Stevens Bonnie, Yamada Janet, Beyene Joseph, Gibbins Sharyn, Petryshen Patricia, Stinson Jennifer, Narciso Janet
Faculties of Nursing and Medicine, University of Toronto, Toronto, Ontario, Canada.
Clin J Pain. 2005 Nov-Dec;21(6):543-8. doi: 10.1097/01.ajp.0000149802.46864.e2.
Preterm neonates undergo numerous painful procedures in the neonatal intensive care unit (NICU). Sucrose, with and without pacifiers, is effective and safe for relieving pain from single painful events. However, repeated use of sucrose for multiple painful procedures has not been adequately evaluated. The study objectives were to: 1) determine the efficacy and safety of consistent management of repeated procedural pain with sucrose; and 2) explore the impact of consistent pain management on clinical outcomes and neurobiological risk status.
Sixty-six preterm infants were randomized to receive standard care (positioning and swaddling; n = 21), sterile water plus pacifier (n = 23), or 24% sucrose plus pacifier (n = 22) prior to all painful procedures in the NICU during the first 28 days of life. Also, at a routine heel lance at 7, 14, 21, and 28 days of life, data were collected to determine efficacy and immediate and long-term adverse events. Data on clinical outcomes and neurobiological risk status were collected at 28 days or NICU discharge.
There was no intervention by time interaction (P = 0.60). There was a significant main effect of intervention (P = 0.03) between the sucrose plus pacifier group, and the standard care group (P = 0.01), but there was no main effect of time (P = 0.72). No group differences existed for adverse events, clinical outcomes, or neurobiological risk status.
Consistent management of painful procedures with sucrose plus pacifier was effective and safe for preterm neonates during their stay in the NICU. Further exploration of consistent pain management with sucrose on clinical, developmental, and neurobiological outcomes is required.
早产新生儿在新生儿重症监护病房（NICU）会接受大量痛苦的操作。蔗糖，无论有无安抚奶嘴，对于缓解单次痛苦事件引起的疼痛都是有效且安全的。然而，对于多次痛苦操作重复使用蔗糖的情况尚未得到充分评估。本研究的目的是：1）确定用蔗糖持续管理重复操作疼痛的有效性和安全性；2）探讨持续疼痛管理对临床结局和神经生物学风险状态的影响。
66名早产婴儿在出生后的前28天在NICU进行所有痛苦操作前被随机分为三组，分别接受标准护理（体位摆放和襁褓包裹；n = 21）、无菌水加安抚奶嘴（n = 23）或24%蔗糖加安抚奶嘴（n = 22）。此外，在出生后第7、14、21和28天进行常规足跟采血时，收集数据以确定有效性以及即刻和长期不良事件。在出生后28天或NICU出院时收集临床结局和神经生物学风险状态的数据。
不存在干预与时间的交互作用（P = 0.60）。蔗糖加安抚奶嘴组与标准护理组之间存在显著的干预主效应（P = 0.03），与标准护理组相比差异有统计学意义（P = 0.01），但不存在时间主效应（P = 0.72）。在不良事件、临床结局或神经生物学风险状态方面，各组之间不存在差异。
对于早产新生儿在NICU住院期间，用蔗糖加安抚奶嘴持续管理痛苦操作是有效且安全的。需要进一步探索蔗糖持续疼痛管理对临床、发育和神经生物学结局的影响。
