早产儿视网膜病变筛查治疗过程的疼痛管理研究进展_Chinese Journal of Ocular Fundus Diseases

Authors：

曾琦 ,  罗先琼 , 张嘉雯

510000 广州医科大学附属广东省妇儿医院 (曾琦); 广东省妇幼保健院新生儿科 (罗先琼、张嘉雯);

Corresponding author：

罗先琼, Email: luoxqgz@126.com

Keywords：

疼痛管理; 早产儿视网膜病/预防和控制; 早产儿视网膜病/治疗; 综述

DOI：

10.3760/cma.j.issn.1005-1015.2015.03.029

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早产儿视网膜病变(ROP)筛查治疗过程的疼痛管理是指通过药物和非药物的手段或方式来减轻、消除筛查治疗技术操作给患儿带来的疼痛和不适。目前ROP筛查和治疗的疼痛管理措施主要有药物性措施、环境措施和非药物性措施。药物性措施是主要减轻疼痛的方式, 包括全身麻醉、表面麻醉和镇静镇痛药物联合表面麻醉等。全身麻醉需在手术室内由麻醉科医生进行, 操作较复杂。表面麻醉和镇静镇痛药物联合表面麻醉可在新生儿科病房进行。表面麻醉广泛用于ROP筛查和治疗中, 但其镇痛效果仍存在争议。镇静镇痛药物联合表面麻醉可由非麻醉科医生进行, 是目前ROP治疗过程疼痛管理的发展方向。环境措施主要是指ROP筛查和治疗应尽量在安静和放松的环境中进行操作, 减少光和噪音等伤害性刺激。非药物性治疗如襁褓包裹、非营养性吸吮、甜味剂治疗等主要用于ROP的筛查过程中。此外, 在ROP筛查中, 与间接检眼镜相比, 使用视网膜照相机产生的疼痛可能更小, 开睑器的使用是疼痛产生的一个重要方面。

Citation： 曾琦, 罗先琼, 张嘉雯. 早产儿视网膜病变筛查治疗过程的疼痛管理研究进展. Chinese Journal of Ocular Fundus Diseases, 2015, 31(3): 310-313. doi: 10.3760/cma.j.issn.1005-1015.2015.03.029 Copy

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1. Belda S, Pallás CR, De la Cruz J et al.Screening for retinopathy of prematurity:is it painful?[J].Biol Neonate, 2004, 86(3):195-200.
2. Humphrey T.The development of human fetal activity and its relation to postnatal behavior[J].Adv Child Dev Behav, 1970, 5:1-57.
3. Stevens B, Johnston C, Taddio A, et a1.Management of pain from heel lance with lidocaine-prilocaine(EMLA)o-earn, is it safe and efficacious in preterm infants?[J].J Dev Behav Pedialr, 1999, 20(4):216-221.
4. Anand KJ, Scalzo FM.Can adverse neonatal experiences alter brain development and subsequent vehavior?[J] Biol Neonate.2000, 77(2):69-82.
5. 聂川, 罗先琼, 王俊平, 等.早产儿视网膜病变激光光凝术后不良反应发生情况及其影响因素[J].吉林医学学报, 2013, 39(4):824-827.
6. Anand KJ, International Evidence-Based Group for Neonatal Pain.Consensus statement for the prevention and management of pain in the newborn[J]. Arch Pediatr Adolesc Med, 2001, 155(2):173-180.
7. Grunau RE, Holsti L, Peters JW.Long-term consequences of pain in human neonates[J].Semin Fetal Neonatal Med, 2006, 11(4):268-275.
8. Peterson BS, Vohr B, Staib LH, et al.Regional brain volume abnormalities and long-term cognitive outcome in preterm infants[J].JAMA, 2000, 284(15):1939-1947.
9. Lago P, Garetti E, Merazzi D, et al.Guidelines for procedural pain in the newborn[J].Acta Paediatr, 2009, 98(6):932-939.
10. 周琪.观察急进性后部型早产儿视网膜病变视网膜激光光凝的治疗效果[J].中国伤残医学, 2014, 22(9):192-193.
11. 吴静珍.全麻下早产儿视网膜光凝手术的麻醉管理[J].经验体会, 2012, 10(13):124.
12. 董翠兰, 杨娟, 杨莺, 等.视网膜光凝术治疗早产儿视网膜病变的护理干预[J].当代护士(专科版), 2014, (6):86-87.
13. 吴本清, 张国明, 曾键, 等.早产儿视网膜病变的冷凝治疗[J].中华围产医学杂志, 2006, 9(6):373-376.
14. 王惠平, 王琴.早产儿视网膜病变全麻下行激光光凝术的护理配合[J].当代护士(专科版), 2014(9):100-101.
15. 尹东明, 黄中宁, 黄杜茹.激光或冷冻治疗早产儿阈值期视网膜病变[J].新医学, 2005, 36(9):537.
16. 项道满, 陆晓和, 陈锋, 等.表面麻醉下激光间接检眼镜早产儿视网膜光凝手术临床分析[J].实用医学杂志, 2011, 27(11):1990-1992.
17. 赵培泉, 单海东, 程朝晖, 等.阈值前病变1型和阈值期早产儿视网膜病变的激光和冷冻治疗[J].中华眼底病杂志, 2005, 21(5):278-281.
18. 冯冉冉, 连朝辉, 张国明, 等.地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病的镇痛效果[J].实用儿科临床杂志, 2012, 27(3):876-878.
19. 李秋平, 王宗华, 陈耀琴, 等.床旁激光治疗早产儿视网膜病变的疗效分析[J].中国当代儿科杂志, 2010, 12(9):696-699.
20. 宋湘梅, 郭金莲, 张国明, 等. 810 nm波长激光治疗早产儿视网膜病变的疗效分析及护理[J].护士进修杂志, 2010, 25(4):322-323.
21. 赵东莹, 张拥军, 何振娟, 等.早产儿视网膜病手术后呼吸暂停临床分析[J].上海交通大学学报, 2010, 30(2):132-134.
22. Chen SD, Sundaram V, Wilkinson A, et al.Variation in anaesthesia for the laser treatment of retinopathy of prematurity-a survey of ophthalmologists in the UK[J].Eye(Lond), 2007, 21(8):1033-1036.
23. 杨宝峰.药理学[M].7版.北京:人民卫生出版社, 2008:136-143.
24. Mandel R, Ali N, Chen J.Nitrous oxide analgesia during retinopathy screening:a randomised controlled trial[J].Arch Dis Child Fetal Neonatal Ed, 2012, 97(2):83-87.
25. 于玲, 孙宏伟, 姚兰.不同矫正胎龄早产儿眼底检查吸人麻醉配合安全性研究[J].中华眼底病杂志, 2013, 29(4):396-399.
26. Aoyama K, Kondou Y, Suzuki Y, et al.Anesthesia protocols for early vitrectomy in former preterm infants diagnosed with aggressive posterior retinopathy prematurity[J].Anesth, 2010, 24(4):633-638.
27. Parulekar MV, Chen SD, Patel CK.Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser[J].Eye(Lond), 2008, 22(3):375-379.
28. Marsh VA, Young WO, Dunaway KK, et al. Efficacy of topical anesthetics to reduce pain in premature infants during eye examinations for retinopathy of prematurity[J]. Ann Pharmacother, 2005, 39(5):829-833.
29. Mehta M, Mansfield T, VanderVeen DK. Effect of topical anesthesia and age on pain scores during retinopathy of prematurity screening[J]. J Perinatol, 2010, 30(11):731-735.
30. Cogen M, Parker JS, Sleep TE, et al. Masked trial of topical anesthesia for retinopathy of prematurity eye examinations[J]. J AAPOS, 2011;15(1):45-48.
31. 项道满, 陆晓和, 陈锋.表面麻醉下激光间接检眼镜早产儿视网膜光凝手术临床分析[J].实用医学杂志, 2011, 27(11):1990-1992.
32. Dilli D, İlarslan NE, KabataŞ EU, et al.Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations[J].Acta Paediatrica, 2014, 103:76-79.
33. Castellanos MA, Schwartz S, Leal R, et al.Pain assessment in premature infants treated with intravitreal antiangiogenic therapy for retinopathy of prematurity under topical anesthesia[J].Graefe's Arch Clin Exp Ophthalmol, 2013, 251(2):491-494.
34. Nesarqi SV, Nithyanandam S, Rao S, et al. Topical anesthesia or oral dextrose for the relief of pain in screening for retinopathy of prematurity:a randomized controlled double-blinded trial[J].J Trop Pediatr, 2015, 61(1):20-24.
35. Haigh PM, Chiswick ML, O'Donoghue EP. Retinopathy of prematurity:systemic complications associated with different anaesthetic techniques at treatment[J].Br J Ophthalmol, 1997, 81:283-287.
36. Kirwan C, O'Keefe M, Prendergast M, et al. Morphine analgesia as an alternative to general anaesthesia during laser treatment of retinopathy of prematurity[J].Acta Ophthalmol Scand, 2007, 85(6):644-647.
37. Sammartino M, Bocci MG, Ferro G, et al.Efficacy and safety of continuous intravenous infusion of remifentanil in preterm infants undergoing laser therapy in retinopathy of prematurity:clinical experience[J].Paediatr Anaesth, 2003, 13(7):596-602.
38. Örge FH, Lee TJ, Walsh M, et al.Comparison of fentanyl and morphine in laser surgery for retinopathy of prematurity[J].J AAPOS, 2013, 17(2):135-139.
39. Celebioğlu B, Pamuk AG, Aypar U, et al.Use of sevoflurane during cardiopulmonary bypass decreases incidence of awareness[J].Eur J Anaesthesiol, 2002, 19(4):283-287.
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