Cong Xiaomei, Cusson Regina M, Hussain Naveed, Zhang Di, Kelly Sharon P
University of Connecticut School of Nursing, Storrs, Connecticut 06269-2026, USA.
Pain Manag Nurs. 2012 Sep;13(3):127-38. doi: 10.1016/j.pmn.2010.10.035. Epub 2011 May 31.
The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants.
本案例研究的目的是描述28周胎龄双胞胎在三种研究条件下的疼痛反应：足跟采血前及采血全程采用较长时间（30分钟）的袋鼠式护理（KC30）、足跟采血前及采血全程采用较短时间（15分钟）的袋鼠式护理（KC15），以及足跟采血全程采用暖箱护理（IC）。通过哭闹时间、早产儿疼痛量表（PIPP）和心率变异性指标来测量疼痛反应，心率变异性指标包括低频功率（LF，代表交感神经活动）、高频功率（HF，副交感神经活动）以及LF/HF比值（交感 - 副交感神经平衡）。在IC条件下，双胞胎在足跟采血时哭闹更多，PIPP疼痛评分更高且出现心动过速。在IC条件下，婴儿B在足跟采血结束时出现呼吸暂停和心动过速事件，在恢复过程中出现心动过缓发作。与IC条件相比，在较长时间和较短时间的KC条件下，双胞胎在恢复过程中的LF/HF比值更低（自主神经系统平衡更好）。在IC条件下，婴儿B在疼痛操作后难以恢复到LF/HF比值的基线水平。这些数据表明，在疼痛操作前及操作全程采用较长时间和较短时间的KC均有助于降低早产儿的行为和生理疼痛反应。
