Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance.
Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance.
复制标题
蔗糖镇痛对新生儿皮肤血流和足跟刺痛反应的随机安慰剂对照试验。
DOI：
10.1097/ajp.0000000000000126
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Aranda,JacobV
中科院分区：
文献类型：
--
作者：
TutagLehr,Victoria;Cortez,Josef;Grever,William;Cepeda,Eugene;Thomas,Ron;Aranda,JacobV
目的：观察口服蔗糖对皮肤血流量的影响（SBF;灌注单位; PU）通过激光多普勒成像仪（LDI）测量足月新生儿和疼痛反应（2）确定足跟穿刺过程中SBF的变化;（3）SBF和NIPS之间的关系。材料和方法：接受常规足跟穿刺术的≤ 7日龄足月儿（n= 56）随机接受2.0 mL口服24%蔗糖（n= 29）或无菌水（n= 27）预处理，盲法安慰剂对照试验分别于穿刺前10 min、兰辛后即刻和采血后5 min行LDI扫描和NIPS评分评估SBF。使用一般线性模型或Kruskal-Wallis比较各组之间的平均SBF和中位NIPS评分。结果：蔗糖治疗的婴儿在足跟穿刺后即刻的平均SBF和中位NIPS评分较低（167.9±15.5 vs. 205.4±16.0 PU，P= 0.09; NIPS 1 [四分位距0 ~ 4] vs. NIPS 3 [四分位距0 ~ 6]，P= 0.02），尽管平均SBF无显著差异。在足跟穿刺期间，NIPS评分可预测SBF。NIPS评分每增加1分，蔗糖组SBF增加11 PU（R2 = 0.21; P= 0.09），安慰剂组增加16 PU（R2 = 0.20; P= 0.014.Conclusions：用LDI评估的SBF增加是足月新生儿常规足跟穿刺后的疼痛反应，口服蔗糖不能完全缓解。SBF增加与NIPS评分相关。蔗糖组的NIPS评分降低证明了蔗糖镇痛疗效。SBF与NIPS评分的相关性表明，LDI可能用于评估新生儿手术疼痛。
Objectives:To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance;(2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS.Materials and Methods:Term infants≤ 7 days old (n= 56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n= 29) or sterile water (n= 27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score.Results:Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P= 0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P= 0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R 2= 0.21; P= 0.09) for sucrose, and 16 PU increase for placebo-treated infants (R 2= 0.20; P= 0.014).Conclusions:Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.