Facial expression of ventilated preterm infants to painful procedures : Proposal for a tentative face scale of pain

本研究は,挿管中の早産児において,先行研究の1事例を通じて抽出された8つの顔表情が痛みを伴う処置(足底穿刺および栄養チューブ抜去)において確認できるか否か,また,痛みの程度を表しているか否かを明らかにすることであった.その結果,次の点が明らかになった: 1)8表情のすべてが処置中に認められた.2)顔面筋の作用と先行研究をも含め,痛みを示す顔表情は5～8の4段階が認められ,顔表情7と8は穿刺による皮膚の損傷に伴う,あるいは,関連するものであった.3)処置の手順が進行するにしたがって顔表情は8へと進み,手順が終わるにしたがって1に進んだ.4)痛みに対する耐用が消失したことを知るには、顔表情以外に、身体の動きや全身の緊張や弛緩の程度、皮膚色を組み合わせることによって、痛みの反応を包括的に捉える必要がある。5)気管内挿管中の早産児に適用するための痛みのフェース･スケール(案)を作成した。臨床での試用を通じて、統合できる顔表情、あるいは、追加すべき顔表情を明らかにする必要がある。The purpose of this study was to confirm eight types of facial expression in response to painful procedures and degree of pain among preterm infants with endotracheal intubation. The subjects were ventilated preterm infants who were born between 25 and 28 weeks of gestational age and hospitalized in NICU. The data were collected between 27 and 32 weeks of postmenstrual age. Facial expressions of the subjects were videotaped and analyzed. Results were as follows: 1) All eight types of facial expression identified in the previous study were found. 2) Four expressions included wrinkles on glabella were also appeared to be painful in this study and giving damage to the skin or stimulating the damaged skin induced crying expression. 3) As the procedure was progressing, the facial expression became more complex with wrinkles and as stimuli were being reduced, facial expression became simpler. 4)It is important to observe body movement and skin color as well as facial expression in order to evaluate the pain experience adequately. 5)A tentative face-scale for pain of ventilated preterm infants was developed. this scale need to be modified by clinical applications

Body weight measurement for preterm infant : Consideration for relief of stress by "wrapping up"

本研究は、体重測定時に「包み込み」を行うことにより、早産児のストレスを緩和できるか否かを明らかにすることを目的とした。当施設での裸のままで保育器外へ出す体重測定法(従来法)と、児をタオルで囲い頭部以外の身体を布で覆った状態で出すという体重測定法(包み込み法)を、早産児4事例において、各方法12場面(4名×3回)を交互に行った。体重測定前の児の状態を安静とし、体重測定中・体重測定後0～5分の5分間・体重測定後6～10分の5分間の各時期を、行動学的側面(ストレスサイン・state)から比較検討し、以下の結果を得た。ストレスサインにおいては、体重測定中では14項目中7項目で有意差が認められ、体重測定後0～5分の5分間・6～10分の5分間においても体重測定中よりは少数であるが、有意差が認められた。stateにおいては、包み込み法では体重測定中に全く上昇が見られないという結果が得られた。これらより、「包み込み」は体重測定中の早産児のストレスを緩和するのに有用であると示唆された。今後もあらゆるケアにおいて、児のストレスサインを適切に読み取り、対処法を探索していく必要がある。The purpose of the present research was to clarify whether or not the stress of preterm infants can be relieved by "wrapping up" during measurement of their body weight. The body weights of four preterm infants were measured using alternately our facility's traditional method, whereby babies are taken naked as they are from the incubator ("traditional method"). and a method whereby the infants were taken out clothed in a towel so that their bodies except for the head were covered in fabric ("wrap-up method"). Each infant's body weight was measured 3 times using the two methods, making a total of 12 cases. Before weight measurement the infants were put into a restful state; subsequently they were examined for behavioral aspects (stress signs and state) during (a) weight measurement. (b) the 5 minute period immediately after weight measurement (minutes 0 to 5). and (c) the subsequent 5 minute period (minutes 6 to 10). Below are the results of the comparison that was made of the behavioral aspects in each of these periods. A significant difference occurred in stress signs during weight measurement, with just 7 out of 14 signs being observed with the wrap-up method. During the 1st (minutes 0-5) and 2nd (minutes 6-10) 5 minute periods following weight measurement the number of stress signs observed was small compared to those occurring during weight measurement, but again there was a significant difference. As regards stress state, the result obtained was that no increase whatever was observed during weight measurement when the wrap-up method was used. These results indicate that the wrap-up method is useful for relieving stress in premature babies during body weight measurement. In the future it will be necessary to read accurately the stress signs in babies under all types of care and to explore methods to remedy such stress