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新生儿足跟采血疼痛: 处理

小布 2018-03-12 来源:儿科医院护理部 组织:儿科医院 123 0 收藏 0

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问题: 有效预防和处理新生儿足跟采血疼痛方法的最好证据

证据指导

环境干预

对于足月儿和病情较重的早产儿建议使用静脉穿刺抽血来替代足跟采血,结果更可靠的同时可以缓解足跟采血时的疼痛。 1(A)

足跟采血前无需热敷来促进足跟部的血液循环2,3(C)

使用相关的护理技术可以阻断痛觉向大脑皮层的传入,例如给予触觉刺激,这些技术包括采血之前,遵医嘱给予糖水口服,同时妈妈或护士可以给宝宝按摩并与宝宝交流4(B)

在对宝宝进行任何操作时都应充分发挥妈妈的作用,采血期间可以考虑给予母婴皮肤接触或母乳喂养5,6(B)

尽量采用自动足跟采血针而不是传统的手动采血针7,8采血(B)

采血时,不要挤脚后跟,虽然那会使得毛细血管充盈,但挤压的本身也会带来一定的疼痛9(D)

非药物性干预

给予蔗糖水口服和非营养性吸吮或人乳10(A)

足月儿在生后2天内重复足跟采血时仅给予蔗糖水口服对缓解疼痛是无效的11(B)

也可以使用葡萄糖溶液来代替蔗糖12,13(C)

对早产儿建议使用低浓度的糖水,因为高浓度的蔗糖/葡萄糖(24-33%)具有较高的渗透压,该渗透压可达到1000 mOsm14(D)

任何可能的情况下都推荐糖水配合安慰奶嘴进行非营养性吸吮来减轻疼痛13,15(B)

多次重复给予糖水口服比单次给予减轻疼痛的效果更明显,(例如可在采血前2分钟,采血前,采血后2分钟重复给予)16(B)

长期使用蔗糖水口服的安全性尚未得到证实17(A)

药物性干预

在足跟采血时不建议使用EMLA软膏,因为并不能缓解疼痛18(B)

在采血前,运用对乙酰氨基酚类药物并不能缓解疼痛19(A)

参考文献

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2.        Barker DP, Willets B, Cappend ijk VC, Rutter N. Capillary blood sampling: should the heel be warmed? Arch Dis Child 1996; 74: F139–140.

3.        Janes M, Pinelli J, Landry S, Downey S, Paes B. Comparison of capillary blood sampling using automated incision device with or without warming of the heel. J Perinatol 2002; 22: 154–158.

4.        Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M, et al. Effect of multisensory stimulation on analgesia in term neonates: a randomised controlled trial. Pediatr Res 2002; 51: 460–3

5.        Johnston CC, Stevens B, Pinelli J. Cangaroo care is effective in diminuishing pain responses. Arch Pediatr Adolesc Med 2003; 157: 1084–1088.

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7.        Vertanen H, Fellman V, Brommels M, Viinikka L. An automatic incision for obtaining blood samples from the heels of preterm infants causes less damage than conventional manual lancet. Arch Dis Child Fetal Neonatal Ed 2001; 84: F53–55.

8.        Shepherd AJ, Glenesk A, Niven CA, Mackenzie J. A Scottish study of heel-prick blood sampling in newborn babies. Midwifery 2006; 22: 158–168

9.        Anand KJS, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155: 173–180.

10.        Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2004; 3: CD001069.

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12.        Skogsdal Y, Eriksson M, Schollin J. Analgesia in newborn given oral glucose. Acta Paediatr 1997; 86: 217–20.

13.        Carbajal R, Chauvet X, Couderc S, Oliver-Martin M. Randomised trial of analgesic effects of sucrose, glucose and pacifier in term neonates. BMJ 1999; 319: 1393–7.

14.        Willis D, Chabot J, Raddle I, Change G. Unsuspected hyperosmolarity of oral solutions contributing to necrotizing enterocolitis in very-low-birth-weight infants. Pediatrics 1977; 60: 535–8.

15.        Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F. Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants: a prospective randomized trial. Biol Neonate 2001; 80: 15–18.

16.        Johnston CC, Stremler R, Horton L, Friedman A. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate 1999; 75: 160–6.

17.        Johnston CC, Filion F, Snider L, Majnemer A, Limperopoulos C, Walker CD, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics 2002; 110: 523–8

18.        Taddio A. A systematic review of EMLA. Pediatrics 1998; 101: 1–9.

19.        Shah V, Taddio A, Ohlsson A. Randomized controlled trial of paracetamol for heel prick pain in neonates. Arch Dis Child Fetal Neonatal Ed 1998; 79: F209–11.


文章来源:儿科医院护理部
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