気管挿管中の早産児の痛みを伴う処置に対する顔表情 : フェース・スケールの試案作成

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.