Lago Paola, Tiozzo Caterina, Boccuzzo Giovanna, Allegro Antonella, Zacchello Franco
Department of Pediatrics, Neonatal Intensive Care, University of Padua, Padua, Italy.
Paediatr Anaesth. 2008 Aug;18(8):736-44. doi: 10.1111/j.1460-9592.2008.02636.x.
There is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants.
To assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants.
Fifty-four neonates [mean gestational age (+/-sd) 28 +/- 2 weeks; birth weight 1126 +/- 337 g] were randomly assigned to remifentanil infusion at 0.03 mcg.kg(-1).min(-1) (R) or placebo (C) in addition to 0.3 ml of 12% sucrose per os and non-nutritive sucking.
Validated pain scales [Neonatal Infants Pain Scale (NIPS) and Premature Infants Pain Profile (PIPP)] administered at the baseline T0, skin preparation T1, needle insertion T2, and recovery T3, revealed differences in mean NIPS scores (C 5.3 +/- 1.3 vs R 4.2 +/- 1.4 at T1 and C 5.0 +/- 1.3 vs R 3.4 +/- 1.3 at T2) and PIPP scores (C 9.3 +/- 1.6 vs R 7.1 +/- 1.5 at T1 and C 8.6 +/- 1.7 vs R 6.1 +/- 1.4 at T2); P < 0.05. Cardiovascular and respiratory response, and body movements during PICC suggested better pain and distress control with remifentanil (P < 0.05), but the time to complete the maneuver and the number of attempts needed remained the same in the two groups.
Low-dose remifentanil has a measurable, synergic analgesic effect in combination with 12% sucrose and non-nutritive sucking, but does not make PICC easier or quicker.
关于阿片类药物在早产儿经皮静脉中心导管（PICC）置入过程中的镇痛效果，证据有限。
评估低剂量瑞芬太尼输注在早产儿PICC置入过程中的镇痛及操作效果。
54例新生儿[平均胎龄（±标准差）28±2周；出生体重1126±337g]被随机分为接受0.03mcg·kg⁻¹·min⁻¹瑞芬太尼输注组（R组）或安慰剂组（C组），此外均口服0.3ml12%蔗糖并进行非营养性吸吮。
在基线T0、皮肤准备T1、穿刺T2和恢复T3时使用经过验证的疼痛量表[新生儿疼痛量表（NIPS）和早产儿疼痛量表（PIPP）]，结果显示平均NIPS评分存在差异（T1时C组5.3±1.3 vs R组4.2±1.4，T2时C组5.0±1.3 vs R组3.4±1.3）以及PIPP评分存在差异（T1时C组9.3±1.6 vs R组7.1±1.5，T2时C组8.6±1.7 vs R组6.1±1.4）；P<0.05。PICC置入过程中的心血管和呼吸反应以及身体活动表明，瑞芬太尼能更好地控制疼痛和痛苦（P<0.05），但两组完成操作的时间和所需尝试次数相同。
低剂量瑞芬太尼与12%蔗糖和非营养性吸吮联合使用具有可测量的协同镇痛作用，但不会使PICC置入更轻松或更快。
