School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.
Int J Nurs Stud. 2012 Mar;49(3):300-9. doi: 10.1016/j.ijnurstu.2011.09.017. Epub 2011 Oct 14.
Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management.
To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures.
Prospective, randomised controlled crossover trial.
Level III Neonatal Intensive Care Unit in Taipei.
Thirty-four preterm infants (gestational age 29-37 weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, non-nutritive sucking. Each treatment condition was performed on a different day to avoid any carry-over effect. Pain was measured by the Premature Infant Pain Profile (PIPP), infant behaviour by a behavioural coding scheme, and physiological signals by electrocardiogram monitors. All data were collected 3 min without stimuli (baseline), during heel-stick procedures, and recovery.
Infants receiving non-nutritive sucking and facilitated tucking had significantly lower mean (standard deviation) pain scores during heel-stick procedures (6.39 [3.35] and 7.15 [3.88], respectively) than those receiving routine care (9.52 [4.95]). Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.39, p=0.011 and 0.34, p=0.005, respectively) for pain (PIPP score≥6) than infants receiving routine care after adjusting for time, baseline pain scores, and infants' characteristics. Similarly, infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.23, p<0.001 and 0.28, p=0.03, respectively) for moderate-to-severe pain (PIPP score≥12) than infants receiving routine care. Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours, abnormal heart rates, and decreased oxygen saturation than infants receiving routine care.
Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures. Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking. However, facilitated tucking showed broader effects not only on relieving pain, but also on enhancing infants' physiological and behavioural stability during heel-stick procedures.
早产儿反复接受疼痛操作可能会导致不良后果。因此，改善早产儿的神经发育结局需要优先考虑他们的疼痛管理。
比较两种非药物性止痛策略（非营养性吸吮和辅助包裹）与常规护理对早产儿足跟采血前、中、后疼痛、行为和生理反应的影响。
前瞻性、随机对照交叉试验。
台北三级新生儿重症监护病房。
采用便利抽样法招募 34 名需要进行 3 次足跟采血的早产儿（胎龄 29-37 周），并随机分配至 3 种治疗方案（2 种止痛干预措施和对照组）：（1）常规护理、非营养性吸吮、辅助包裹，（2）非营养性吸吮、辅助包裹、常规护理，和（3）辅助包裹、常规护理、非营养性吸吮。每种治疗方案在不同的日子进行，以避免任何残留效应。疼痛通过早产儿疼痛评分（PIPP）测量，行为通过行为编码方案测量，生理信号通过心电图监测仪测量。所有数据均在无刺激（基线）、足跟采血过程中和恢复期采集 3 分钟。
接受非营养性吸吮和辅助包裹的婴儿在足跟采血过程中的平均（标准差）疼痛评分（分别为 6.39[3.35]和 7.15[3.88]）显著低于接受常规护理的婴儿（9.52[4.95]）。接受非营养性吸吮和辅助包裹的婴儿疼痛（PIPP 评分≥6）的比值比（OR）（0.39，p=0.011 和 0.34，p=0.005，分别）显著低于接受常规护理的婴儿，调整时间、基线疼痛评分和婴儿特征后。同样，接受非营养性吸吮和辅助包裹的婴儿中，疼痛（PIPP 评分≥12）为中度至重度疼痛的 OR（0.23，p<0.001 和 0.28，p=0.03，分别）显著低于接受常规护理的婴儿。接受辅助包裹的婴儿应激相关行为、异常心率和氧饱和度下降的频率比接受常规护理的婴儿低。
非营养性吸吮和辅助包裹在足跟采血过程中均能比常规护理更有效地降低疼痛评分。非营养性吸吮比辅助包裹更有效地降低 PIPP 疼痛评分。然而，辅助包裹不仅在缓解疼痛方面，而且在增强婴儿足跟采血过程中的生理和行为稳定性方面都具有更广泛的效果。
