Prestes Ana Claudia Y, Guinsburg Ruth, Balda Rita C X, Marba Sérgio T M, Rugolo Lígia M S S, Pachi Paulo R, Bentlin Maria Regina
Disciplina Pediatria Neonatal, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brazil.
J Pediatr (Rio J). 2005 Sep-Oct;81(5):405-10. doi: 10.2223/JPED.1392.
To evaluate the use of drugs to relieve procedural pain of newborn infants hospitalized in Neonatal Intensive Care Units (NICU) of university hospitals.
A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of patients; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Multiple linear regression analysis was performed to study the factors associated with the use of analgesia in this cohort of patients with SPSS 8.0.
Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received any systemic analgesia. No specific drug was administered to relieve acute pain during any of the following painful procedures: arterial, venous, capillary and lumbar punctures and tracheal intubation. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters, 8% of the newborn infants received analgesia. Only nine of the 17 newborn infants that underwent surgical procedures received any dose of analgesics during the postoperative period. Regarding patients who received analgesia, the drug of choice was fentanyl in 93%. The presence of mechanical ventilation increased 6.9 times the chance of the newborn receiving analgesia and the presence of a chest tube increased this chance by 5.0 times.
It is necessary to train health professionals in order to shorten the lag between scientific knowledge regarding newborn pain and clinical practice.
评估在大学医院新生儿重症监护病房(NICU)住院的新生儿使用药物缓解操作疼痛的情况。
对2001年10月在四个NICU住院的所有新生儿进行前瞻性队列研究。收集以下数据:患者的人口统计学数据;临床发病率;潜在疼痛操作的次数和镇痛药物的使用频率。使用SPSS 8.0对该队列患者进行多元线性回归分析,以研究与使用镇痛相关的因素。
在研究期间,91名新生儿入住NICU(1025个患者日)。在1025个患者日中,只有25%接受了任何全身镇痛。在以下任何疼痛操作(动脉穿刺、静脉穿刺、毛细血管穿刺、腰椎穿刺和气管插管)期间,未给予任何特定药物来缓解急性疼痛。对于胸腔闭式引流管置入,100%的新生儿接受了特定镇痛。对于中心静脉导管置入,8%的新生儿接受了镇痛。在接受手术的17名新生儿中,只有9名在术后接受了任何剂量的镇痛药。在接受镇痛的患者中,93%选择的药物是芬太尼。机械通气的存在使新生儿接受镇痛的机会增加了6.9倍,胸腔闭式引流管的存在使这一机会增加了5.0倍。
有必要对卫生专业人员进行培训,以缩短关于新生儿疼痛的科学知识与临床实践之间的差距。