蔗糖可能對兒童止痛有幫助


  March 3, 2009 — 根據一項發表在3月號兒科醫學期刊上的雙盲、隨機分派研究結果顯示,蔗糖可能對兒童止痛有幫助。
  
  來自加拿大安大略多倫多大學的Anna Taddio博士與其同事們寫到,蔗糖對新生兒具有止痛與安定的作用。目前為止,蔗糖對於執行會造成疼痛處置後照護措施是否有效仍不清楚。我們的目的在於確定,蔗糖對於在接下來的照護措施中,之前因處置引起的疼痛,嬰幼兒疼痛反應的影響。
  
  健康的新生兒被分為兩組(正常嬰兒與糖尿病母親產下的嬰兒),將這些嬰兒隨機分派,讓受試者在所有產後扎針處置之前接受蔗糖或是安慰劑(水)。以早產嬰兒疼痛指標(PIPP)來評估接受新生兒篩檢靜脈穿刺後換尿布時的疼痛反應;這是一種經過確效的多面向評量。
  
  在2003年9月15日到2004年7月27日之間,總共有412位病患被詢問讓他們的嬰兒加入這項研究,其中有263位簽署同意書。這些受試者中,23位嬰兒並非隨機選擇的,兩組各有120位,讓每個嬰兒分層有同樣數目的受試者。在240位隨機選出的受試者中,186位(78%)完成這項研究。
  
  這兩組的出生特徵相仿,相較於接受安慰劑的嬰兒,接受蔗糖的嬰兒在換尿布時的疼痛指數較低。有疼痛反應的相對風險(定義為PIPP分數大於等於6分)是0.64,這是蔗糖與安慰劑比較的結果。
  
  研究作者寫到,這項研究結果顯示,當用於處理疼痛,蔗糖降低接下來接受常規照護措施的疼痛反應。因此,蔗糖止痛的好處超過了其他令人厭惡與潛在可能造成疼痛的措施。
  
  這項研究的限制包括僅評估嬰兒前20秒的反應。
  
  根據這些結果,蔗糖可能被建議用於新生兒致痛處置後的照護措施,這些結果也進一步支持使用蔗糖處理新生兒的疼痛。
  
  加拿大健康機構贊助這項研究。Respironics有限公司(賓州門羅維爾)提供這項研究所需(蔗糖與安慰劑)。Taddio博士接受加拿大健康研究機構的新研究者獎的贊助。共同作者Joel Katz博士接受約克大學加拿大健康精神學主席的贊助。共同作者Vibhuti Shah醫師表示沒有相關資金上往來。

Sucrose May Be Helpful for Pediatric Analgesia

By Laurie Barclay, MD
Medscape Medical News

March 3, 2009 — Sucrose may be helpful for pediatric analgesia, according to the results of a double-blind, randomized controlled trial reported in the March issue of Pediatrics.

"Sucrose has analgesic and calming effects in newborns," write Anna Taddio, PhD, from the University of Toronto in Toronto, Ontario, Canada, and colleagues. "To date, it is not known whether the beneficial effects extend to caregiving procedures that are performed after painful procedures. Our objective was to determine the effect of sucrose analgesia for procedural pain on infant pain responses during a subsequent caregiving procedure."

Healthy neonates were stratified into 2 groups (normal infants and infants of diabetic mothers) and randomly assigned to receive sucrose or placebo (water) before all postpartum needle procedures. The Premature Infant Pain Profile (PIPP), a validated multidimensional measure, was used to assess pain response during a diaper change performed after venipuncture for the newborn screening test.

Between September 15, 2003, and July 27, 2004, a total of 412 parents were asked to have their infants participate in the study, and 263 consented. Of these, 23 infants were not randomly selected, and 120 were in each group, with an equal number in each infant stratum. Of the 240?randomly selected participants, 186 (78%) completed the study.

The 2 groups had similar birth characteristics. Infants receiving sucrose had lower pain scores during diaper change vs infants receiving placebo. The relative risk of having pain (defined as a PIPP score of ? 6) was 0.64 with sucrose vs placebo.

"This study demonstrates that when used to manage pain, sucrose reduces the pain response to a subsequent routine caregiving procedure," the study authors write. "Therefore, the benefits of sucrose analgesia extend beyond the painful event to other aversive and potentially painful procedures."

Limitations of this study include assessment of only the first 20 seconds of the infants' response.

"Based on these results, sucrose may be recommended for postprocedural caregiving procedures that follow painful procedures," the study authors conclude. "The results also further support the use of sucrose to manage procedural pain in newborn infants."

The Canadian Institutes of Health funded this study. Respironics Inc (Monroeville, Pennsylvania) provided study supplies (sucrose and placebo). Dr. Taddio was supported by a New Investigator Award by the Canadian Institutes of Health Research. Coauthor Joel Katz, PhD, was supported by a Canada Research Chair in Health Psychology at York University. Coauthor Vibhuti Shah, MD, has disclosed no relevant financial relationships.

Pediatrics. 2009;123:e425-e429.

    
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