Trace Blood Of Newborns Three Kinds Of Ways And Its Painful Stimuli

ObjectiveTo explore the optimal blood sampling method for neonates which has the least effect on physiological parameters and has the least pain reactions through comparing the most three common invasion blood sampling methods.MethodsThis study is a randomizated controlled clinical study,it applied before-after control study in the same subject and repeated measurement design.180 NICU neonates were randomly sampled who was applied with inclusion criteria and was hospitalized in ShanDong Provincial Hospital neonatal department during April,2007 to December,2007,then,these subjects were randomly assigned to three groups(heel stick,scalp venepuncture and fourth finger blood sampling).Physiological parameters of subjects(including heart rate,HR;respiratory rate,RR; transcutaneous oxygen saturation,SpO₂)was monitored pre-operatively,during-operatively and post-operatively;at the same time,pain reaction was evaluated by using neonatal infants pain scales(NIPS),mean±standard deviation was used in statistical description.Statistical inference consisted of two parts:physiological parameters were used univariate analysis of variance of repeated measurement two elements(intervention elements～3 blood sampling methods), multiple levels(measurement times～per-operation,during-operation and post-operation)design; NIPS scores was used complete random design multi-samples rank test(Kruskal Wallis H test),if the difference was significant,Nemenyi test was used to comparing means between two-two groups.Results1.The difference of 3 blood sampling methods which exerting effect on neonates' HR was significant(P＜0.0001),and had statistical siginificance.The subjects who underwent heel stick whose HR increased greatest(the increased data was 28.36±1.96b.m.p);Post-operatively,it took more time to return to the baseline,and the HR was still greater post-operatively than pre-operatively;however,scalp venepuncture blood sampling had the least effect on neonatal HR, the degree of HR increased was least(the increased data was 12.77±0.61b.m.p.),and HR of post-operation had basically returned to the level of pre-operation.The effects of fourth finger blood sampling on neonatal HR was between the heel stick and scalp venepuncture blood sampling.2.The difference of 3 blood sampling methods which exerting effect on neonates' SpO₂ was significant,and had statistical siginificance(P＜0.0001).During operation,all subjects' SpO₂ of three groups were decreased obviously.Compared with the level of pre-operation,the subjects who underwent heel stick whose SpO₂ decreased greatest(the decreased data was 7.83%±0.408%); and the subjects who underwent scalp venepuncture blood sampling whose SpO₂ decreased least(the decreased data was 3.10%±0.859%),and the subjects of fourth finger whose SpO₂ deceased between the group of heel stick and the group of scalp venepuncture(the decreased data was 5.15%±0.168%).Post-operatively,the level of SpO₂ of the heel stick group was still lower, howvere,the scalp venepuncture group had basically returned to the level of pre-operation,the SpO₂ level of fourth finger group was between the group of heel stick and scalp venepuncture groups.From this,we could draw the conclusion:heel stick blood sampling had the greatest effect on neonatal SpO₂.Scalp venepuncture blood sampling had the least effect on neonatal SpO₂.The effect of fourth finger blood sampling on neonatal SpO₂ was between the heel stick and scalp venepuncture blood sampling.3.The difference of 3 blood sampling methods which exerting effect on neonates' RR was significant(P＜0.0001),and had statistical siginificance.Pre-operatively,the RR of three gruops of subjects was comparative.During operation,all subjects' RR of three groups were increased evidently.The subjects who underwent heel stick whose RR increased greatest(the increased data was 11.15±0.295b.m.p);whereas,the subjects of scalp venepuncture whose RR increased lowest(the increased data was 6.78±0.592b.m.p.),and the level of RR of the fourth finger blood sampling increased between the groups of heel stick and scalp venepuncture.Post-operatively, the level of RR of the heel stick group was still apparently greater than the level of pre-operation. Whereas,the group of scalp venepuncture had basically returned to the level pre-operation.The RR level of fourth finger group was between the group of heel stick and scalp venepuncture groups.From this,we could draw the conclusion:heel stick blood sampling had the greatest effect on neonatal RR.Scalp venepuncture blood sampling had the least effect on neonatal RR. The effect of fourth finger blood sampling on neonatal RR was between the heel stick and scalp venepuncture blood sampling.4.Comparing results of the NIPS scores of the three blood sampling methods:the population means of three groups were different.Nemenyi test was applied to analyze the difference between two-two groups,and it demonstrated that the NIPS score of heel stick was evidently greater than the score of scalp venepuncture group;The NIPS score of heel stick was obviously greater than the score of fourth finger group;The score of fourth finger was apparently greater than the score of scalp venepuncture.We could summarize that:the score of NIPS of three blood sampling methods ranged from high to low:heel stick group＞fourth finger group＞scalp venepuncture group.ConclusionThe conclusion can be drawn from comparing three neonatal blood sampling methods: scalp venepuncture was the most optimal neonatal method which had the least effect on physiological parameters and the pain reaction was lightest.However,heel stick had the greatest effect on neonatal physiological parameters and its pain reaction was most serious.And the effect of fourth finger blood sampling was between the groups of heel stick and scalp venepuncture.