Carbajal Ricardo, Rousset André, Danan Claude, Coquery Sarah, Nolent Paul, Ducrocq Sarah, Saizou Carole, Lapillonne Alexandre, Granier Michèle, Durand Philippe, Lenclen Richard, Coursol Anne, Hubert Philippe, de Saint Blanquat Laure, Boëlle Pierre-Yves, Annequin Daniel, Cimerman Patricia, Anand K J S, Bréart Gérard
Centre National de Ressources de lutte contre la Douleur, Hôpital d'enfants Armand Trousseau, 26, av du Dr Netter, 75012 Paris, France.
JAMA. 2008 Jul 2;300(1):60-70. doi: 10.1001/jama.300.1.60.
Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain.
To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.
DESIGN, SETTING, AND PATIENTS: Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.3 millions inhabitants) for the Epidemiology of Procedural Pain in Neonates (EPIPPAIN) study.
Number of procedures considered painful or stressful by health personnel and corresponding analgesic therapy.
The mean (SD) gestational age and intensive care unit stay were 33.0 (4.6) weeks and 8.4 (4.6) calendar days, respectively. Neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6%) painful and 18,556 (30.4%) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8%) for painful and 1180 (10.2%) for stressful procedures. Each neonate experienced a median of 115 (range, 4-613) procedures during the study period and 16 (range, 0-62) procedures per day of hospitalization. Of these, each neonate experienced a median of 75 (range, 3-364) painful procedures during the study period and 10 (range, 0-51) painful procedures per day of hospitalization. Of the 42,413 painful procedures, 2.1% were performed with pharmacological-only therapy; 18.2% with nonpharmacological-only interventions, 20.8% with pharmacological, nonpharmacological, or both types of therapy; and 79.2% without specific analgesia, and 34.2% were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons. Prematurity, category of procedure, parental presence, surgery, daytime, and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia.
During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.
改善新生儿疼痛管理的有效策略需要对程序性疼痛的流行病学和管理有清晰的认识。
基于对新生儿的直接床边观察，报告从一个地理区域收集的新生儿疼痛流行病学数据。
设计、地点和患者：在2005年9月至2006年1月期间，在6周内前瞻性收集了法国巴黎地区（1130万居民）三级护理中心收治的430例新生儿入院前14天内所有疼痛性和应激性操作及相应镇痛治疗的数据，用于新生儿程序性疼痛流行病学（EPIPPAIN）研究。
医护人员认为疼痛或应激的操作数量及相应的镇痛治疗。
平均（标准差）胎龄和重症监护病房住院时间分别为33.0（4.6）周和8.4（4.6）个日历日。新生儿经历了60969次首次尝试操作，其中42413次（69.6%）为疼痛性操作，18556次（30.4%）为应激性操作；操作过程中进行了11546次补充尝试，其中10366次（89.8%）用于疼痛性操作，1180次（10.2%）用于应激性操作。在研究期间，每个新生儿经历的操作中位数为115次（范围4 - 613次），住院期间每天经历的操作中位数为16次（范围0 - 62次）。其中，每个新生儿在研究期间经历的疼痛性操作中位数为75次（范围3 - 364次），住院期间每天经历的疼痛性操作中位数为10次（范围0 - 51次）。在42413次疼痛性操作中，2.1%仅采用药物治疗；18.2%仅采用非药物干预；20.8%采用药物、非药物或两种治疗方式；79.2%未进行特异性镇痛，34.2%的操作是在新生儿因其他原因接受同时性镇痛或麻醉输注时进行的。早产、操作类别、家长在场、手术、日间以及入院第一天后的操作日与更多使用特异性操作前镇痛相关，而机械通气、无创通气和给予非特异性同时性镇痛与较少使用特异性操作前镇痛相关。
在巴黎地区的新生儿重症监护期间，进行了大量疼痛性和应激性操作，其中大多数未进行镇痛。
