Cignacco E, Denhaerynck K, Nelle M, Bührer C, Engberg S
Institute of Nursing Science, University of Basel, Basel, Switzerland.
Acta Paediatr. 2009 May;98(5):842-6. doi: 10.1111/j.1651-2227.2008.01203.x. Epub 2009 Jan 13.
To explore the variability in pain response in preterm infants across time who received sucrose during routine heel stick.
Single group, exploratory repeated measures design.
Two tertiary level neonatal intensive care units (NICU) in Switzerland.
Nine preterm infants born between 28 2/7 and 31 4/7 weeks of gestation during their first 14 days of life.
Pain was assessed by the Bernese Pain Scale for Neonates (BPSN), the Premature Infant Pain Profile (PIPP) and the Visual Analogue Scale (VAS). Salivary cortisol was analysed.
72-94% of the variability was within-subject variability, indicating inconsistency of pain responses across the 5 heel sticks. Interrater agreement was highest during heel sticks 1-3 and decreased during heel stick 4 and 5, indicating a possible alteration of pain patterns. No significant differences in the amount of cortisol could be detected before and after the heel sticks (p = 0.55), indicating no stress-induced peak after the painful intervention. However, a general gradual decrease of cortisol levels across time could be detected.
A high variability in pain response among preterm neonates across time could be described. Consistency of cortisol levels before and after the heel sticks could indicate the effectiveness of sucrose across time.
探讨在常规足跟采血期间接受蔗糖的早产儿疼痛反应随时间的变化情况。
单组探索性重复测量设计。
瑞士的两家三级新生儿重症监护病房（NICU）。
9名在出生后14天内、孕龄在28又2/7至31又4/7周之间出生的早产儿。
采用伯尔尼新生儿疼痛量表（BPSN）、早产儿疼痛量表（PIPP）和视觉模拟量表（VAS）评估疼痛。分析唾液皮质醇。
72%至94%的变异性为个体内变异性，表明在5次足跟采血过程中疼痛反应不一致。评分者间一致性在第1至3次足跟采血时最高，在第4次和第5次足跟采血时降低，表明疼痛模式可能发生了改变。足跟采血前后皮质醇量无显著差异（p = 0.55），表明疼痛干预后无应激诱导的峰值。然而，可检测到皮质醇水平随时间总体呈逐渐下降趋势。
可以描述早产儿疼痛反应随时间存在高度变异性。足跟采血前后皮质醇水平的一致性可表明蔗糖随时间的有效性。
