经外周静脉置入中心静脉导管术（PICC）中早产儿 crSO 与疼痛相关的变化。

Pain-related changes in crSO among premature infants undergoing PICC insertion.

机构信息

Division of Newborn Medicine, Department of Pediatrics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.

Clinical Nursing Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.

出版信息

J Matern Fetal Neonatal Med. 2023 Dec;36(2):2241976. doi: 10.1080/14767058.2023.2241976.

DOI:10.1080/14767058.2023.2241976

PMID:37527965

Abstract

OBJECTIVE

To evaluate the effectiveness of cerebral regional oxygen saturation (crSO) values, measured using near-infrared spectroscopy (NIRS), in assessing pain associated with the peripherally inserted central catheter (PICC) in premature infants.

METHODS

NIRS was used to measure the crSO levels of 48 premature infants with gestational age (GA) of < 32 weeks or a birth weight of < 1500 g. Premature infant pain profile (PIPP) scores, vital signs, transcutaneous oxygen tension (TcpO), transcutaneous carbon dioxide tension (TcpCO), and crSO values were monitored. One-way repeated measure analysis of variance was used to compare heart rate (HR), respiratory rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO), TcpO, TcpCO, and crSO values before (Time 1), during (Time 2), and after (Time 3) PICC insertion. The correlation between the PIPP scores at Time 2 and the fluctuations (values detected at Time 2 minus those at Time 1) of SpO TcpO and crSO were also analyzed.

RESULTS

The PIPP score at Time 2 was significantly higher than those at Times 1 and 3. HR, RR, and BP values increased ( < .05), and SpO and crSO levels decreased at Time 2 ( < .05) compared with those at Time 1. Stratified analysis based on GA revealed significant differences in HR, RR, and crSO values between Times 1 and 2 in infants with a GA of ≥ 32 weeks. In infants with a GA < 32 weeks, significant differences were observed in HR, RR, SpO, BP, and crSO values between Times 1 and 2. The fluctuation of the crSO level was strongly correlated with the PIPP score at Time 2 ( = -0.829, < .001). A weak correlation was observed between the PIPP score at Time 2 and TcpO level fluctuation ( = 0.375, = .009). No correlation was observed between the PIPP score at Time 2 and SpO level fluctuation ( = 0.242, = .097).

CONCLUSION

The fluctuation of crSO levels strongly correlates with PICC procedural pain. Hence, crSO levels measured using NIRS may be used as an indicator for pain assessment in premature infants.

摘要

目的

评估使用近红外光谱（NIRS）测量脑局部血氧饱和度（crSO）值在评估早产儿外周中心静脉置管（PICC）相关疼痛中的有效性。

方法

使用 NIRS 测量 48 名胎龄（GA）<32 周或出生体重<1500 g 的早产儿的 crSO 水平。监测早产儿疼痛概况（PIPP）评分、生命体征、经皮氧分压（TcpO）、经皮二氧化碳分压（TcpCO）和 crSO 值。采用单向重复测量方差分析比较 PICC 插入前（Time 1）、插入时（Time 2）和插入后（Time 3）的心率（HR）、呼吸率（RR）、血压（BP）、外周血氧饱和度（SpO）、TcpO、TcpCO 和 crSO 值。还分析了 PIPP 评分在 Time 2 时与 SpO、TcpO 和 crSO 的波动（Time 2 时检测到的值减去 Time 1 时的值）之间的相关性。

结果

Time 2 时的 PIPP 评分明显高于 Time 1 和 Time 3。与 Time 1 相比，Time 2 时 HR、RR 和 BP 值增加（<0.05），SpO 和 crSO 水平降低（<0.05）。基于 GA 的分层分析显示，GA≥32 周的婴儿在 Time 1 和 Time 2 之间 HR、RR 和 crSO 值存在显著差异。GA<32 周的婴儿在 Time 1 和 Time 2 之间 HR、RR、SpO、BP 和 crSO 值存在显著差异。crSO 水平的波动与 Time 2 时的 PIPP 评分呈强相关（=−0.829，<0.001）。Time 2 时的 PIPP 评分与 TcpO 水平波动呈弱相关（=0.375，=0.009）。Time 2 时的 PIPP 评分与 SpO 水平波动无相关性（=0.242，=0.097）。