Venipuncture is more effective and less painful than heel lancing for blood tests in neonates
Venipuncture is more effective and less painful than heel lancing for blood tests in neonates
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DOI：
10.1542/peds.101.5.882
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发表时间：
1998-05-01
期刊：
影响因子：
8
通讯作者：
Olsson, GL
中科院分区：
文献类型：
--
作者：
Larsson, BA;Tannfeldt, G;Olsson, GL
Objective.足跟兰辛迄今为止一直是新生儿先天性代谢缺陷筛查试验的首选方法。局部麻醉剂的优泌乐混合物在应用于早产儿和足月儿的足跟时几乎没有镇痛作用。今天似乎没有一个实用的方法，有效地减轻疼痛所造成的脚跟兰辛。本研究的目的是调查其他方法，如手背静脉穿刺，是否比足跟兰辛疼痛更少，更有效。120例健康足月婴儿接受苯丙酮尿症（PKU）检测。他们被随机分为三组：静脉穿刺组（VP）（n = 50），脚跟柳叶刀组与小柳叶刀（SL）（n = 50），或大柳叶刀（LL）（n = 20）。疼痛反应通过新生儿面部编码系统（NFCS）进行评估。分析了第一声啼哭的潜伏期和持续时间以及总的尖叫时间。该方法的有效性通过完成PKU测试所需的时间和必须刺穿皮肤的次数来评估。结果。伤害性反应。第一次皮肤穿刺后的NFCS评分为：VP，247; SL，333; LL，460。VP组的NFCS评分显著低于足跟兰辛组。在皮肤穿刺后的前60秒内，VP组有44%的婴儿哭泣，SL组和LL组分别为72%和85%。VP组中86%的患者仅进行了一次皮肤穿刺成功的PKU试验，但SL组仅为19%，LL组为40%。获得PKU血样所需的总时间VP组为191秒（中位数），SL组为419秒，LL组为279秒。在新生儿血液检查中，静脉穿刺比足跟兰辛更有效且疼痛更少。
Objective. Heel lancing has hitherto been the method of choice for screening tests of inborn errors of metabolism in neonates. Eutectic mixture of local anesthetic has little, if any, analgesic effect when applied to the heel of pre-and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by heel lancing. The aim of this study was to investigate whether other methods, such as venipuncture of the dorsal side of the hand, are less painful and more efficient than heel lancing in neonates.Methods. One hundred twenty healthy, full-term infants who underwent testing for phenylketonuria (PKU) were included in the study. They were randomized into three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). Pain reactions were assessed by the Neonatal Facial Coding System (NFCS). The latency and duration of the first cry as well as the total screaming time was analyzed. The efficacy of the method was assessed by the time taken to complete the PKU test and number of times the skin had to be punctured.Results. Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjected to heel lancing. During the first 60 seconds after skin puncture, 44% of the infants cried in the VP group, compared with 72% and 85% in the SL and LL groups, respectively.Efficacy. A successful PKU test with only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time needed to obtain the PKU blood sample was 191 seconds (median) in the VP group, 419 seconds in the SL group, and 279 seconds in the LL group.Conclusion. Venipuncture is more effective and less painful than heel lancing for blood tests in neonates.