Gonsalves S, Mercer J
Stockton State College, Pomona, New Jersey.
Clin J Pain. 1993 Jun;9(2):88-93. doi: 10.1097/00002508-199306000-00003.
The study investigates the physiological responses of preterm infants to procedures that are routinely performed in intensive care nurseries. Changes in heart rate, respiration rate, and oxygen saturation were examined as indicators of the level of discomfort experienced by the infant during the procedures.
Clinical descriptive. Systematic observations of the infants were conducted during periods of rest as well as during routine interventions.
All observations were recorded from monitored preterm infants in the intensive care units of two urban hospitals.
Thirty-five preterm infants 24-30 weeks gestational age and weighing < 2,000 g at birth. Data were collected from all infants in the units who met the weight criterion.
The researchers observed the infants while the intensive care nursery staff were performing routine care procedures. Observations were made during procedures that adults would consider to be painful, such as injection, heel stick, tape removal, and squeezing of the heel to induce blood flow after heel stick, as well as nonpainful procedures, such as handling, temperature taking, alcohol swabbing, patting, taping a tube, feeding, and placing a pacifier.
Heart rate, respiration rate, and oxygen saturation were recorded from infant monitors. Mean values of the three measures during procedures were compared with mean values before and after procedures.
Significant differences (p < 0.001) were found among pre-, peri-, and post-procedures for all three outcome measures. Heart rate and respiration rate means were significantly (p < 0.001) higher during procedures that adults consider to be painful than in those regarded as nonpainful. Oxygen saturation was lower (p < 0.001) for painful procedures than for nonpainful procedures. Gender and infant size comparisons yielded inconclusive results.
The outcome measures appear to be reliable indices of preterm infant responses to painful stimulation.
本研究调查早产儿对重症监护病房常规操作的生理反应。将心率、呼吸频率和血氧饱和度的变化作为婴儿在操作过程中不适程度的指标进行检查。
临床描述性研究。在婴儿休息期间以及常规干预期间对其进行系统观察。
所有观察记录均来自两家城市医院重症监护病房中接受监测的早产儿。
35名孕周为24 - 30周、出生体重<2000克的早产儿。从符合体重标准的该病房所有婴儿中收集数据。
研究人员在重症监护病房工作人员进行常规护理操作时观察婴儿。观察操作包括成人认为会引起疼痛的操作，如注射、足跟采血、去除胶布以及足跟采血后挤压足跟以促使血流，还有无痛操作，如抱持、测量体温、酒精擦拭、轻拍、固定管道、喂食以及放置安抚奶嘴。
通过婴儿监护仪记录心率、呼吸频率和血氧饱和度。将操作过程中这三项指标的平均值与操作前和操作后的平均值进行比较。
所有三项观察指标在操作前、操作期间和操作后均存在显著差异（p<0.001）。成人认为会引起疼痛的操作过程中的心率和呼吸频率平均值显著高于（p<0.001）无痛操作时的平均值。疼痛操作时的血氧饱和度低于（p<0.001）无痛操作时的血氧饱和度。性别和婴儿大小比较结果不明确。
这些观察指标似乎是早产儿对疼痛刺激反应的可靠指标。
