改良口腔运动干预对早产儿经口喂养能力及结局的影响

王菊; 张冉; 王钦; 翟芳; 张雪

doi:10.16766/j.cnki.issn.1674-4152.002770

改良口腔运动干预对早产儿经口喂养能力及结局的影响

doi: 10.16766/j.cnki.issn.1674-4152.002770

王菊^1, ,,
张冉¹,
王钦²,
翟芳³,
张雪³

1.
南阳市中心医院产科，河南南阳 473000
2.
南阳市中心医院儿童肾病科，河南南阳 473000
3.
南阳市中心医院新生儿重症监护室，河南南阳 473000

基金项目:

河南省科技攻关项目 182103210412

详细信息

通讯作者:
王菊, E-mail: wangj904@163.com

中图分类号: R722
计量
- 文章访问数: 175
- HTML全文浏览量: 73
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-12
- 网络出版日期: 2023-02-07

Effect of modified oral exercise intervention on oral feeding ability and outcome of premature infants

WANG Ju^{1
, ,},
ZHANG Ran¹,
WANG Qin²,
ZHAI Fang³,
ZHANG Xue³

1.
Department of Obstetrics, Nanyang Central Hospital, Nanyang, Henan 473000, China

摘要

摘要: 目的探讨改良口腔运动干预对早产儿经口喂养能力及结局的影响。方法选取2018年5月—2020年7月在南阳市中心医院NICU住院的146例早产儿为研究对象，采用随机数字表法分为研究组和对照组，每组73例。对照组接受常规治疗及发育支持干预，研究组采用改良早产儿口腔运动干预，干预至可完全经口喂养为止。观察2组患儿经口喂养能力、喂养进程及表现，以及不良反应发生情况。结果干预当天，2组早产儿准备经口喂养评估量表(PIOFRA Scale-CV)得分差异无统计学意义(P＞0.05)，随着干预时间的延长，2组PIOFRA Scale-CV得分呈现上升趋势，组间比较差异有统计学意义(F_组间=14.297，P_组间＜0.001)。2组静脉营养时间、开始经口喂养成效组间差异无统计学意义(均P＞0.05)，全经口喂养过渡时间、开始经口喂养效率、完全经口喂养效率、完全经口喂养成效、完全经口喂养时体重组间差异均有统计学意义(均P＜0.05)。研究组不良反应总发生率为18.31%，对照组为29.17%，差异无统计学意义(χ²=2.325，P=0.127)，其中研究组血氧饱和度下降和疲乏单种不良反应发生率低于对照组，差异有统计学意义(均P＜0.05)。结论改良早产儿口腔运动干预可提高早产儿经口喂养能力，缩短全经口喂养过渡时间，提升喂养效率，减少血氧饱和度下降及疲乏不良反应发生率。
- 改良口腔运动干预 /
- 临床结局 /
- 早产儿
Abstract: Objective To explore the effect of modified oral exercise intervention on oral feeding ability and outcome of premature infants. Methods A total of 146 premature infants who were hospitalised in the Neonatal Intensive Care Unit (NICU) of Nanyang Central Hospital from May 2018 to July 2020 were selected as research objects. The infants were divided into study and control groups using a random-number table method, with 73 cases in each group. The control group received conventional treatment, and for developmental support intervention, a modified oral exercise intervention was adopted for premature infants in the study group until the intervention can be a complete oral feeding. The oral feeding ability, feeding process and performance of the two groups of children and the occurrence of adverse reactions were observed. Results On the day of intervention, no significant difference was observed in the scores in the Chinese version of preterm infant oral feeding readiness assessment scale (PIOFRA Scale-CV) between the two groups of preterm infants (P>0.05). With the extension of intervention period, the PIOFRA Scale-CV scores of the two groups showed an upward trend. The differences between groups were statistically significant (F_{between group}=14.297, P_{between group} < 0.001). No statistically significant difference was noticed between the intravenous nutrition time and the effectiveness of oral feeding (all P>0.05). The transition time of complete oral feeding, efficiency of starting oral feeding, efficiency of complete oral feeding, and the weight at the time of complete oral feeding were statistically significant (both P < 0.05). The total incidence of adverse reactions reached 18.31% and 29.17% in the study and control groups, respectively, and the difference was not statistically significant (χ²=2.325, P=0.127). The incidences of single adverse reaction of decreased oxygen saturation and fatigue in the study group were lower than those in the control group, and the difference was statistically significant (all P < 0.05). Conclusion Improved oral exercise intervention can improve the oral feeding ability of premature infants, shorten the transition time to total oral feeding, improve the feeding efficiency and reduce the incidence of oxygen saturation decline and fatigue adverse reactions.
- Modified oral exercise intervention /
- Clinical outcome /
- Preterm infants

HTML全文

表 1 改良早产儿口腔运动干预方案

Table 1. Improved oral motor intervention program for premature infants

内容	部位	具体操作方法	频次	时长
口周按摩	脸颊	用食指指腹轻敲患儿脸颊，并快速向嘴角方向移动。	每侧5次	30 s
		将食指放于患儿嘴角，边轻压边向耳朵方向做弧度移动，再返回嘴角。	每侧3次	30 s
	口唇	食指与中指指腹放于患儿唇沿中央，边按压边将两手指分别向嘴角移动，再返回。	上下唇各4次	40 s
		食指放于一侧嘴角，边按压边沿唇向对侧移动，再返回。	上下唇各4次	40 s
口内按摩	牙龈	将小指伸入患儿口内，指腹放于牙龈中央，边按压边向一侧牙龈后方移动，再返回，双侧交替进行。	上下牙龈各3次	30 s
	腭	手指放于前硬腭，边按摩边移动至软腭，再返回。	4次	10 s
	口唇内侧	一个手指伸入口内唇中央，另一个手指放于对应唇外，边按压边向一侧移动，嘴角间往返。	上下唇各4次	30 s
	舌	小指放于舌尖，轻按舌苔2 s再放松。	2次	10 s
		手指放于舌根中央，轻轻按压推至一侧再经中央返至对侧。	4次	20 s
非营养性吮吸	口	用无孔奶嘴轻触患儿嘴唇和硬腭，诱导其非营养性吮吸。	持续	2 min
口腔支持	下颌	左手托起患儿头肩，右手拇指和食指、中指分别放于患儿嘴角外水平面颊部，收紧手指，轻轻挤压患儿双侧面颊，使其嘴唇稍稍向外凸起，同时无名指和小指轻轻向上托起患儿下颌，持续3 s，反复进行。	5次	2 min

下载: 导出CSV

表 2 2组早产儿一般资料比较

Table 2. Comparison of general data of two groups of premature infants

组别	例数	性别[例(%)]		胎龄(x±s, 周)	出生体重(x±s, kg)	出生身长(x±s, cm)	阿普加评分(x±s, 分)			出生方式[例(%)]
组别	例数	男	女	胎龄(x±s, 周)	出生体重(x±s, kg)	出生身长(x±s, cm)	出生1 min	出生5 min	出生10 min	剖宫产	阴道分娩
研究组	71	38(53.52)	33(46.48)	33.75±1.28	1.97±0.26	44.72±1.97	7.96±1.43	9.05±0.84	9.73±0.67	41(57.75)	30(42.25)
对照组	72	41(56.94)	31(43.06)	33.81±1.32	1.99±0.27	45.01±2.07	8.03±1.39	8.99±0.91	9.85±0.72	43(59.72)	29(40.28)
统计量		0.169^a		0.276^b	0.451^b	0.858^b	0.297^b	0.409^b	1.031^b	0.058^a
P值		0.681		0.783	0.653	0.392	0.767	0.683	0.304	0.811
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 3 2组早产儿不同时间PIOFRA Scale-CV得分比较(x±s，分)

Table 3. Comparison of PIOFRA Scale CV scores of two groups of premature infants at different times(x±s, points)

组别	例数	干预当天	干预7 d	干预10 d	干预14 d
研究组	71	25.78±1.75	28.08±1.35	31.81±1.08	33.71±0.89
对照组	72	25.83±1.81	27.56±1.44	28.43±1.25	29.83±1.17
t值		0.168	2.227	17.292	22.297
P值		0.867	0.028	＜0.001	＜0.001

下载: 导出CSV

表 4 2组早产儿喂养进程、表现和结局比较(x±s)

Table 4. Comparison of feeding process, performance and outcome between two groups of premature infants(x±s)

组别	例数	静脉营养时间(d)	全经口喂养过渡时间(d)	开始经口喂养效率(mL/min)	开始经口喂养成效(%)	完全经口喂养效率(mL/min)	完全经口喂养成效(%)	完全经口喂养时体重(g)
研究组	71	19.51±6.83	7.85±1.27	5.56±2.84	63.73±15.98	11.54±4.33	97.47±12.53	2 264.82±217.62
对照组	72	19.85±7.79	10.37±1.52	3.61±1.97	61.38±14.63	8.09±2.94	78.95±11.37	2 095.16±248.58
t值		0.277	10.751	4.776	0.917	5.581	9.259	4.341
P值		0.782	＜0.001	＜0.001	0.361	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 5 2组早产儿相关不良反应发生情况比较[例(%)]

Table 5. Comparison of adverse reactions related to premature infants between the two groups[cases(%)]

组别	例数	喂养不耐受	血氧饱和度下降	疲乏	高胆红素血症	坏死性小肠结肠炎
研究组	71	6(8.45)	5(7.04)	1(1.41)	7(9.86)	2(2.82)
对照组	72	12(16.67)	14(19.44)	10(13.89)	8(11.11)	4(5.56)
χ²值		2.193	4.773	7.842	0.059	0.159
P值		0.139	0.029	0.005	0.807	0.689

下载: 导出CSV

参考文献(20)

[1]	聂莉莉, 邓春贵, 何建龙, 等. 重力管饲喂养联合口腔运动对早产儿喂养不耐受的影响[J]. 中华全科医学, 2017, 15(11): 1922-1924, 1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.030 NIE L L, DENG C G, HE J L, et al. The effect of combined treatment with gravitational tube feeding and oral motor in treatment of feeding intolerance in preterm[J]. Chinese Journal of General Practice, 2017, 15(11): 1922-1924, 1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.030
[2]	吕天婵, 张玉侠, 胡晓静, 等. 早期口腔运动干预方案改善早产儿经口喂养的效果评价[J]. 中华护理杂志, 2013, 48(2): 101-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201302005.htm LYU T C, ZHANG Y X, HU X J, et al. The effect of early oral stimulation program on oral feeding of preterm infants[J]. Chinese Journal of Nursing, 2013, 48(2): 101-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201302005.htm
[3]	RUSCELLO D M, VALLINO L D. The use of nonspeech oral motor exercises in the treatment of children with cleft palate: A re-examination of available evidence[J]. Am J Speech Lang Pathol, 2020, 29(4): 1811-1820. doi: 10.1044/2020_AJSLP-20-00087
[4]	孟凡喆, 汪军. 早产儿口腔运动干预研究进展[J]. 中国儿童保健杂志, 2020, 28(7): 766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202007015.htm MENG F Z, WANG J. Research progress on oral motor intervention in premature infant[J]. Chinese Journal of Child Health Care, 2020, 28(7): 766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202007015.htm
[5]	李海燕, 张士发. 新生儿喂养及喂养问题的处理[J]. 中华全科医学, 2018, 16(9): 1414-1415. http://www.zhqkyx.net/article/id/1ac3074c-d894-4f69-b15b-96b99ff50982 LI H Y, ZHANG S F. Feeding of Newborn and Treatment of Feeding Problems[J]. Chinese Journal of General Practice, 2018, 16(9): 1414-1415. http://www.zhqkyx.net/article/id/1ac3074c-d894-4f69-b15b-96b99ff50982
[6]	吴静, 谢云朋, 俞君, 等. 喂养困难早产儿口腔运动干预次数的影响因素研究[J]. 中国妇幼保健, 2020, 35(18): 3407-3409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202018028.htm WU J, XIE Y P, YU J, et al. Study on the influencing factors of oral motor intervention frequency in preterm infants with feeding difficulties[J]. Maternal & Child Health Care of China, 2020, 35(18): 3407-3409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202018028.htm
[7]	高莉莉, 周雪姣, 李佳, 等. 应用初乳进行口腔按摩对早产儿经口喂养状况的影响[J]. 上海护理, 2019, 19(6): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL201906016.htm GAO L L, ZHOU X J, LI J, et al. Effect of oral massage with colostrum on oral feeding of premature infants[J]. Shanghai Nursing, 2019, 19(6): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL201906016.htm
[8]	杜钦霞, 骆丽华, 刘冬云, 等. 综合喂养干预对早产儿喂养不耐受的临床治疗效果观察[J]. 中华临床营养杂志, 2019, 27(5): 304-305, 308. DU Q X, LUO L H, LIU D Y, et al. Effect of comprehensive feeding intervention on feeding intolerance of premature infants[J]. Chinese Journal of Clinical Nutrition, 2019, 27(5): 304-305, 308
[9]	朱晓芸, 何敏斯, 陆春梅, 等. 口腔运动干预对喂养困难早产儿进食能力的改善及影响因素研究[J]. 中国儿童保健杂志, 2019, 27(2): 142-145. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201902009.htm ZHU X Y, HE M S, LU C M, et al. Effects of oral motor intervention on the feeding performance of preterm infants with oral feeding disorder and the analysis of high risk factors influencing the number of interventions[J]. Chinese Journal of Child Health Care, 2019, 27(2): 142-145. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201902009.htm
[10]	FUCILE S, MILUTINOV M, TIMMONS K, et al. Oral sensorimotor intervention enhances breastfeeding establishment in preterm infants[J]. Breastfeed Med, 2018, 13(7): 473-478.
[11]	ZIEGLER A, MARON J L, BARLOW S M, et al. Effect of pacifier design on nonnutritive suck maturation and weight gain in preterm infants: A pilot study[J]. Curr Ther Res Clin Exp, 2020, 93(11): 100617. DOI: 10.1016/j.curtheres.2020.100617.
[12]	KANG J H, SON H, BYUN S Y, et al. Effect of direct breastfeeding program for premature infants in neonatal intensive care unit[J]. J Korean Acad Nurs, 2021, 51(1): 119-132.
[13]	NATALUCCI G, LATAL B, KOLLER B, et al. Neurodevelopmental outcomes at age 5 years after prophylactic early high-dose recombinant human erythropoietin for neuroprotection in very preterm infants[J]. JAMA, 2020, 324(22): 2324-2327.
[14]	MAYERL C J, EDMONDS C E, CATCHPOLE E A, et al. Sucking versus swallowing coordination, integration, and performance in preterm and term infants[J]. J Appl Physiol, 2020, 129(6): 1383-1392.
[15]	吴平, 范巧玲, 陈芳, 等. 口腔按摩促进早产儿经口喂养的研究进展[J]. 解放军护理杂志, 2018, 35(21): 42-44. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201821014.htm WU P, FAN Q L, CHEN F, et al. Effect of Oral Massage on Oral Feeding in Premature Infants[J]. Nursing Journal of Chinese People's Liberation Army, 2018, 35(21): 42-44. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201821014.htm
[16]	THKKAR P A, ROHITOHI H R, RANJANDAS R, et al. Effect of oral stimulation on feeding performance and weight gain in preterm neonates: A randomised controlled trial[J]. Paediatr Int Child Health, 2018, 38(3): 181-186.
[17]	TAFFONI F, FOCAROLI V, VISCO A M, et al. New methods and tools to assess nutritive sucking in new-borns: Effect of different feeding bottles on nutritive performance[J]. J Biol Regul Homeost Agents, 2020, 34(3): 137-146.
[18]	孙静, 李东雅. 早产儿口腔运动干预的研究进展[J]. 现代临床护理, 2020(3): 76-81. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202003015.htm SUN J, LI D Y. Preterm oral motor intervention: a literature review[J]. Modern Clinical Nursing, 2020(3): 76-81. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202003015.htm
[19]	WOLTHUIS M I, DA COSTA S P, BOS A F, et al. Sucking behaviour in infants born preterm and developmental outcomes at primary school age[J]. Dev Med Child Neurol, 2017, 59(8): 871-877.
[20]	王燕, 崔慧敏, 李胜玲, 等. 综合口腔运动干预对早产儿喂养表现及临床结局的影响[J]. 中华护理杂志, 2019, 54(3): 363-368. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201903009.htm WANG Y, CUI H M, LI S L, et al. The effect of Integrated Oral Motor Interventions on clinical outcomes in premature infants[J]. Chinese Journal of Nursin, 2019, 54(3): 363-368. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201903009.htm