| 摘要: | 背景：早產兒較足月兒需要接受更多的侵入性醫療，足跟穿刺為常見之醫療處置，也是造成疼痛與壓力的來源，這些刺激帶來的生理功能變化可能會影響早產兒的神經發育。為早產兒提供積極的感官支持介入措施以減輕疼痛和壓力為重要議題與近年研究方向。
目的：本文旨在探討：母乳氣味對早產兒接受足跟穿刺疼痛反應，以及對壓力賀爾蒙（唾液皮質醇濃度）的影響。
方法：本研究為隨機對照試驗，自2022年12月至2023年12月於台灣北部某醫學大學附設醫院進行收案（IRB: N20220423，ClinicalTrials.gov: NCT05557435）。研究對象為妊娠週數30至36週又6天、生命徵象穩定且出生10天內之早產兒，採隨機分派將早產兒分配至實驗組（母乳氣味）及對照組（蒸餾水氣味）。結果指標包括：使用早產兒疼痛評估量表修訂版 (PIPP-R) 測量疼痛程度、穿刺期間哭泣行為、及唾液皮質醇濃度。數據使用 SPSS 26.0 (SPSS Inc., Chicago, IL, USA) 進行描述性統計分析、獨立 t 檢定及線性迴歸模型搭配廣義估計式(GEE) 分析，設定p value < 0.05 為具有統計上顯著差異。
結果：本研究共納入64位早產兒，兩組早產兒人口學變項及研究基準值皆無顯著差異。研究發現母乳氣味組穿刺期間PIPP-R總分平均為10.0 ± 1.7分，低於對照組12.4 ± 3.1分，具統計學上顯著差異 (p = 0.009)。母乳氣味組穿刺時PIPP-R心跳改變分數為 2.5 ± 0.7，低於對照組 2.7 ± 0.5，具統計學上顯著差異 (p = 0.05)。PIPP-R血氧飽和下降得分及三項行為指標（皺眉、閉眼、鼻唇溝紋）母乳氣味組分數略低於對照組，但不具統計顯著差異 (all p > 0.05)。母乳氣味組在穿刺過程平均哭泣總時間為152.3 ± 76.1秒，較對照組163.9 ± 72.2秒短，然而不具統計學上顯著差異 (p = 0.534) ，母乳氣味組穿刺後25分鐘之唾液皮質醇濃度平均為24.8 ± 22.3 nmol/L，較對照組31.0 ± 25.5 nmol/L低，但不具統計學上顯著差異 (p = 0.060) 。出生週數、出生體重、疼痛經驗與是否接受母乳氣味為早產兒接受足跟穿刺之疼痛程度之影響因素 (p < 0.05) ，出生週數越大、體重越重、疼痛經驗越多，其疼痛程度越高。
結論：早產兒足跟穿刺時給予母乳氣味可減輕穿刺過程之疼痛程度及減少心率變化，雖然母乳氣味組的早產兒在穿刺後25分鐘之唾液皮質醇濃度較對照組低，穿刺期間之總哭泣時間也較對照組短，但未達統計學上顯著差異。母乳氣味為非侵入性之介入措施，故仍建議未來於早產兒接受治療處置過程，除常規之包裹及環境調控外，可另外給予母乳氣味，以減輕其壓力及疼痛程度。本研究礙於妊娠週數小於34週個案較少，未來可擴大樣本數以提升研究結果之推論性。此外，探討母乳氣味減輕疼痛之適用範圍及持續追蹤長期腦部結構及發展發育，也將更促進新生兒止痛護理措施於臨床照護、護理教學及護理研究之應用。
Background: Premature infants undergo more invasive procedures than full-term infants, with heel sticks being a common source of pain and stress. Such stimuli may affect their neurodevelopment. Providing positive sensory support interventions to alleviate pain and stress in premature infants is an important issue.
Purpose: This study aimed to explore the effects of breast milk odor on pain response and salivary cortisol levels during heel stick procedures in premature infants.
Methods: This randomized controlled trial, conducted from December 2022 to December 2023 at a hospital in northern Taiwan (IRB: N20220423, ClinicalTrials.gov: NCT05557435), involved premature infants with a gestational age of 30 to 36 weeks and 6 days, who are stable in vital signs. Participants were randomly assigned to receive either breast milk odor or distilled water odor during heel stick procedures. Outcome measures include the pain level assessed using the Premature Infant Pain Profile-Revised (PIPP-R), crying behavior, and salivary cortisol concentration. Data were analyzed using SPSS 26.0 for descriptive statistics, independent t-tests, and linear regression with generalized estimating equations (GEE) analysis, with statistical significance set at p < 0.05.
Results: This study included 64 premature infants with no significant demographic differences between groups. The breast milk odor group had a lower average PIPP-R score during heel sticks (10.0 ± 1.7) compared to the control group (12.4 ± 3.1), with a significant difference (p = 0.009). The heart rate change score of PIPP-R was also lower in the breast milk odor group (2.5 ± 0.7 vs. 2.7 ± 0.5; p = 0.05). No significant differences were found in PIPP-R oxygen saturation scores or behavioral indicators (brow bulge, eye squeeze, and nasolabial furrow) (all p > 0.05). The total crying time was shorter in the breast milk odor group (152.3 ± 76.1 seconds) compared to the control group (163.9 ± 72.2 seconds), but this was not statistically significant (p = 0.534). The average salivary cortisol concentration 25 minutes post heel stick was lower in the breast milk odor group (24.8 ± 22.3 nmol/L) than in the control group (31.0 ± 25.5 nmol/L), though not significantly (p = 0.060). Factors influencing pain levels during heel puncture included gestational age, birth weight, pain experience, and exposure to breast milk odor (p < 0.05); higher gestational age, weight, and pain experience were associated with increased pain levels.
Conclusion: Providing breast milk odor during heel punctures reduces pain levels and heart rate changes in premature infants. While salivary cortisol levels and total crying time were lower in the breast milk odor group, these differences were not statistically significant. Given breast milk odor is recommended alongside routine swaddling and environmental control to reduce stress and pain. Future studies with larger sample sizes and long-term follow-up on developmental outcomes are needed to better validate and apply neonatal pain management strategies in clinical care, nursing education, and research. |
