婴儿的痛觉

doi:10.3724/SP.J.1042.2020.01723

摘要/Abstract

摘要：

婴儿痛觉对婴儿的生长发育有重要意义, 已经日益引发研究者的兴趣。痛觉本质上是一种不愉悦的感官和情绪体验, 是通过早年与伤害有关的经历习得的。在心理学角度, 在介绍婴儿痛觉概念、神经生理机制、评估工具的基础上, 系统梳理痛觉对婴儿生长发育的影响及其影响因素十分必要。后续研究需继续完善婴儿痛觉的测量方法, 考察疼痛反应在不同文化和不同群体间的差异。

关键词: 婴儿痛觉, 大脑发育, 痛觉评估

Abstract:

Pain perception in infants is of great significance to the growth and development of infants, which has aroused increasing interests of researchers. Pain is essentially an unpleasant sensory and emotional experience that is acquired through early injury-related experiences. From the perspective of psychology, it is meaningful to systematically demonstrate the effects of pain perception on infant growth and development on the basis of understanding the concept of infant pain, its neurophysiological mechanism and evaluation tools. Subsequent research should continue to improve the measurement tools of pain perception in infants, and to investigate the differences in pain responses among different cultures and groups.

Key words: infant pain, brain development, pain evaluation

中图分类号:

B844

刘慧晨, 陈坚. (2020). 婴儿的痛觉. 心理科学进展 , 28(10), 1723-1732.

LIU Huichen, CHEN Jian. (2020). The pain perception of infant. Advances in Psychological Science, 28(10), 1723-1732.

图/表 1

参考文献 79

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量表名称	适用对象	测量指标	计分标准	信效度	优缺点
疼痛评估工具(PAT)	危重症患儿(使用肌肉松弛剂的患儿除外)	生理指标：心率、血氧饱和度、呼吸、血压; 行为指标：体位、肌张力、睡眠型态、面部表情、肤色、哭声	每项从1分(最差)到3分(最佳)计分, 共计4~12分, 分数越高表示痛感越强	信效度良好	包括护士对新生儿疼痛的感知, 这是其他测量方法没有涉及到的
新生儿使用量表(SUN)	早产儿、足月儿	生理指标：中枢神经系统、呼吸、心率、血压; 行为指标：面部表情、四肢活动度、肌张力	分数越高表示痛感越强	改进了疼痛评估的计分设计, 具有一定的有效性和可靠性	评估相似的行为和生理变量时对比其他评估工具具有更好的易用性和规模的对称性, 但使用难度较大
新生儿疼痛与不适量表(EDIN)	0~5岁儿童持续性疼痛	面部表情、肢体活动、睡眠质量、可安慰程度	每个条目包含4种行为描述, 分别赋予0, 1, 2, 3分, 总分15分。由儿童的监护人填写。得分0分代表无任何疼痛或不适; 得分15分代表严重疼痛与不适	评分者信度0.59~0.74, 内部一致性系数0.86~ 0.94, 内容效度较好	可测量婴幼儿的持续性疼痛, 具有更高的临床实用性, 但部分条目不适合评估早产儿与镇静患儿, 或易受主观因素的影响
新生儿术后疼痛评估工具(CRIES)	32周以上的新生儿术后疼痛	生理指标：心率、血氧饱和度; 行为指标：哭声、面部表情、睡眠情况	每项评分0~2分, 总分0~10分, >3分需要镇痛, 4~6分为中度疼痛, 7~10分为重度疼痛	信效度良好	有较强的实用性和可靠性, 但在评估新生儿术后疼痛时对血氧饱和度>95%所需氧浓度以及生命体征升高的情况无法解释
新生儿疼痛、烦躁、镇静评估量(N-PASS)	早产儿、足月儿	生理指标：心率、血氧饱和度、呼吸形态、血压; 行为指标：哭声、易怒、行为状态、四肢肌张力	每项评分0~2分, 总分0~10分; 镇静评分通常用于使用镇静药物的患儿, 每项标准为-2~0分, 总分为-10~0分。疼痛得分>2分和镇静得分<-2分均需要进行干预	评分者信度0.85~0.95, 内部一致性系数0.82~ 0.87, 结构效度较好	可单独评估每一项, 但很难对疼痛与激动进行区分
新生儿急性疼痛评估量表(NIAPAS)	机械通气患儿	5项行为指标(警觉性、面部表情、哭闹、肌张力、对操作的反应)、3项生理性指标(呼吸、心率、氧饱和度)及一个相关因素(孕周)	总分0~18分, 0~5分表示没有疼痛或轻度疼痛, 可根据情况考虑非药物干预; 6~9分为中度疼痛, 需进行非药物干预, 并考虑药物干预; ≥10分为重度疼痛, 需要非药物和药物的共同干预	评分者信度0.991~0.997, 内部一致性系数0.732, 内容效度指数1.0, 结构效度也较好	是一个准确评估NICU患儿疼痛的多维性评估工具, 具有较高的临床实用性
新生儿疼痛量表(NIPS)	28~38周新生儿	生理指标：呼吸型态; 行为指标：面部表情、哭声、四肢活动、觉醒状态	总分0~7分, 4分为临界值	信效度良好	内容较为简便, 临床适用性较强
新生儿疼痛评估(PAIN)	新生儿	面部表情、哭声、呼吸模式、肢体运动、唤醒状态、维持饱和度所需的氧含量(95%), 以及生命体征的增加, 心率	每项评分0~2分。总分0~10分, 得分越高说明疼痛越严重	仅通过NIPS测试, 没有迹象表明可靠性	评估新生儿疼痛时使用广泛
早产儿疼痛量表(PIPP)	早产儿、足月儿	2个基线指标(行为状态、胎龄)、2个生理指标(血氧饱和度、心率)、3个行为指标(皱眉、挤眼、鼻唇沟加深)	每个项目指标采用4分制, 总分最高18分(足月儿)或21分(早产儿), 6分为临界值。6分或以下通常表示轻微或没有疼痛, 高于12分表示中度或重度疼痛	评分者信度0.95; 用于确定可行性的标准没有具体说明	用于测量急性和持续性疼痛, 在评估长期、持续和慢性疼痛方面的临床应用和可行性上研究有限
儿童疼痛行为量表(FLACC)	2个月~7岁的儿童	表情、肢体运动、活动、哭泣、可安慰性	每项评分0~2分, 总分最低为0分, 最高为10分, 1~3分为轻度疼痛, 4~6分为中度疼痛, 7~10分为重度疼痛, 得分越高说明患儿的疼痛和不适感越明显。	量表内部一致性系数0.853, 具有较好的稳定性和可靠性	可作为我国学龄前儿童术后疼痛评估的有效工具, 从而为临床镇痛药物和技术的使用提供可靠依据
Bernes 疼痛评估量表(BPSN)	早产儿、足月儿、极低出生体重儿	生理指标：心率、呼吸、血压、血氧饱和度; 行为指标：面部表情、体位、四肢活动、警觉性	分数越高表示痛感越强	信效度良好	可用于评价急性疼痛

量表名称	适用对象	测量指标	计分标准	信效度	优缺点
疼痛评估工具(PAT)	危重症患儿(使用肌肉松弛剂的患儿除外)	生理指标：心率、血氧饱和度、呼吸、血压; 行为指标：体位、肌张力、睡眠型态、面部表情、肤色、哭声	每项从1分(最差)到3分(最佳)计分, 共计4~12分, 分数越高表示痛感越强	信效度良好	包括护士对新生儿疼痛的感知, 这是其他测量方法没有涉及到的
新生儿使用量表(SUN)	早产儿、足月儿	生理指标：中枢神经系统、呼吸、心率、血压; 行为指标：面部表情、四肢活动度、肌张力	分数越高表示痛感越强	改进了疼痛评估的计分设计, 具有一定的有效性和可靠性	评估相似的行为和生理变量时对比其他评估工具具有更好的易用性和规模的对称性, 但使用难度较大
新生儿疼痛与不适量表(EDIN)	0~5岁儿童持续性疼痛	面部表情、肢体活动、睡眠质量、可安慰程度	每个条目包含4种行为描述, 分别赋予0, 1, 2, 3分, 总分15分。由儿童的监护人填写。得分0分代表无任何疼痛或不适; 得分15分代表严重疼痛与不适	评分者信度0.59~0.74, 内部一致性系数0.86~ 0.94, 内容效度较好	可测量婴幼儿的持续性疼痛, 具有更高的临床实用性, 但部分条目不适合评估早产儿与镇静患儿, 或易受主观因素的影响
新生儿术后疼痛评估工具(CRIES)	32周以上的新生儿术后疼痛	生理指标：心率、血氧饱和度; 行为指标：哭声、面部表情、睡眠情况	每项评分0~2分, 总分0~10分, >3分需要镇痛, 4~6分为中度疼痛, 7~10分为重度疼痛	信效度良好	有较强的实用性和可靠性, 但在评估新生儿术后疼痛时对血氧饱和度>95%所需氧浓度以及生命体征升高的情况无法解释
新生儿疼痛、烦躁、镇静评估量(N-PASS)	早产儿、足月儿	生理指标：心率、血氧饱和度、呼吸形态、血压; 行为指标：哭声、易怒、行为状态、四肢肌张力	每项评分0~2分, 总分0~10分; 镇静评分通常用于使用镇静药物的患儿, 每项标准为-2~0分, 总分为-10~0分。疼痛得分>2分和镇静得分<-2分均需要进行干预	评分者信度0.85~0.95, 内部一致性系数0.82~ 0.87, 结构效度较好	可单独评估每一项, 但很难对疼痛与激动进行区分
新生儿急性疼痛评估量表(NIAPAS)	机械通气患儿	5项行为指标(警觉性、面部表情、哭闹、肌张力、对操作的反应)、3项生理性指标(呼吸、心率、氧饱和度)及一个相关因素(孕周)	总分0~18分, 0~5分表示没有疼痛或轻度疼痛, 可根据情况考虑非药物干预; 6~9分为中度疼痛, 需进行非药物干预, 并考虑药物干预; ≥10分为重度疼痛, 需要非药物和药物的共同干预	评分者信度0.991~0.997, 内部一致性系数0.732, 内容效度指数1.0, 结构效度也较好	是一个准确评估NICU患儿疼痛的多维性评估工具, 具有较高的临床实用性
新生儿疼痛量表(NIPS)	28~38周新生儿	生理指标：呼吸型态; 行为指标：面部表情、哭声、四肢活动、觉醒状态	总分0~7分, 4分为临界值	信效度良好	内容较为简便, 临床适用性较强
新生儿疼痛评估(PAIN)	新生儿	面部表情、哭声、呼吸模式、肢体运动、唤醒状态、维持饱和度所需的氧含量(95%), 以及生命体征的增加, 心率	每项评分0~2分。总分0~10分, 得分越高说明疼痛越严重	仅通过NIPS测试, 没有迹象表明可靠性	评估新生儿疼痛时使用广泛
早产儿疼痛量表(PIPP)	早产儿、足月儿	2个基线指标(行为状态、胎龄)、2个生理指标(血氧饱和度、心率)、3个行为指标(皱眉、挤眼、鼻唇沟加深)	每个项目指标采用4分制, 总分最高18分(足月儿)或21分(早产儿), 6分为临界值。6分或以下通常表示轻微或没有疼痛, 高于12分表示中度或重度疼痛	评分者信度0.95; 用于确定可行性的标准没有具体说明	用于测量急性和持续性疼痛, 在评估长期、持续和慢性疼痛方面的临床应用和可行性上研究有限
儿童疼痛行为量表(FLACC)	2个月~7岁的儿童	表情、肢体运动、活动、哭泣、可安慰性	每项评分0~2分, 总分最低为0分, 最高为10分, 1~3分为轻度疼痛, 4~6分为中度疼痛, 7~10分为重度疼痛, 得分越高说明患儿的疼痛和不适感越明显。	量表内部一致性系数0.853, 具有较好的稳定性和可靠性	可作为我国学龄前儿童术后疼痛评估的有效工具, 从而为临床镇痛药物和技术的使用提供可靠依据
Bernes 疼痛评估量表(BPSN)	早产儿、足月儿、极低出生体重儿	生理指标：心率、呼吸、血压、血氧饱和度; 行为指标：面部表情、体位、四肢活动、警觉性	分数越高表示痛感越强	信效度良好	可用于评价急性疼痛