臺灣博碩士論文加值系統

本研究旨在探討極低出生體重早產兒對急性疼痛刺激過程的生理和行為反應是否隨著出生後的年齡增長而有所變化。本研究採前瞻性縱貫式研究設計，以立意取樣選取某一醫學中心之新生兒加護病房之懷孕週數26 - 32週、出生體重772至1500公克的早產兒為對象，收集20位有效樣本，以靜脈導管留置穿刺過程為疼痛刺激方法，於出生後第一、二、三週各收集一次資料。
研究工具以生理監視器收集疼痛刺激時的生理反應，包括心跳速率、呼吸速率及血氧飽和濃度，以數位錄影機全程錄影疼痛刺激時的行為反應包括臉部表情的眉頭皺起、眼睛緊閉、鼻唇間皺褶等，並以早產兒疼痛評估量表（Premature Infant Pain Profile, PIPP）測量疼痛程度。
研究結果發現每一週次的穿刺期、消毒期的心跳速率和呼吸速率皆高於基準期，血氧飽和濃度在穿刺期低於基準期，臉部表情方面穿刺期以眼睛緊閉呈現比率最多，眉頭皺起次之。早產兒遭受靜脈導管留置穿刺期，顯示最大心跳速率和最低血氧飽和濃度隨著出生週次增加並無一致的變化，最大呼吸速率隨著出生週次增加有逐漸降低趨勢，臉部表情的眉頭皺起和眼睛緊閉都隨著出生週次增加有逐漸增加的趨勢。進一步經控制疾病嚴重度後，以重複測量變異數檢定其差異，結果最大心跳速率、最低血氧飽和濃度、最大呼吸速率和臉部表情都未達顯著差異，表示出生後週齡增長在生理與行為反應之變化並無顯著差異。
本研究結果可提供臨床護理人員照護極低出生體重兒疼痛評估之依據，以提昇早產兒的護理照護品質。

The objective of the study was to explore the pain response in very low birth weight neonates. The method of a prospective longitudinal study design was adopted. Twenty premature infants with gestational age (GA) between 26 to 32 weeks and birth body weight between 772 to 1500 grams were enrolled in the study. Data were collected on premature neonates during venous catheter insertion once a week at the first, second, and third week of postnatal age. Cardiopulmonary monitor was used to record physiology parameters including heart rate, respiratory rate, and oxygen saturation. Video tapping was used to observe the behavioral pain response and PIPP (premature infant pain profile) was used to quantify the magnitude of pain. All data were analyzed according to the four phase of catheter insertion: baseline phase, sterilization phase, puncture phase, and recovery phase.
Heart rate and respiratory rate at sterilization and puncture phases were higher than the baseline phase at all three weeks. Oxygen saturation at the puncture phase was lower than the baseline phase at all three weeks. Facial expression with eye squeeze was most frequently observed in the puncture phase, followed by the brow bulge.
No consistent changes were noted on maximal heart rate or minimal oxygen saturation with greater GA. Facial expression with episodes of eye squeeze or brow bulge increased with their GA. However, after controlling the severity of their disease status, no significant differences were noted among maximal heart rate, minimum oxygen saturation, maximum respiratory rate, or facial expression with repeated measures analysis of variance. These results could signify that postnatal age of the first three weeks places no effects on the physiologic or behavior responses of VLBW infants to pain.
The result of this study can be used as a clinical guide for nurses taking care of very low birth weight neonates for the advancement of the quality of nursing care.

目 錄
致謝 ………………………………………………………… Ι
中文摘要………………………………………………………….. Ⅲ
英文摘要………………………………………………………….. V
目錄………………………………………………………………… VII
圖表目次…………………………………………………………… IX
第一章 緒論
第一節 研究動機及重要性……………………………………… 1
第二節 研究目的………………………………………………… 3
第三節 研究問題………………………………………………… 3
第四節 名詞解釋………………………………………………… 3
第二章 文獻查證
第一節 新生兒疼痛的定義………………………………………. 6
第二節 疼痛機轉…………………………………………..……..7
第三節 疼痛的發展與痛覺………………………………………. 8
第四節 早產兒的疼痛反應………………………………………. 10
第五節 早產兒的疼痛評估量表…………………………………. 23
第六節 研究架構與假設…………………………………………. 24
第三章 研究方法
第一節 研究設計………………………………………………… 27
第二節 研究對象與場所…………………………………………. 28
第三節 研究工具………………………………………… 29
第四節 研究步驟………………………………………………… 33
第五節 資料分析方法…………………………………………… 37
第六節 研究對象倫理考量………………………………………. 38
第四章 分析與結果
第一節 研究對象的基本屬性……………………………….….. 40
第二節 研究對象插置靜脈導管期間對疼痛的反應……………. 45
第三節 早產兒出生後週齡對疼痛反應之影響…….……... 69
第五章 討論
第一節 早產兒對靜脈導管留置穿刺時期疼痛反應之探討…… 80
第二節 早產兒出生後週數的成長對疼痛刺激反應的變化…… 83
第六章 結論與建議
第一節 結論………………………………………………………. 89
第二節 護理上的應用……………………………………………. 90
第三節 研究限制與建議………………………………………… 92
參考資料
中文部分………………………………………………………….. 96
英文部分………………………………………………………….. 97
附錄
附錄一 PIPP(premature infant pain profile)量表相關研究 107
附錄二 臨床試驗受試者說明及同意書………………………. 110
附錄三 早產兒疼痛反應記錄基本資料表……………………. 112
附錄四 新生兒疾病嚴重度評分表（NTISS）………………... 113
附錄五 早產兒疼痛反應記錄表………………………………. 115
附錄六 早產兒疼痛評估量表（PIPP）……..…………………. 116
圖表目次
圖一 研究架構圖……………………………………………. 25
圖二 平均心跳速率隨各時期的變化之趨勢圖 ………….. 47
圖三 平均呼吸速率隨各時期的變化之趨勢圖 ………….. 52
圖四 平均血氧飽和濃度隨各時期的變化之趨勢圖……… 56
圖五 研究對象各時期眉頭皺起變化之趨勢圖……………. 60
圖六 研究對象各時期眼睛緊閉變化之趨勢圖…………….. 63
圖七 各時期疼痛分數趨勢圖 66
表一 研究過程中早產兒疼痛刺激反應觀察的項目………. 39
表二 研究對象的基本屬性（一）…………………………. 41
表三 研究對象的基本屬性（二）…………………………. 43
表四 研究對象對疼痛的反應：平均心跳速率……………. 46
表五 研究對象對疼痛的反應：最大心跳速率………….. 48
表六 研究對象對疼痛的反應：心跳、血氧飽和濃度恢復 49
基準值時間
表七 研究對象對疼痛的反應：平均呼吸速率……………. 51
表八 研究對象對疼痛的反應：最大呼吸速率………..…. 53
表九 研究對象對疼痛的反應：血氧飽和濃度………..…. 55
表十 研究對象對疼痛的反應：最低血氧飽和濃度……… 57
表十一 研究對象對疼痛的行為反應：眉頭皺起…………... 59
表十二 研究對象對疼痛的行為反應：眼睛緊閉…………… 62
表十三 研究對象對疼痛的行為反應：鼻唇間皺褶……….. 64
表十四 研究對象對疼痛的反應程度……………………….. 67
表十五 不同出生週數對疼痛反應的變化………………….. 68
表十六 重複測量變異數分析：不同週次穿刺期最大心跳速
率變異數檢定……………………………………. 70.
表十七 重複測量變異數分析：不同週次穿刺期最大心跳速
率增加比率……………………………………….. 72
表十八 重複測量變異數分析：不同週次穿刺期最大呼吸速
率變異數檢定……………………………….. 73
表十九 重複測量變異數分析：不同週次穿刺期最大呼吸速
率增加比率…………………………………… .. 74
表二十 重複測量變異數分析：不同週次穿刺期最低血氧飽 76
和濃度變異數檢定
表二十一 重複測量變異數分析：不同週次穿刺期最低血氧飽 77
和濃度降低比率
表二十二 重複測量變異數分析：不同週次穿刺期臉部表情 79
變異數檢定
表二十三 本研究與其他研究的早產兒在出生後週數成長對疼 88
痛刺激反應之比較

中文部分
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