Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week
Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week
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DOI：
10.1046/j.1365-2648.2002.02358.x
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发表时间：
2002-10-01
影响因子：
3.8
通讯作者：
Lin, CH
中科院分区：
文献类型：
--
作者：
Chang, YJ;Anderson, GC;Lin, CH
背景/理由。机械通气中的早产儿是脆弱的，可能表现出生理不稳定和混乱的行为状态时，响应外部刺激。适当的体位策略可能在保护婴儿免受环境应激源的影响和提高睡眠质量方面发挥重要作用。然而，还没有研究探讨俯卧位和仰卧位对早产儿出生后关键的第一周内的行为状态和应激体征（包括惊吓、震颤和抽搐反应）的影响。本研究的目的是比较机械通气早产儿的行为状态和应激反应的俯卧位和仰卧位的影响。这些婴儿的年龄为25-36孕周，小于或等于7天，没有镇静或先天性异常。采用交叉设计，28名婴儿被随机分配到仰卧/俯卧或俯卧/仰卧位置序列。婴儿被放置在每个位置2小时。在观察每个位置之前允许10分钟的稳定期。在方案期间，护理程序保持最低限度，呼吸机设置保持不变。行为状态和频率的压力迹象，包括惊吓，震颤，抽搐进行了系统记录和分析重复测量方差分析。与仰卧位相比，俯卧位婴儿（a）哭闹少，睡眠活跃度低，睡眠状态安静，（B）惊吓、震颤和抽搐等应激反应少。结果表明，俯卧位改善了睡眠质量，降低了早产儿出生后第一周内通气的压力。这些可以保存能量并帮助婴儿适应子宫外环境。
Background/rationale. Preterm infants in mechanical ventilation are vulnerable and may manifest physiological instability and a disorganized behavioural state when responding to external stimuli. Adequate positioning strategies may play an important role in protecting infants from environmental stressor and assisting quality of sleep. However, no study has examined effects of prone and supine positions on behavioural state and stress signs including startle, tremor, and twitch responses for ventilated preterm infants during the critical first week postbirth.Aim of the study. The purpose of this study was to compare effects of prone and supine positions on behavioural state and stress responses in mechanically ventilated preterm infants.Design/methods. The infants were aged 25-36 weeks of gestation, less than or equal to 7 days of age, and without sedation or congenital abnormalities. Using a crossover design, 28 infants were randomly assigned to supine/prone or prone/supine position sequence. Infants were placed in each position for 2 hours. A stabilization period of 10 minutes before observation of each position was allowed. During the protocol, care procedures were kept minimal and ventilator settings remained unchanged. Behavioural state and frequencies of stress signs including startle, tremor, and twitch were systemically recorded and analysed with repeated measures analysis of variance.Findings. Infants when prone compared with supine had (a) less crying, less active sleep, and more quiet sleep states, and (b) fewer stress responses of startle, tremor, and twitch.Conclusion. Results indicate that prone positioning improves the quality of sleep and decreases stress for ventilated preterm infants during the first week postbirth. These may conserve energy and assist infants' extrauterine adaptation.