School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Children's Hospital of Nanjing Medical University, China.
Int J Nurs Stud. 2018 Jul;83:25-33. doi: 10.1016/j.ijnurstu.2018.04.006. Epub 2018 Apr 7.
Sucrose combined with non-nutritive sucking provided better pain relief than sucrose or non-nutritive sucking alone in a single painful procedure. However, whether the combination of non-nutritive sucking with sucrose could obtain a significant difference in analgesic effect of the repeated procedural pain than any single intervention has not been established.
To compare the effect of non-nutritive sucking and sucrose alone and in combination of repeated procedural pain in preterm infants.
Randomized controlled trial.
A level III neonatal intensive care unit of a university hospital in China.
Preterm infants born before 37 weeks of gestation were randomly assigned to four groups: routine care group (routine comfort through gentle touch when infants cried; n = 21), non-nutritive sucking group (n = 22), sucrose group (0.2 ml/kg of 20%; n = 21), sucrose (0.2 ml/kg of 20%) plus non-nutritive sucking group (n = 22). Each preterm infant received three nonconsecutive routine heel sticks. Each heel stick included three phases: baseline (the last 1 min of the 30 min without stimuli), blood collection, recovery (1 min after blood collection). Three phases of 3 heel stick procedures were videotaped. Premature infant pain profile (PIPP) score, heart rate, oxygen saturation and percentage of crying time were assessed by five independent evaluators who were blinded to the purpose of the study at different phases across three heel sticks. Data were analyzed by analysis of variance, with repeated measures at different evaluation phases of heel stick.
86 preterm infants completed the protocol. During the blood collection and recovery phases, combination group, had lower PIPP score (4.4 ± 1.5; 3.0 ± 0.8), lower heart rate (138.6 ± 7.9; 137.4 ± 4.7), higher oxygen saturation (95.2 ± 1.6; 96.0 ± 1.2), and smaller percentage of crying time (11.5 ± 8.6; 4.6 ± 3.4), compared with the group has given non-nutritive sucking (9.3 ± 1.3, 6.8 ± 1.4; 154.2 ± 9.0, 148.0 ± 9.3; 92.9 ± 2.4, 94.1 ± 1.0; 44.2 ± 9.6, 31.2 ± 10.5; respectively) or sucrose (10.1 ± 2.0, 7.4 ± 1.6; 151.6 ± 9.6, 147.9 ± 6.9; 93.5 ± 1.7, 94.5 ± 1.2; 53.8 ± 16.7, 35.2 ± 13.9; respectively) or routine care (13.3 ± 1.6, 10.6 ± 1.9; 156.8 ± 7.2, 151.7 ± 7.9; 92.9 ± 2.1, 93.8 ± 1.6; 80.6 ± 7.6, 68.2 ± 9.9; respectively). Both non-nutritive sucking and sucrose were more effective in reducing preterm infants' PIPP score and percentage of crying time than routine care. There was no difference in PIPP score, heart rate, oxygen saturation and percentage of crying time between the non-nutritive sucking and sucrose groups.
The combination of non-nutritive sucking with sucrose provided better pain relief during repeated painful procedures than when non-nutritive sucking or sucrose was used alone. The effect of non-nutritive sucking was similar to that of sucrose on repeated procedural pain.
在单次疼痛操作中，与蔗糖或非营养性吸吮单独使用相比，蔗糖联合非营养性吸吮能更好地缓解疼痛。然而，非营养性吸吮与蔗糖联合应用是否能在反复程序性疼痛的镇痛效果上取得显著差异尚未确定。
比较非营养性吸吮和蔗糖单独及联合应用于早产儿反复程序性疼痛的效果。
随机对照试验。
中国一所大学医院的三级新生儿重症监护病房。
将胎龄小于 37 周的早产儿随机分为四组：常规护理组（当婴儿哭泣时，通过轻柔触摸进行常规舒适护理；n=21）、非营养性吸吮组（n=22）、蔗糖组（0.2ml/kg 20%；n=21）、蔗糖（0.2ml/kg 20%）加非营养性吸吮组（n=22）。每个早产儿接受三次非连续的常规足跟采血。每次足跟采血包括三个阶段：基线（采血前 30 分钟无刺激的最后 1 分钟）、采血、恢复（采血后 1 分钟）。三个足跟采血过程的三个阶段都进行了录像。采用五个独立评估者在足跟采血的三个阶段对早产儿疼痛特征（PIPP）评分、心率、氧饱和度和哭泣时间百分比进行评估，评估者对研究目的均不知情。采用重复测量方差分析对数据进行分析。
86 例早产儿完成了方案。在采血和恢复阶段，联合组的 PIPP 评分（4.4±1.5；3.0±0.8）、心率（138.6±7.9；137.4±4.7）、氧饱和度（95.2±1.6；96.0±1.2）和哭泣时间百分比（11.5±8.6；4.6±3.4）均低于非营养性吸吮组（9.3±1.3，6.8±1.4；154.2±9.0，148.0±9.3；92.9±2.4，94.1±1.0；44.2±9.6，31.2±10.5；分别）或蔗糖组（10.1±2.0，7.4±1.6；151.6±9.6，147.9±6.9；93.5±1.7，94.5±1.2；53.8±16.7，35.2±13.9；分别）或常规护理组（13.3±1.6，10.6±1.9；156.8±7.2，151.7±7.9；92.9±2.1，93.8±1.6；80.6±7.6，68.2±9.9；分别）。与常规护理相比，非营养性吸吮和蔗糖均能更有效地降低早产儿的 PIPP 评分和哭泣时间百分比。非营养性吸吮组与蔗糖组的 PIPP 评分、心率、氧饱和度和哭泣时间百分比无差异。
与单独使用非营养性吸吮或蔗糖相比，非营养性吸吮联合蔗糖在反复疼痛操作中能更好地缓解疼痛。非营养性吸吮的效果与蔗糖相似，均可缓解反复程序性疼痛。
