臺灣博碩士論文加值系統

新生兒在出生後會經歷許多不可避免之例行處置，而這些侵入性治療
會造成新生兒的壓力及疼痛反應，因無法由語言表達，可能造成醫療人員
忽略他們的疼痛問題，若新生兒早期暴露於重複例行處置之疼痛，會影響
其未來之身心發展，因此許多國內外學者開始重視並發展減緩新生兒壓力
及疼痛之非藥物介入措施，雖然許多介入結果有效，但許多組織認為新生
兒疼痛的現行處置仍不足，除了因為無法言語表達而使醫療人員忽略他們
的疼痛問題外，可能和介入的可用及可近性有關，探討臨床現象後，引起
作者思考，以母嬰親善為出發點，合併並比較這些不同感官之介入對於減
緩新生兒的壓力及疼痛之成效。因此本研究的主要目的為探討給予多感官
介入措施在新生兒進行足跟採血期間和結束後，對於其疼痛反應、生理指
數（心跳及血氧飽和濃度）及哭泣事件的差異與其影響因素。
本研究採用臨床控制試驗方式進行，以方便取樣的方式，將符合收案
條件之120 名新生兒，區集隨機分派到三個組別，(1)觸摸+輕聲安慰（2）
聞母乳+觸摸+輕聲安慰（3）聞母乳+口服母乳+觸摸+輕聲安慰，在其採集
代謝篩檢足跟血時，給予各組之介入護理措施，並每20 秒蒐集一次心跳速
率、血氧飽和濃度與每分鐘蒐集一次新生兒疼痛量表。資料收集擬於足跟
採血前5 分鐘（無接受任何刺激的基準值）、採血期間5 分鐘內及採血後恢
復期5 分鐘內。
研究結果顯示，在調整基準期之相關資料、分期時間及新生兒特
性後發現，「聞母乳+觸摸+輕聲安慰」及「聞母乳+口服母乳+觸摸+輕聲安
慰」兩種組合之介入措施，能有效減輕新生兒接受代謝篩檢足跟採血之疼
痛反應，其新生兒疼痛量表得分(p<0.001)、平均心跳速率、血氧飽和濃度
變化及哭泣事件(p<0.001)都顯著低於控制組。
期望未來能運用多感官介入減輕新生兒執行足跟採血時之疼痛和壓力，
藉由此可近性較高之措施，讓臨床護理人員更了解新生兒的感官能力，也
使臨床護理人員更願意去幫助緩解新生兒疼痛，進而讓新生兒的未來發展
可以更正向。

Newborns undergo many necessary invasive procedures for routine care,
but these treatments may cause stress and pain. Newborns are unable to verbally express their pain and stress . Therefore, caregivers often neglect their pain, which can influence their physical and neurodevelopment in the future.
Therefore, many clinicians and researchers began paying attention to this issue and developed nonpharmacological interventions to reduce neonatal pain and stress. Some nonpharmacological interventions might be effective, but it is still unavailable and inaccessible for clinicians to use these interventions in newborns who receiving painful procedures. These pain-relief
nonpharmacological interventions were still insufficient meet the current needs of newborns. Therefore, the study purposes are to compare the effects of
different combinations of sensory interventions on newborns’ pain responses,
physiological index (heart rate and oxygen saturation), and crying event during heel stick procedures.
This study was a prospective, randomized controlled trial. Infants were
recruited by convenience sampling in a baby room of a medical center in
northern Taiwan from October in 2017 to October in 2018. One-hundred and
twenty term newborns who met the criteria were recruited by blocked random to
three treatment groups: (1)Gentle touch + Talk, (2) Smell + gentle touch + Talk,(3) Smell + Taste + Touch + Talk. Pain response was measured by the Neonatal Infant Pain Scale (NIPS). The physical index (heart rate, oxygen saturation)were measured by and crying event. All data were collected 5 minutes before heel-stick (baseline), during heel-stick and in recovery status.
The results of the study showed that infants receiving ‘Smell + Taste +
Touch + Talk’ presented lesser painful response when they underwent heel-stick
than the control group. The outcomes showed the NIPS scale (p<0.001), average
heart rate, average oxygen saturation, and crying events (p<0.001) were all
significantly better than ‘Touch + Talk’ after adjusting the baseline data, time,and neonatal characteristics.
It is hoped that multi-sensory interventions can be used to reduce the
neonatal pain and stress when they undergo the heel-stick in the future. Clinical pediatric nurses can also learn more about the sensory abilities of newborns and use this implication to relieve neonatal pain and to create healthier development of newborns.

正文目錄
表目錄....................................................................IV
圖目錄.....................................................................V
中文摘要.................................................................VII
英文摘要................................................................VIII
第一章 緒論................................................................1
第一節 研究背景及動機（含重要性）............................................1
第二節 研究目的............................................................4
第二章 文獻查證............................................................5
第一節 新生兒疼痛及其影響...................................................5
第二節 新生兒例行性疼痛之評估...............................................7
第三節 減緩新生兒疼痛之多感官介入措施.......................................10
第三章 研究架構...........................................................12
第一節 研究概念架構.......................................................12
第二節 名詞定義...........................................................13
第三節 研究假設...........................................................15
第四節 研究假設...........................................................16
第四章 研究方法...........................................................17
第一節 研究設計...........................................................17
第二節 研究場所及對象.....................................................19
第三節 研究工具...........................................................21
第四節 資料收集過程.......................................................23
第五節 資料分析計畫.......................................................27
第六節 研究對象倫理考量...................................................28
第五章 研究結果...........................................................29
第一節 研究對象之基本特性..................................................30
第二節 介入措施對新生兒行足跟採血之疼痛分數的影響............................33
第三節 介入措施對新生兒行足跟採血之生理指數的影響............................38
第四節 介入措施對新生兒行足跟採血之哭泣事件的影響............................47
第六章 討論..............................................................51
第一節 介入措施對新生兒行足跟採血疼痛分數之影響..............................51
第二節 介入措施對新生兒行足跟採血生理指數之影響..............................53
第三節 介入措施對新生兒行足跟採血哭泣事件之影響..............................54
第四節 影響新生兒行足跟採血疼痛反應相關因素之探討............................55
第七章 結論與建議.........................................................56
第一節 結論............................................................ .56
第二節 護理上的應用.......................................................57
第三節 研究限制與建議.....................................................59
參考文獻.................................................................60
英文資料.................................................................60
中文資料.................................................................66

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中文部分
周伊純、葉宏軒、張麗玉、林建亨 ( 2012 )•運用行為介入法減輕新生兒接種疫苗之疼痛•護理暨健康照護研究，8(1)，3-13。
曾雯萍、尹玓、楊美紅、廖珍娟 ( 2009 )•新生兒疼痛概念分析•源
遠護理，3(2)，38-45。
劉美芳、李慈音 ( 2006 )•早產兒和新生兒之疼痛處置與護理評估•
護理雜誌，53(6)，65-72。