不同疼痛干预方式在极低出生体重儿PICC置管中的效果研究  

Effects of different pain intervention methods on PICC in very low birth weight infants

作　　者：沈飞 李芳 戎惠[1] 王茜 陈秀利[1] SHEN Fei;LI Fang;RONG Hui;WANG Qian;CHEN Xiuli(Neonatal Medical Center,Children's Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院新生儿医疗中心,江苏南京210008

出　　处：《护士进修杂志》2023年第12期1063-1068,共6页Journal of Nurses Training

基　　金：南京医科大学科技发展基金项目(编号:NMUB2018103)。

摘　　要：目的探讨非营养性吸吮(NNS)、蔗糖液单独或联合使用在极低出生体重儿(VLBWI)经外周静脉置入中心静脉导管(PICC)中的疼痛干预效果。方法选取2020年6月-2021年12月我院新生儿重症监护室收治的112例VLBWI作为研究对象,按随机数字表分为对照组、NNS组、蔗糖液组和联合组(NNS联合蔗糖液),各28例。(1)比较4组患儿PICC置管6个时段中的疼痛评分(PIPP)及生理指标[心率(HR)和经皮动脉血氧饱和度(SpO2)]。(2)比较4组患儿PICC置管3个时期中的行为指标(疼痛面容时间和啼哭时间)。(3)比较4组患儿PICC置管操作时间。结果(1)4组患儿PICC置管6个时段PIPP、HR变化和3个时期疼痛面容时间、啼哭时间变化均存在时间、组间及交互效应(P<0.01);SpO2变化存在时间、交互效应(P<0.01),但组间差异无统计学意义(P>0.05)。(2)联合组患儿在PICC置管消毒期、穿刺期的PIPP低于其他3组(P<0.01);在送管期的PIPP低于对照组和蔗糖液组(P<0.01),但与NNS组比较差异无统计学意义(P>0.05)。(3)NNS组和联合组患儿在PICC置管消毒期和穿刺期的HR稳定效果优于其他2组,联合组患儿在PICC置管送管期的HR稳定、在穿刺期的SpO2水平均优于对照组,差异有统计学意义(P<0.01)。(4)NNS组和联合组患儿在置管过程期中的疼痛面容时间、啼哭时间均短于其他2组(P<0.01)。(5)联合组患儿PICC置管操作时间少于其他3组(P<0.01)。结论NNS单独或联合蔗糖液使用在稳定VLBWI行PICC置管消毒期和穿刺期中HR的效果更佳,还可降低置管过程期中患儿疼痛面容时间与啼哭时间。NNS联合蔗糖液使用可降低VLBWI患儿PICC置管过程中消毒期和穿刺期的PIPP,缓解患儿疼痛感、进而提升患儿舒适程度;与此同时,还能够缩短PICC置管操作时间,减轻护士工作量。提示临床护理人员针对VLBWI行PICC置管不同阶段应采取针对性的措施以缓解患儿疼痛状况。Objective To explore the effects of non-nutritive sucking(NNS)and sucrose solution alone or in combination on pain intervention in very low birth weight infants(VLBWI)undergoing peripherally inserted central catheter(PICC).Methods A total of 112 VLBWI admitted to the neonatal intensive care unit(NICU)of our hospital from June 2020 to December 2021 were selected as the study subjects.According to the random number table,they were divided into control group,NNS group,sucrose group,and combined group(NNS combined with sucrose solution),with 28 cases in each group.(1)The pain score(PIPP)and physiological indicators,namely heart rate(HR)and transcutaneous oxygen saturation SpO 2 in 6 periods of PICC in the 4 groups were compared.(2)The behavioral indicators(pain facial time and crying time)in 3 periods of PICC were compared between the 4 groups.(3)The PICC operation time of the 4 groups was compared.Results(1)There were time,between-group,and interaction effects in the changes of PIPP and HR during 6 periods of PICC and changes in pain facial time and crying time during 3 periods of PICC in 4 groups(P<0.01);The change of SpO 2 had time and interaction effects(P<0.01),but there was no statistically significant difference between groups(P>0.05).(2)The PIPP in the combined group during the disinfection and puncture stages of PICC were lower than those in the other 3 groups(P<0.01),and the PIPP in the tube delivery stage was lower than that of the control group and the sucrose group(P<0.01),but there was no significant difference with the NNS group(P>0.05).(3)The HR stabilization effect in the NNS group and the combined group were better than those in the other 2 groups during the disinfection and puncture stages of PICC,and the stable HR of the infants in the combined group and the level of SpO 2 in the puncture stage were better than those in the control group,and the difference was statistically significant(P<0.01).(4)The pain facial time and crying time of the infants in the NNS group and the combined group were short

关 键 词：疼痛管理 非营养性吸吮 蔗糖液 经外周静脉置入中心静脉导管 极低出生体重儿 

分 类 号：R473.72[医药卫生—护理学]