调整体位角度护理对极低出生体重儿胃食管反流和胃排空的影响

The Effect of Adjusting Body Position Angle Nursing on Gastroesophageal Reflux and Gastric Emptying in Extremely Low Birth Weight Infants

目的探讨不同体位角度下极低出生体重儿(VLBWI)的胃食管反流与胃排空情况,为规避VLBWI吸入风险提供参考。方法以2022年9月至2023年9月我院收治的120例VLBWI为研究对象,用随机数字表法分为3组,予以不同喂养体位护理方案。试验组40例,近似坐位(90°)喂养,喂养后近似坐位30 min+头高足低60°30 min+头高足低30°保持。对照1组40例,头高足低60°喂养,喂养后头高足低60°30 min+头高足低30°保持。对照2组40例,头高足低30°喂养,喂养后头高足低30°保持。喂养期间,统计3组溢乳/呕吐与呼吸暂停的发生例次,计算3组呼吸暂停与气管内呛咳的发生率,评价胃食管反流情况。统计3组胃残留、减量喂养与停喂的发生例次,评价胃排空情况。结果试验组溢乳/呕吐发生例次少于对照1组,溢乳/呕吐与呼吸暂停发生例次少于对照2组,呼吸暂停和气管内呛咳发生率低于对照2组(P<0.05)。试验组胃残留、减量喂养与停喂发生例次少于对照1组和对照2组,对照1组胃残留、减量喂养与停喂发生例次少于对照2组(P<0.05)。结论采用近似坐位喂养VLBWI,喂养后保持近似坐位30 min,再调至头高足低位60°保持30 min,最后降至头高足低30°并保持的体位护理方案,可以加快VLBWI胃排空,减少胃食管反流。

Objective To explore the gastroesophageal reflux and gastric emptying in extremely low birth weight infants(VLBWI)at different body positions and angles,and provide reference for avoiding the risk of VLBWI inhalation.Methods A total of 120 VLBWI patients admitted to our hospital from September 2022 to September 2023 were divided into 3 groups by random number table method and given different nursing schemes.In the experimental group,40 cases were fed in approximately sitting position(90°),and maintained in approximately sitting position for 30 min+head height and foot height for 60°30 min+head height and foot height for 30°after feeding.Control group 1(40 cases)was fed with head height and foot height at 60°,and maintained with head height and foot height at 60°30 min+head height and foot height at 30°after feeding.Forty cases in control group 2 were fed at 30°lower head height and foot height,and maintained at 30°lower head height and foot height after feeding.During feeding,the cases of galactorrhea/vomiting and apnea in 3 groups were counted,the incidence of apnea and tracheal cough in 3 groups were calculated,and the gastroesophageal reflux was evaluated.The cases of gastric residual,reduced feeding and stop feeding in 3 groups were counted to evaluate the gastric emptance.Results The number of cases of galactorrhea/vomiting in experimental group was less than that in control group 1,the number of cases of galactorrhea/vomiting and apnea was less than that in control group 2,and the incidence of apnea and intraduct cough was lower than that in control group 2(P<0.05).The cases of gastric residual,reduced feeding and stop feeding in experimental group were less than those in control group 1 and control group 2,and the cases of gastric residual,reduced feeding and stop feeding in control group 1 were less than those in control group 2(P<0.05).Conclusions The nursing plan of feeding VLBWI in an approximate sitting position,maintaining an approximate sitting position for 30 min after feeding,then adjusting to a head high and foot low position of 60°for 30 min,and finally lowering to a head high and foot low position of 30°and maintaining it can accelerate gastric emptying and reduce gastroesophageal reflux during VLBWI.