口腔运动训练联合小儿推拿对早产儿喂养不耐受的疗效观察

doi:10.3969/j.issn.1674-8115.2024.08.006

摘要/Abstract

摘要：

目的·探讨口腔运动训练联合小儿推拿对早产儿喂养不耐受的干预效果，以提供新的治疗选择和提高护理质量。方法·采用非同期对照的临床试验方法，选取济南市某三级甲等医院新生儿科2022年入院的75例符合条件的早产儿作为试验组，实施口腔运动训练联合小儿推拿治疗。另选取2020年入院的60例早产儿作为对照组，已接受过口腔运动训练，未接受小儿推拿治疗。试验组治疗7 d，比较2组患儿喂养不耐受表现如呕吐、胃残余，以及其他结局指标如首次经口喂养时间、胃管留置时间、治疗开始后的第3天和第7天医嘱奶量的增加量、早产儿开奶时间、治疗后第3天及第7天的体质量、恢复出生体质量时间及住院天数等。结果·治疗前2组间性别、日龄、出生体质量，以及1 min、5 min、10 min的Apgar评分等差异无统计学意义（P>0.05），具有可比性。治疗后，试验组早产儿在喂养表现如呕吐、胃潴留、首次经口喂养时间、胃管留置时间、治疗开始后的第3天和第7天医嘱奶量的增加量、治疗后第3天和第7天的体质量及住院天数等观察指标上均较对照组显著改善，差异具有统计学意义（P<0.05）。而在早产儿开奶时间和恢复出生体质量时间方面，2组早产儿差异无统计学意义（P>0.05）。结论·口腔运动训练与小儿推拿联合应用对早产儿喂养不耐受的短期治疗效果显著，优于单一口腔运动训练。联合治疗有助于早产儿增加奶量摄入、加快体质量增长，有助于患儿恢复肠道功能、建立早期营养支持，促进患儿生长发育，减少远期并发症的风险。该疗法简便、安全、高效，具推广价值。

关键词: 早产儿, 小儿推拿, 喂养不耐受, 口腔运动训练

Abstract:

Objective ·To investigate the intervention effect of oral motor training combined with pediatric tui-na on feeding intolerance in preterm infants to provide new treatment options and improve the quality of care. Methods ·By using a non-simultaneous controlled clinical trial method, 75 eligible preterm infants from the neonatal unit of a tertiary care hospital in Jinan were selected as the experimental group to implement oral training combined with pediatric massage therapy. Another 60 preterm infants admitted in 2020 were selected as the control group, who had already received oral motor training but had not received pediatric massage. The experimental group was treated for 7 d and the efficacy of the two groups was compared. Comparisons between the two groups included signs of feeding intolerance such as vomiting, gastric remnants and other outcome indicators such as first oral feeding time, gastric tube retention time, increased milk volume at day 3 and increased milk volume at day 7, feeding initiation time, increased weight at day 3 and increased weight at day 7, recovery time of birth weight, and days of hospitalization in both groups. Results ·The differences in gender, age, birth weight, and Apgar score between the two groups before treatment were not statistically significant (P>0.05) indicating comparability. After treatment, preterm infants in the experimental group showed significant improvement in feeding performance, first oral feeding time, gastric tube retention time, increased milk volume at day 3 and increased milk volume at day 7, increased weight at day 3 and increased weight at day 7,hospitalization days and other observed indexes compared with the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the feeding initiation time and recovery time of birth weight between the two groups (P>0.05). Conclusion ·The combined application of oral motor training and pediatric tui-na is significantly more effective than single oral motor training in the short-term treatment of feeding intolerance in preterm infants. This combination therapy helps preterm infants to increase milk intake and accelerate weight gain, helps the children to recover intestinal function, establishes early nutritional support, promotes growth and development, and reduces the risk of long-term complications. This treatment is simple, safe and efficient, and has the value of popularization.

Key words: preterm infant, pediatric tui-na, feeding intolerance, oral motor training

中图分类号:

R473.72

崔方明, 王静娜, 张玉霞. 口腔运动训练联合小儿推拿对早产儿喂养不耐受的疗效观察[J]. 上海交通大学学报（医学版）, 2024, 44(8): 975-980.

CUI Fangming, WANG Jingna, ZHANG Yuxia. Clinical effect of oral motor training combined with pediatric tui-na on feeding intolerance in preterm infants[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(8): 975-980.

图/表 3

参考文献 21

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Item	Control group (n=60)	Experimental group (n=75)	χ²/t/Z value	P value
Age/min	41.58±9.19	42.93±13.03	-0.687^①	0.066
Birth weight/kg	1.64±0.57	1.65±0.61	-1.200^①	0.100
Gestational age/week	30.16±1.81	30.91±2.80	-1.784^①	0.065
1-minute Apgar score	8.27±1.69	7.85±1.89	1.342^②	1.000
5-minute Apgar score	9.12±0.99	9.01±1.06	0.583^②	0.866
10-minute Apgar score	9.33±0.80	9.39±0.90	-0.365^②	0.283
Gender/n(%)			1.929	0.171
Male	28 (46.7)	44 (58.7)
Female	32 (53.3)	31 (41.3)

Item	Control group (n=60)	Experimental group (n=75)	χ²/t/Z value	P value
Age/min	41.58±9.19	42.93±13.03	-0.687^①	0.066
Birth weight/kg	1.64±0.57	1.65±0.61	-1.200^①	0.100
Gestational age/week	30.16±1.81	30.91±2.80	-1.784^①	0.065
1-minute Apgar score	8.27±1.69	7.85±1.89	1.342^②	1.000
5-minute Apgar score	9.12±0.99	9.01±1.06	0.583^②	0.866
10-minute Apgar score	9.33±0.80	9.39±0.90	-0.365^②	0.283
Gender/n(%)			1.929	0.171
Male	28 (46.7)	44 (58.7)
Female	32 (53.3)	31 (41.3)

Item	Control group (n=60)	Experimental group (n=75)	χ²/t /Z value	P value
Vomit/n(%)			8.584	0.003
No	35 (58.3)	61 (81.3)
Yes	25 (41.7)	14 (18.7)
Gastric residue/n(%)			15.418	0.000
No	23 (38.3)	54 (72.0)
Yes	37 (61.7)	21 (28.0)
Feeding initiation time/week	31.02±1.75	30.80±2.41	0.593^①	0.551
First oral feeding time/week	34.43±1.48	32.84±2.26	4.722^①	0.000
Gastric tube retention time/d	26.58±14.24	15.87±9.92	5.144^①	0.000
Increased milk volume-D3/mL	2.98±1.61	7.12±7.77	-4.053^②	0.000
Increased milk volume-D7/mL	4.95±2.43	9.71±8.78	-4.071^②	0.000

Item	Control group (n=60)	Experimental group (n=75)	χ²/t /Z value	P value
Vomit/n(%)			8.584	0.003
No	35 (58.3)	61 (81.3)
Yes	25 (41.7)	14 (18.7)
Gastric residue/n(%)			15.418	0.000
No	23 (38.3)	54 (72.0)
Yes	37 (61.7)	21 (28.0)
Feeding initiation time/week	31.02±1.75	30.80±2.41	0.593^①	0.551
First oral feeding time/week	34.43±1.48	32.84±2.26	4.722^①	0.000
Gastric tube retention time/d	26.58±14.24	15.87±9.92	5.144^①	0.000
Increased milk volume-D3/mL	2.98±1.61	7.12±7.77	-4.053^②	0.000
Increased milk volume-D7/mL	4.95±2.43	9.71±8.78	-4.071^②	0.000

Item	Control group (n=60)	Experimental group (n=75)	t/Z value	P value
Recovery time of birth weight/week	32.47±1.42	32.28±2.85	0.461^①	0.646
Weight-D3/kg	1.29±0.33	1.85±0.67	-5.922^②	0.000
Weight-D7/kg	1.33±0.33	2.00±0.73	-6.643^②	0.000
Days of hospitalization/d	65.98±42.37	39.57±22.78	4.629^①	0.000