目的 分析早期口腔运动干预措施在新生儿重症监护室(NICU)早产儿预后改善的临床意义,为早产儿管理提供科学依据。方法 选取2015年1月-2017年1月在聊城市人民医院NICU住院治疗的151例早产儿为研究对象,分为干预组和对照组,生命体征稳定后两组均接受早产儿常规治疗,干预组在常规治疗的基础上接受Sandra Fucile所采用的口腔按摩方法,1次/d,连续14 d;采用中文版早产儿准备经口喂养评估量表(PIOFRA Scale-CV)对早产儿的经口喂养能力进行评价,比较两组经口喂养表现、喂养进程和喂养结局,以及神经行为测定评分,分别于生后3、6月龄时采用婴儿神经系统国际测验量表(Infanib)进行早期运动发育评估。结果 到达完全胃肠道喂养时,干预组的矫正胎龄(PMA)明显小于对照组,差异有统计学意义(t=3.01,P=0.04);干预组开始经口喂养时的喂养效率明显高于对照组,差异有统计学意义(t=2.30,P=0.03),干预组完全经口喂养时体重明显低于对照组,差异有统计学意义(t=3.45,P=0.01);干预开始第10、14天干预组PIOFRA Scale-CV评分显著高于对照组(F=5.658,P=0.02),不同时间和分组之间存在交互效应(F=12.60,P<0.001)。干预组除干预开始后第14天的评分和第10天间评分差异无统计学意义外,各时间段评分差异有统计学意义(P<0.001)。两组患儿3月龄时接受 Infanib评估,干预组评估结果为正常的比例明显高于对照组(χ²=4.00,P=0.03)。6月龄时接受 Infanib评估,干预组评估结果为异常的比例明显低于对照组,结果为正常的比例明显高于常规组(χ²=10.52,12.10,P<0.01)。结论 早产儿经口喂养是一个系统、复杂的过程,监护病房内早期口腔运动干预方案能够缩短早产儿从管饲喂养到完全经口喂养的过渡时间,改善早产儿喂养时的表现。

Objective To analyze the efficacy of early premature infant oral motor intervention (PIOMI) on the prognosis of premature infants in neonatal intensive care unit (NICU), in order to provide evidence for the management of premature infants. Methods A total of 151 preterm infants in NICU of Liaocheng People′s Hospital were enrolled in this study, and were divided into intervention group and control group from January 2015 to January 2017.Both groups received routine treatment of preterm infants after stable vital signs, and the intervention group was given oral massage method adopted by Sandra Fucile additionally,with 1 time per day for 14 consecutive days.Chinese Version of Peterm Infant Oral Feeding Readiness Assessment Scale(PIOFRA scale-CV) was used to evaluate the preterm infant′s oral feeding ability, including the oral feeding performance, feeding process and feeding outcome, and Neonatal Behavioral Neurological Assessment(NBNA) results.Infant Neurological International Battery(Infanib) was used for early motor development evaluation at 3 and 6 months after birth respectively. Results The postmenstrual age of the intervention group was significantly smaller than the control group till the completely gastrointestinal feeding(t=3.01,P=0.04).The feeding efficiency of the intervention group was significantly higher than that in the control group (t=2.30,P=0.03).The weight of the intervention group reaching completely gastrointestinal feeding was significantly lower than that in the control group (t=3.45,P=0.01).The score of PIOFRA Scale-CV in intervention group was significantly higher than that in control group (F=5.658, P=0.02), and there were interaction effects between different time and groups (F=12.60, P<0.001).Infanib was used to evaluate early motor development at 3 months of age in both groups, and the proportion of normal results in intervention group was significantly higher than that of control group(χ²=4.00,P=0.03).At 6 months of age, the proportion of abnormal results in intervention group was significantly lower than that in the control group, and the proportion of normal results was significantly higher than that in the control group (χ²=10.52,12.10,P<0.01). Conclusions Oral feeding in preterm infants is a systematical and complex process.Early oral exercise intervention scheme can shorten the transition time from tube feeding to complete oral feeding, and can improve the performance of feeding in premature infants.