非营养性吸吮联合音乐治疗对新生儿疼痛的缓解作用

目的观察非营养性吸吮（NNS）、音乐治疗（MT）及非营养性吸吮联合音乐治疗（NNS＋MT）在缓解新生儿疼痛中的作用。方法收集2008年1～6月在南京医科大学附属南京儿童医院新生儿医学中心普通新生儿病房收治的新生儿作为研究对象,对符合纳入和排除标准的新生儿按照住院号从小到大顺序分为干预组（NNS亚组、MT亚组、NNS＋MT亚组）和空白对照组,干预措施在新生儿足后跟采血前2min开始持续至研究结束,共15min,空白对照组不予干预措施。通过观察新生儿的心率、经皮氧饱和度（SpO2）及新生儿疼痛行为（NIPS）评分,采集采血针刺前1min、针刺时和针刺后13min过程中的每一分种数据,比较各种干预措施缓解新生儿疼痛的临床效果。采用SPSS11.0软件进行多变量方差分析,ANOVA方差检验,同时应用PostHoc进行组间比较。结果纳入住院新生儿80例,男54例,女26例;各亚组和空白对照组各20例。疼痛刺激后各组的心率均显著加快,于刺激后0～2min达峰值,之后逐渐减慢;NNS亚组与空白对照组心率差异无统计学意义,MT、NNS＋MT亚组与空白对照组心率差异均有统计学意义,MT亚组和NNS＋MT亚组心率差异无统计学意义。疼痛刺激后各亚组SpO2均显著降低,于刺激后2～4min降至最低值,之后逐渐升高;NNS亚组与对照组SpO2差异无统计学意义,MT、NNS＋MT亚组与空白对照组SpO2差异均有统计学意义,MT亚组和NNS＋MT亚组SpO2差异无统计学意义。疼痛刺激后各组NIPS评分均显著提高,于0～1min达峰值,之后逐渐降低,各亚组NIPS评分差异均无统计学意义。与空白对照组比较,MT、NNS＋MT干预措施均可缓解疼痛刺激引起的心率、SpO2和NIPS评分变化。结论新生儿临床医护人员可通过使用MT和NNS＋MT可缓解新生儿疼痛。

Nonnutritive sucking and music therapy soothing pain-elicited distress in neonates

Objective To test the effect of nonnutritive sucking （ NNS）, music therapy （ MT）, and combined NNS and MT （NNS ＋ MT）, versus no intervention, on heart rate, transcutaneous oxygen （SpO2 ） levels, and pain behavior of neonates in intensive care units had being blood taken by a heel-stick procedure. Methods A within-subjects, counter-balancing, repeated- measures design was conducted in the newborn medical center of Nanjing Children Hospital, comparing SpO2 levels, heart rate, and pain behavior outcomes（NIPS） in 80 neonates. The neonates with good general state of health bad been selected. Those with the nervous system disorders （intracranial hemorrhage, hypoxic ischemic encephalopathy） were ruled out and sedative and acesodyne were given. All patients had been divided into four groups （NNS, MT, NNS ＋ MT and control） randomly according to admission number（AD）. The effct of various intervention （NNS,MT,NNS ＋ MT and control） on Sp02 levels, heart rate, and pain behavior outcomes （NIPS） had been recorded. SPSS 11.0 ANOVA variance test and Post Hoc were used to analyze all the valid data. Results Repeated-measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions. One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonate heart rate, improved their SpO2 levels , and reduced their pain behavior. Posthoc scheffe tests revealed that NNS ＋ MT had the strongest effect on neonates SpO2 levels and pain behavior; MT alone had the strongest effect on neonates＂ heart rate. The significant difference had been seen in all groups compared with control （ P 〈 0.05 ） except NNS in heart rate and SpO2. There were no significant difference in the MT, NNS ＋ MT subgroups. Conclusions WTBZIHealth professionals using NNS ＋ MT when doing heel-sticks can improve the SpO2 levels of neonates and reduce their pain. Using MT alone can improve the heart rate of neonates.