topical mydriatics. No significant changes in blood pressure, temperature, or respiratory rate from their respective baseline values were observed throughout the ROP screening examination. Gestational age of the infant did not correlate with level of distress during the examination.
Regardless of the severity of prematurity, infants seem to undergo significant distress during the eyelid speculum examination. Thus ophthalmologists should take into consideration the infant's discomfort caused by physical manipulation of the eyes and attempt to perform the examination as swiftly, yet safely, as possible using topical anesthetic.
确定在早产儿视网膜病变（ROP）筛查检查期间通过生命体征变化表现出的不良反应是由于眼药水的药理特性还是眼部的物理操作。作者还研究了筛查过程中的痛苦与婴儿早产严重程度之间的关系。
设计了一项前瞻性观察性研究，纳入2002年6月至2003年2月在德克萨斯州西北部医院或浸信会圣安东尼医院新生儿重症监护病房（NICU）入院的所有体重≤1500 g或出生时胎龄≤32周的婴儿。本研究招募了30名参与者。在检查期间的不同时间间隔记录血压、脉搏、体温、呼吸频率和血氧饱和度。如果婴儿正在使用呼吸机、被认为患有急性疾病、出生时有严重出生缺陷、目前正在服用强心药物或在检查前2小时接受过沙丁胺醇治疗，则将其排除在研究之外。
眼部物理操作后的血氧饱和度和脉搏率与基线值以及局部散瞳剂三次滴注期间获得的值有显著差异。在整个ROP筛查检查过程中，未观察到血压、体温或呼吸频率相对于各自基线值有显著变化。婴儿的胎龄与检查期间的痛苦程度无关。
无论早产的严重程度如何，婴儿在眼睑撑开器检查期间似乎都会经历明显的痛苦。因此，眼科医生应考虑到眼部物理操作给婴儿带来的不适，并尝试使用局部麻醉剂尽可能迅速且安全地进行检查。
