Castral Thaila C, Warnock Fay, Leite Adriana M, Haas Vanderlei J, Scochi Carmen G S
University of Sao Paulo at Ribeirao Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Av. Bandeirantes 3900, Ribeirao Preto-SP, CEP: 14040-902, Brazil.
Eur J Pain. 2008 May;12(4):464-71. doi: 10.1016/j.ejpain.2007.07.012. Epub 2007 Sep 14.
Several promising non-pharmacological interventions have been developed to reduce acute pain in preterm infants including skin-to-skin contact between a mother and her infant. However, variability in physiological outcomes of existing studies on skin-to-skin makes it difficult to determine treatment effects of this naturalistic approach for the preterm infant. The aim of this study was to test the efficacy of mother and infant skin-to-skin contact during heel prick in premature infants.
Fifty nine stable preterm infants (born at least 30 weeks gestational age) who were undergoing routine heel lance were randomly assigned to either 15 min of skin-to-skin contact before, during and following heel prick (n=31, treatment group), or to regular care (n=28, control group). Throughout the heel lance procedure, all infants were assessed for change in facial action (NFCS), behavioral state, crying, and heart rate.
Statistically significant differences were noted between the treatment and control groups during the puncture, heel squeeze and the post phases of heel prick. Infants who received skin-to-skin contact were more likely to show lower NFCS scores throughout the procedure. Both groups of infants cried and showed increased heart rate during puncture and heel squeeze although changes in these measures were less for the treated infants.
Skin-to-skin contact promoted reduction in behavioral measures and less physiological increase during procedure. It is recommended that skin-to-skin contact be used as a non-pharmacologic intervention to relieve acute pain in stable premature infants born 30 weeks gestational age or older.
已开发出几种有前景的非药物干预措施来减轻早产儿的急性疼痛，包括母婴皮肤接触。然而，现有关于母婴皮肤接触研究的生理结果存在差异，这使得难以确定这种自然疗法对早产儿的治疗效果。本研究的目的是测试早产儿足跟采血时母婴皮肤接触的疗效。
59名接受常规足跟采血的稳定早产儿（胎龄至少30周）被随机分为两组，一组在足跟采血前、采血期间和采血后进行15分钟的皮肤接触（n = 31，治疗组），另一组接受常规护理（n = 28，对照组）。在整个足跟采血过程中，对所有婴儿的面部动作变化（NFCS）、行为状态、哭闹和心率进行评估。
在穿刺、足跟挤压和足跟采血后的阶段，治疗组和对照组之间存在统计学上的显著差异。接受皮肤接触的婴儿在整个过程中更有可能表现出较低的NFCS评分。两组婴儿在穿刺和足跟挤压时均哭闹且心率增加，尽管治疗组婴儿的这些指标变化较小。
皮肤接触可减少行为指标变化，并在操作过程中减少生理反应的增加。建议将皮肤接触作为一种非药物干预措施，用于缓解胎龄30周及以上稳定早产儿的急性疼痛。
