不同鼻腔冲洗方法对婴儿鼻塞疼痛、哭闹及操作时间的影响：一项随机对照试验

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中文摘要

引言： 鼻腔生理盐水冲洗是缓解儿童上呼吸道感染鼻部症状和维持上气道通畅的推荐方法。本研究旨在评估不同鼻腔冲洗方法缓解婴儿急性上呼吸道感染鼻塞对疼痛、哭闹、操作时间及生理参数的影响。
方法： 共126例急性上呼吸道感染婴儿随机分为4组：等渗盐水鼻腔冲洗组（n=31）、高渗盐水鼻腔冲洗组（n=31）、等渗盐水鼻腔冲洗+无创鼻咽吸引组（n=32）和高渗盐水鼻腔冲洗+无创鼻咽吸引组（n=32）。等渗盐水鼻腔冲洗组使用10 mL等渗盐水进行鼻腔冲洗，高渗盐水鼻腔冲洗组使用10 mL高渗盐水进行鼻腔冲洗。等渗盐水鼻腔冲洗+无创鼻咽吸引组在等渗盐水冲洗后行无创鼻咽吸引，高渗盐水鼻腔冲洗+无创鼻咽吸引组在高渗盐水冲洗后行无创鼻咽吸引。记录操作前1分钟、操作过程中的疼痛评分、哭闹时间和操作时间，并在操作后5分钟额外记录生理参数。
结果： 等渗盐水鼻腔冲洗组和等渗盐水鼻腔冲洗+无创鼻咽吸引组婴儿的面部、腿部、活动、哭闹和可安慰性（FLACC）评分均值低于高渗盐水鼻腔冲洗组和高渗盐水鼻腔冲洗+无创鼻咽吸引组（F=32.165；P=.00；η2=0.442）。等渗盐水鼻腔冲洗组婴儿的哭闹时间低于高渗盐水鼻腔冲洗组和高渗盐水鼻腔冲洗+无创鼻咽吸引组。此外，等渗盐水鼻腔冲洗+无创鼻咽吸引组婴儿的哭闹时间低于高渗盐水鼻腔冲洗组（F=5.178；P=.002；η2=.113）。等渗盐水鼻腔冲洗组婴儿的操作时间短于其他组（F=8.779；P=.00；η2=0.178）。
讨论： 等渗盐水鼻腔冲洗和等渗盐水鼻腔冲洗+无创鼻咽吸引可有效减少上呼吸道感染婴儿鼻腔冲洗相关的疼痛、哭闹和操作时间。急诊护士可单独使用等渗盐水鼻腔冲洗或联合无创鼻咽吸引来缓解婴儿鼻塞。

英文摘要

INTRODUCTION: Nasal saline irrigation is a recommended approach to relieve nasal symptoms and maintain upper airway patency in children with upper respiratory tract infections. This study aimed to evaluate the effects of different nasal irrigation methods for relieving nasal obstruction on pain, crying, and procedure times, and physiologic parameters in infants with acute upper respiratory tract infection.
METHODS: A total of 126 infants with acute upper respiratory tract infection were randomized into 4 groups: isotonic saline nasal irrigation (n = 31), hypertonic saline nasal irrigation (n = 31), isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration (n = 32), and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration (n = 32). Nasal irrigation was performed with 10 mL of isotonic saline in the isotonic saline nasal irrigation group and 10 mL of hypertonic saline in the hypertonic saline nasal irrigation group. Nontraumatic nasopharyngeal aspiration was performed after isotonic saline irrigation in the isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group and hypertonic saline irrigation in the hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group. The pain scores, crying and procedure times, and physiologic parameters were recorded 1 minute before and during the procedure and additionally 5 minutes after the procedure for physiological parameters.
RESULTS: The mean face, legs, activity, cry, and consolability scores of infants in the isotonic saline nasal irrigation and isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups were lower than those in the hypertonic saline nasal irrigation and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups (F = 32.165; P = .00; η2 = 0.442). The crying time of infants in the isotonic saline nasal irrigation group was lower than that in the hypertonic saline nasal irrigation and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups. Moreover, the crying time of infants in the isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group was lower than that in the hypertonic saline nasal irrigation group (F = 5.178; P = .002; η2 = .113). The procedure time for infants in the isotonic saline nasal irrigation group was shorter than that in the other groups (F = 8.779; P = .00; η2= 0.178).
DISCUSSION: Isotonic saline nasal irrigation and isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration are effective in reducing pain, crying, and procedural times associated with nasal irrigation in infants with upper respiratory tract infection. Emergency nurses can use isotonic saline nasal irrigation alone or in combination with nontraumatic nasopharyngeal aspiration to relieve nasal obstruction in infants.