CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / RecÃm-Nascidos PrÃ-Termo (RNPT) sÃo submetidos, diariamente, à punÃÃo arterial nas primeiras horas de vida para exames de dosagem do pH e gases. A punÃÃo arterial, embora dolorosa, raramente à acompanhada de medida analgÃsica. Objetivou-se avaliar o efeito das intervenÃÃes mÃsica, mÃsica e glicose 25% e glicose 25% no alÃvio da dor dos RNPT submetidos à punÃÃo arterial e analisar a relaÃÃo das variÃveis neonatais e terapÃuticas com os escores da dor do RNPT, obtidos atravÃs da escala Premature Infant Pain Profile (PIPP). Ensaio clÃnico randomizado transversal de carÃter experimental triplo cego, conduzido no setor da Unidade de InternaÃÃo Neonatal (UIN) de um hospital pÃblico, em Fortaleza/CearÃ/Brasil de novembro/2011 a agosto/2012. A amostra constou de 80 RNPT, 24 randomizados no Grupo Experimental 1 (GE1 â mÃsica); 33, no Grupo Experimental 2 (GE2 - mÃsica e glicose 25%) e 23, no Grupo Controle Positivo (GCP). Uma mÃsica de ninar foi tocada durante 10 minutos antes da punÃÃo arterial por meio de MP3 interligado ao fone de ouvido, para os neonatos do grupo GE1 e GE2, sendo a glicose 25% administrada para os RNPT do grupo GE2 e GCP dois minutos antes da punÃÃo arterial. O desfecho primÃrio foi o escore da dor obtido com a escala PIPP nos 240 segundos apÃs a punÃÃo arterial em um intervalo de 30 em 30 segundos. Os desfechos secundÃrios foram alteraÃÃes relacionadas à mÃmica facial, FrequÃncia CardÃaca (FC) e SaturaÃÃo de OxigÃnio (SatO2). Pesquisa aprovada por comità de Ãtica parecer n 060717/11. Observou-se que as variÃveis neonatais numÃricas dos RNPT do grupo GE1 versus valores totais PIPP mostraram-se com p significante nas variÃveis: perÃmetro cefÃlico (PC â p=0,003), perÃmetro torÃcico (PT â p=0,032), Apgar 1 (p=0,001), Apgar 5 (p=0,047), idade gestacional corrigida (p=0,003) e idade gestacional corrigida em dias (p=0,008). No grupo GE2 versus valores totais PIPP, o p foi significante nas variÃveis: PT (p=0,002), Apgar 1 (p=0,009) e no Apgar 5 (p=0,002). Jà no grupo GCP versus valores totais PIPP, o p mostrou-se significante nas variÃveis: peso ao nascer (p=0,045) e ao PC (p=0,027). Quanto Ãs variÃveis terapÃuticas, os RNPT tiveram a maior concentraÃÃo dos valores PIPP, entre valores ≥7 de dor intensa a moderada. A variÃvel terapÃutica significante foi o uso de oxigenoterapia, sendo o Continuous Positive Airway Pressure (CPAP), a medida mais presente nos escores de dor intensa a moderada (p=0,012) no grupo GE2. Em relaÃÃo ao escore total de dor medido pelos trÃs avaliadores atravÃs da escala de dor PIPP, observou-se diferenÃa estatisticamente significante dos escores de dor devido à intervenÃÃo (p=0,000). O grupo GE2 (57,6%) apresentou maior porcentagem de dor mÃnima, ≤ 6, em relaÃÃo aos outros grupos GE1 (29,2) e GCP (47,8). Conclui-se que à considerada vÃlida a hipÃtese de que os RNPT submetidos ao efeito da mÃsica e glicose 25%, antes e durante a punÃÃo arterial, apresentam menores escores de dor, em comparaÃÃo Ãqueles em uso somente de mÃsica ou de glicose 25%, com uma diferenÃa de 1,5 pontos, conforme a classificaÃÃo da escala PIPP. / Every day preterm infants (PI) are submitted to arterial puncture in the first hours of life for testing the gases and pH dosage. Although arterial puncture is painful, it is rarely accompanied by any analgesic measure. We Aimed to evaluate the effects of interventions: music, music and 25% glucose, and 25% glucose in relieving the pain of PI undergoing arterial puncture, and analyze the association of neonatal and therapeutic variables with the pain scores of PI obtained through the Premature Infant Pain Profile (PIPP). A cross-sectional randomized clinical trial of triple-blind experimental type, carried out at the Neonatal Care Unit (NCU) in a public hospital in Fortaleza-CE, Brazil, from November 2011 to August 2012. The sample consisted of 80 preterm infants, 24 randomized in Experimental Group 1 (EG1 â music); 33 in Experimental Group 2 (EG2 â music and 25% glucose); and 23 in Positive Control Group (PCG). Lullaby music was played for 10 minutes before arterial puncture through a MP3-player connected to earphones, for the infants in the EG1 e EG2, with 25% glucose administered to infants in the EG2 and PCG two minutes before arterial puncture. The primary outcome was the pain scores obtained with the PIPP in the first 240 seconds after the arterial puncture in an interval of 30 to 30 seconds. Secondary outcomes were the changes related to facial movements, Heart Rate (HR) and oxygen saturation (SpO2). This research was approved by the ethics committee under protocol No. 060 717/11. It was observed that the numeric neonatal variables of the PI in the EG1 versus total PIPP scores presented significant p in the variables: head circumference (HC â p=0.003), chest girth (CG â p=0.032), 1-minute Apgar (p=0.001), 5-minute Apgar (p=0.047), corrected gestational age (p=0.003), and corrected gestational age in days (p=0.008). In the EG2 versus total PIPP scores, p was significant in the variables: HC (p=0.002), 1-minute Apgar (p=0.009) and 5-minute Apgar (p=0.002). In the PCG versus total PIPP scores, p was significant in the variables: birth weight (p=0.045) and HC (p=0.027). Regarding therapeutic variables, PI had the highest concentration of PIPP scores among values ≥ 7 of moderate to severe pain. The therapeutic variable significant was the use of oxygen, with the Continuous Positive Airway Pressure (CPAP) as the most present in scores of moderate to severe pain (p=0.012) in the EG2. Regarding the total pain score measured in the three interventions through the PIPP, we observed a statistically significant difference in pain scores due to the intervention (p=0.000). The EG2 (57.6%) presented a higher percentage of minimal pain, ≤ 6, regarding the other groups, EG1 (29.2) and PCG (47.8). We conclude that it is considered valid the hypothesis that preterm infants submitted to the effects of music and 25% glucose, before and during arterial puncture, present lower pain scores compared to those that only use music or 25% glucose, with a difference of 1.5 points, according to the PIPP classification.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:6967 |
| Date | 27 May 2013 |
| Creators | Leiliane Martins Farias |
| Contributors | Maria Vera LÃcia Moreira LeitÃo Cardoso, Ana Karina Bezerra Pinheiro, Edna Maria Camelo Chaves, Carmen Gracinda Silvan Scochi, Adriana Moraes Leite |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Enfermagem, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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