Carbajal Ricardo, Gall Olivier, Annequin Daniel
Centre National de Ressources de Lutte contre la Douleur, Hôpital d'enfants Armand Trousseau, 26, av du Dr A Netter, 75012 Paris, France.
Expert Rev Neurother. 2004 May;4(3):491-505. doi: 10.1586/14737175.4.3.491.
Multiple lines of evidence suggest an increased sensitivity to pain in neonates. Repeated and prolonged pain exposure may affect the subsequent development of pain systems, as well as potentially contribute to alterations in long-term development and behavior. Despite impressive gains in the knowledge of neonatal pain mechanisms and strategies to treat neonatal pain acquired during the last 15 years, a large gap still exists between routine clinical practice and research results. Accurate assessment of pain is crucial for effective pain management in neonates. Neonatal pain management should rely on current scientific evidence more than the attitudes and beliefs of care-givers. Parents should be informed of pain relief strategies and their participation in the health care plan to alleviate pain should be encouraged. The need for systemic analgesia for both moderate and severe pain, in conjunction with behavioral/environmental approaches to pain management, is emphasized. A main sources of pain in the neonate is procedural pain which should always be prevented and treated. Nonpharmacological approaches constitute important treatment options for managing procedural pain. Nonpharmacological interventions (environmental and preventive measures, non-nutritive sucking, sweet solutions, skin-skin contact, and breastfeeding analgesia) can reduce neonatal pain indirectly by reducing the total amount of noxious stimuli to which infants are exposed, and directly, by blocking nociceptive transduction or transmission or by activation of descending inhibitory pathways or by activating attention and arousal systems that modulate pain. Opioids are the mainstay of pharmacological pain treatment but there are other useful medications and techniques that may be used for pain relief. National guidelines are necessary to improve neonatal pain management at the institutional level, individual neonatal intensive care units need to develop specific practice guidelines regarding pain treatment to ensure that all staff are familiar with the effects of the drugs being used and to guarantee access and safe administration of pain treatment to all neonates.
多项证据表明新生儿对疼痛更为敏感。反复且长时间暴露于疼痛中可能会影响疼痛系统的后续发育，并可能导致长期发育和行为的改变。尽管在过去15年中，我们对新生儿疼痛机制及治疗策略的认识取得了显著进展，但常规临床实践与研究结果之间仍存在很大差距。准确评估疼痛对于新生儿的有效疼痛管理至关重要。新生儿疼痛管理应更多地依赖当前的科学证据，而非护理人员的态度和观念。应告知家长疼痛缓解策略，并鼓励他们参与医疗保健计划以减轻疼痛。强调对于中度和重度疼痛，除了采用行为/环境方法进行疼痛管理外，还需要进行全身镇痛。新生儿疼痛的一个主要来源是程序性疼痛，对此应始终加以预防和治疗。非药物方法是管理程序性疼痛的重要治疗选择。非药物干预措施（环境和预防措施、非营养性吸吮、甜味溶液、皮肤接触和母乳喂养镇痛）可以通过减少婴儿接触的有害刺激总量间接减轻新生儿疼痛，也可以通过阻断伤害性转导或传递、激活下行抑制通路或激活调节疼痛的注意力和觉醒系统直接减轻疼痛。阿片类药物是药物性疼痛治疗的主要手段，但还有其他有用的药物和技术可用于缓解疼痛。有必要制定国家指南以在机构层面改善新生儿疼痛管理，各个新生儿重症监护病房需要制定关于疼痛治疗的具体实践指南，以确保所有工作人员熟悉所用药物的效果，并保证所有新生儿都能获得并安全使用疼痛治疗。
