检索历史 清除

目的 探讨口服不同浓度葡萄糖和蔗糖对足跟采血所致新生儿疼痛的影响.方法 选取2011年10月-2012年5月重庆医科大学附属儿童医院新生儿科560例需要足跟采血的新生儿(男295例,女265例),按随机数字表法随机分为7组(各80例):白开水安慰剂组,10％、25％、50％浓度葡萄糖组,12％、24％、30％浓度蔗糖组.各组在足跟采血前2min用注射器经口给予2 ml指定种类和浓度的甜味剂.检测记录各组采血后心率、氧饱和度变化和疼痛评分指标,采用方差分析和t检验比较组间差异.结果 穿刺后3、5、10 min,25％、50％葡萄糖组,12％、24％、30％蔗糖组的心率升高值(次/min)均明显低于安慰剂组[37.33(15.00 ～ 88.66)、4.00(0.00 ～34.00)、0.00(0.00 ～44.66),30.33(9.33 ～68.00)、0.00(0.00 ～31.00)、0.00(0.00 ～ 28.00),26.00(5.33 ～ 56.00)、0.00(0.00 ～ 48.00)、0.00 (0.00 ～ 40.66),28.00 (0.00 ～ 60.66)、0.00 (0.00 ～ 31.66)、0.00 (0.00 ～39.33),20.66(0.00～52.00)、0.00 (0.00 ～52.66)、0.00(0.00～43.00)比46.33(18.67 ～ 84.00)、5.00(0.00～48.00)、0.34(0.00～77.34),P＜0.01或0.05]；穿刺后3 min总蔗糖组的心率升高值明显低于总葡萄糖组[25.00(0.00 ～60.66)比36.34(4.33 ～88.66)次/min,P＜0.01]；30％蔗糖组的心率升高值均低于12％、24％蔗糖组(均P＜0.05).穿刺后3、5、10 min,50％葡萄糖组,12％、24％、30％蔗糖组血氧饱和度降低值均低于安慰剂组[穿刺后3 min:4.64％(0.00％～11.33％)、2.23％(0.00％ ～ 10.33％)、2.00％ (0.00％ ～ 9.67％)、1.87％ (0.00％ ～9.33％)比5.44％ (2.67％ ～13.33％),均P＜0.01]；穿刺后3 min总蔗糖组的血氧饱和度降低值低于总葡萄糖组[2.47％(0.00％ ～10.33％)比5.27％ (0.00％ ～ 11.33％),P＜0.01].穿刺后3、5、10 min,10％、25％、50％葡萄糖组,12％、24％、30％蔗糖组疼痛评分均低于安慰剂组[穿刺后3 min 3.30 (0～5)、1.79(0 ～5)、0.80(0 ～5)、0.32(0 ～5)、0.23(0 ～5)、0.28(0～5)比4.88(3 ～5),均P＜0.01]；穿刺后3 min总蔗糖组的疼痛评分低于总葡萄糖组[0.83(0 ～5)比2.30(0～5)分,P＜0.01].结论 甜味剂有缓解足跟采血所致新生儿疼痛的效果,且蔗糖的镇痛效果优于葡萄糖；30％蔗糖服用后心率升高值比12％和24％蔗糖低,但蔗糖的最佳镇痛浓度还有待进一步明确.

Objective To compare the effect of different types and concentrations of sweet solutions on neonatal pain during heel lance procedure.Method Totally 560 full term neonates (male 295,female 265) were randomized into 7 groups:placebo group (plain water),10％ glucose,25％ glucose,50％ glucose,12％ sucrose,24％ sucrose and 30％ sucrose groups.In each group,2 ml corresponding oral solutions were administered through a syringe by dripping into the neonate's mouth 2 minute before heel lance.The procedure process was recorded by videos,from which to collect heart rate,oxygen saturation and pain score 1 min before puncture,3,5 and 10 min after puncture.Result The average heart rate increase 3,5 and 10 min after procedure in the 25％ and 50％ glucose groups,12％ and 24％ and 30％ sucrose groups was significantly lower than those in the placebo group (P ＜ 0.01 or 0.05).The average heart rate increase 3 min after procedure in the sucrose group was lower than that in the glucose group (P ＜0.01).Neonates who received 30％ sucrose has a significantly lower average heart rate increase than those who received 12％ and 24％ sucrose 3 min after heel lance (both P ＜ 0.05).The average oxygen saturation decrease 3,5,10 min after procedure was significantly lower than those in the placebo group (P ＜ 0.01).The average oxygen saturation decrease 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P ＜ 0.01).The average pain score 3,5,10 min after procedure was significantly lower than those in the placebo group (P ＜ 0.01).The average pain score 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P ＜ 0.01).Conclusion Oral administration of sweet solutions is an effective way to relieve neonatal pain on procedure,and sucrose has a better pain relief action than glucose,moreover,30％ sucrose provides better effect in control of heart rate increase 3 min after heel lance,but the best concentration of sucrose for pain relief needs further study.