DEVELOPMENT OF BEHAVIORAL INDICATORS FOR PAIN ASSESSMENT OF PRETERM INFANTS

本研究旨在发展早产儿疼痛行为评估指标。受试者为26名早产儿，他们符合出生时胎龄小于32周且无神经系统异常的入选标准，且其父母同意。在97次常规手术（足跟穿刺、静脉穿刺、插入或取出饲管）中收集生理和行为数据。结果表明：（1）消毒阶段与针刺/穿刺阶段的HR和RR无显著性差异，不是特异性疼痛反应，（2）采血时针刺/穿刺、挤压等疼痛刺激可引起肩部或躯干的扭转、手臂或腿部的弯曲;（3）对12种面部表情进行了定性分析，并将其定量分为4类。根据上述结果，编制了由面部表情和身体动作组成的早产儿疼痛量表，分为4个疼痛反应水平。本疼痛量表之信度与效度有待进一步检验，以供护理人员应用于早产儿之护理。

The purpose of this study was to develop behavioral indicators for pain assessment of preterm infants. Subjects were 26 preterm infants who met the inclusion criteria of being less than 32 weeks gestational age at birth and having no neurologic abnormalities, and whose parents gave consent. Physiologic and behavioral data was collected at 97 sessions for routine procedures (heel stick, venipuncture, insertion or removal of feeding tube). Facial actions were videotaped, analyzed qualitatively and quantitatively, and we explored the relation to body movement, HR and RR.Results were as follows: 1) HR and RR were not specific pain response because no significant difference was found between disinfection phase and stick/puncture phase; 2) Twist of shoulder or trunk and bend of arm or leg were found on painful stimuli such as stick/puncture and squeeze on blood sampling; 3) 12 facial expressions were qualitatively found and classified into 4 types quantitatively. The rate of change of facial action showed a significant difference among each type.Through the above results, a pain scale of preterm infants which is composed of facial expression and body movement, classified into 4 levels as pain response was made. This pain scale should be examined for reliability and validity for nurses to use for care of oreterm infants havine oain.