早产儿散瞳滴眼后的疼痛反应。
The pain response to mydriatic eyedrops in preterm infants.
机构信息
Divisions of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
出版信息
J Perinatol. 2013 Jun;33(6):462-5. doi: 10.1038/jp.2012.149. Epub 2012 Dec 13.
OBJECTIVE
Evaluate physiological and behavioral pain responses of premature infants following instillation of mydriatic eyedrops for retinopathy of prematurity (ROP) examinations. While burning and stinging occurs in older patients, the infant pain response is not well characterized.
STUDY DESIGN
Vital sign and video monitor recorded infant responses before, during and after mydriatic (tropicamide 1%, phenylephrine 2.5%) administration upon first ROP exam. Two masked observers graded Premature Infant Pain Profile (PIPP) scores immediately before and following eyedrop administration. Scores <7 indicate no/minimal pain, 7 to 12 slight/moderate, >12 severe.
RESULT
Twenty infants had mean premydriatic PIPP score 3.6 (s.d. 1.6), mean postmydriatic score 5.7 (s.d. 3.4), mean change 2.1 (s.d. 3.4) (P=0.01). One (5%) had premydriatic PIPP score ≥7, seven (35%) post scores ≥7 (P=0.07) with one >12.
CONCLUSION
Mydriatic drops cause a clinically significant pain response in one-third of infants. Non-pharmacological supportive measures are recommended for all infants until predictive factors are defined.
目的
评估早产儿在接受早产儿视网膜病变（ROP）检查时滴用散瞳眼药后的生理和行为疼痛反应。虽然在年龄较大的患者中会出现烧灼感和刺痛感，但婴儿的疼痛反应尚未得到很好的描述。
研究设计
在首次 ROP 检查时，在散瞳（托吡卡胺 1%，苯肾上腺素 2.5%）给药前、给药期间和给药后，通过生命体征和视频监视器记录婴儿的反应。两名蒙眼观察者在滴眼前和滴眼后立即对早产儿疼痛概况（PIPP）评分进行评分。得分<7 表示无/轻度疼痛，7-12 表示轻度/中度疼痛，>12 表示重度疼痛。
结果
20 名婴儿的平均预散瞳 PIPP 评分为 3.6（标准差 1.6），平均散瞳后评分为 5.7（标准差 3.4），平均变化为 2.1（标准差 3.4）（P=0.01）。有 1 名（5%）婴儿的预散瞳 PIPP 评分≥7，7 名（35%）婴儿的散瞳后评分≥7（P=0.07），其中 1 名婴儿的评分>12。
结论
散瞳滴眼会引起三分之一的婴儿出现明显的疼痛反应。建议对所有婴儿采取非药物支持措施，直到确定预测因素。
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