3/4俯臥措施對緩解早產兒足跟穿刺疼痛之成效

The effects of pain response to heelstick by using 3/4 prone position in premature infants

林秀儀(Hsiu-I Lin)

指導教授 ： 李 淑 杏

中山醫學大學/醫學院/護理研究所/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00023

摘要

背景：足跟穿刺對早產兒是一常見引起疼痛的侵入檢查措施，疼痛刺激對早產新生兒有負面影響，臨床上應積極的發展處理新生兒的疼痛以及預防疼痛發生的介入措施。
目的：比較3/4俯臥築巢及仰臥築巢不同臥姿於足跟穿刺時緩解早產兒疼痛的效果。
方法：於南部某區域教學醫院新生兒中心，選取符合研究收案條件之32-36週早產兒，以亂數隨機分配決定早產兒先採取3/4俯臥築巢足跟穿刺，24小時後採仰臥築巢足跟穿刺之交叉配對設計(Cross-over design)，共收案49位符合條件之早產兒，於足跟穿刺採集檢體之前、中、後共10分鐘時間，針對不同臥位早產兒以攝影機記錄過程。根據新生兒疼痛評估量表Neonatal Infant Pain Scale (NIPS)分析不同臥位早產兒之疼痛分數、疼痛人數及其心跳、呼吸速率、血氧濃度之生理指標，比較不同臥姿緩解疼痛反應之成效。統計分析以SPSS for window 12.0版本軟體進行分析，以配對t檢定(Paired-t test)、線性複回歸(multiple linear regression)以及McNemar-Bowker對稱檢定分析。
結果：早產兒於3/4俯臥築巢之疼痛總分於穿刺第一分鐘、恢復期第一分鐘、第二分鐘及第四分鐘低於仰臥築巢，且達統計顯著水準；3/4俯臥築巢各階段之疼痛反應人數均少於仰臥築巢，其心跳、呼吸速率、血氧濃度之生理指標相較仰臥築巢亦趨穩定；顯示3/4俯臥築巢能緩解早產兒足跟穿刺疼痛。本結果可增進醫護人員對早產兒疼痛的認知，提供臨床護理人員於早產兒進行足跟穿刺時緩解疼痛之參考。

關鍵字

早產兒疼痛 ； 足跟穿刺 ； 3/4俯臥築巢 ； 仰臥築巢

並列摘要

Background: Heelstick in preterm infants is a common practice of invasive inspection causing pain, which has negative impacts on infants. Following the advancement of medical care, neonatal pain treatment and prevention of pain caused by interventions should be developed.
Objective: To compare the effects of heelstick pain relief methods between the 3/4 prone nesting and supine nesting positions in preterm infants.
Methods: This is a Cross-over Design study. Forty-nine preterm infants of 32-36 weeks met the inclusion criteria were selected from a neonatal center of a regional teaching hospital in southern Taiwan. Infants were randomly assigned into two groups. Determined by random number, 3/4 prone nesting heelstick did the intervention first, and then the supine nesting 24 hours later. Cameras filmed the process of total 10 minutes before, during, and after the heelstick specimen collection. Based on the Neonatal Infant Pain Scale (NIPS), different supine preterm infants’ pain scores, heart rates, respiratory rates, and oxygen concentration of physiological indicators were collected and analyzed by a senior nurse to compare the difference in effectiveness on pain responses.
Results: Pain scores of the the 3/4 prone nesting at the first minute after heelstick and recovery periods at the first, second, and the fourth minutes were all statistically significant lower than the supine nesting. The 3/4 prone nesting physiological indicators, including heartbeat rates, breathing rates, and blood oxygen concentration, also showed a more stabilized trend than the supine nesting. The result illustrates the intervention of 3/4 prone nesting position can better relieve the heelstick pain for premature infants. This research may not only help improve the healthcare professionals’ perceptions about the pain in preterm infants, but also provide references for clinical nurses about the pain relief of heelstick in premature infants.

並列關鍵字

preterm infants pain ； heelstick ； 3/4 prone nesting ； supine nesting

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