Hoffman Karin, Bromster Therése, Hakansson Stellan, van den Berg Johannes
Department of Clinical Sciences, Pediatrics, Umeå University, Sweden.
Adv Neonatal Care. 2013 Aug;13(4):252-61. doi: 10.1097/ANC.0b013e31829d8baf.
The purpose of this article was to study an infant who suffered from asphyxia undergoing induced hypothermia with regard to (1) describe the pain and stress as measured by physiological variables skin conductance algesimeter (SCA) and pain rating scales, (2) the correlation between SCA and pain rating scales, and (3) how temperature cycles in the cooling blanket affect the response of the sympathetic nervous system as measured by the SCA and physiological variables. A single prospective case study was used for this article. Data were recorded every 15 minutes for 96 hours. Each observation was categorized according to treatment phase: cooling 0 to 72 hours, rewarming, and controlled normal temperature up to 96 hours. Structured observations were carried out and all nursing care was documented. In addition, 5 periods with no other nursing interventions were identified in which data were recorded every minute for analysis. Skin conductance algimetry showed a variable response during treatment. During cooling, 68% of the 15-minute periods, signs of stress and pain were recorded. During rewarming, the corresponding figure was 83%. During the time sequences with normal temperature, 89% of the periods were associated with stress and pain. During 80% of the nursing procedures, the SCA showed stress and pain. There was no correlation between the pain-rating scales and SCA. When the cooling blanket temperature was lower than core temperature, the infant had more stress and pain according to SCA (P < .001) and an increase in heart rate and blood pressure (P < .001). In infants during induced hypothermia, SCA seem to detect pain and stress. Future evaluation of SCA for the detection of pain and stress during hypothermia treatment is necessary. Pain-rating scales do not appear reliable in this case report.
本文旨在研究一名接受亚低温治疗的窒息婴儿，内容包括：（1）通过生理变量皮肤电导痛觉计（SCA）和疼痛评分量表描述疼痛和应激情况；（2）SCA与疼痛评分量表之间的相关性；（3）降温毯的温度循环如何影响通过SCA和生理变量测量的交感神经系统反应。本文采用了单例前瞻性病例研究。每15分钟记录一次数据，共记录96小时。每次观察根据治疗阶段进行分类：0至72小时降温、复温以及直至96小时的体温控制正常阶段。进行了结构化观察并记录了所有护理措施。此外，还确定了5个无其他护理干预的时间段，在此期间每分钟记录数据用于分析。皮肤电导痛觉测量显示治疗期间反应多变。降温期间，15分钟时间段中有68%记录到应激和疼痛迹象。复温期间，相应数字为83%。在体温正常的时间段，89%的时间段与应激和疼痛相关。在80%的护理操作过程中，SCA显示有应激和疼痛。疼痛评分量表与SCA之间无相关性。当降温毯温度低于核心温度时，根据SCA测量，婴儿有更多的应激和疼痛（P<0.001），心率和血压升高（P<0.001）。在亚低温治疗的婴儿中，SCA似乎能检测到疼痛和应激。未来有必要对SCA在低温治疗期间检测疼痛和应激的情况进行评估。在此病例报告中，疼痛评分量表似乎不可靠。
