口腔刺激和非营养性吸吮对早产儿经口喂养表现的干预效果

Effect of Non-nutritive Sucking and Oral Stimulation on Oral Feeding Performance in Preterm Infants

目的：探讨口腔刺激和非营养性吸吮单独使用和联合使用对早产儿经口喂养表现的影响。方法按照简单随机化分组的方法，将122例早产儿随机分为4组，其中非营养性吸吮组28例，在管饲喂养期间，喂养前、喂养后各给予安慰奶嘴吸吮5 min，7~8次/d；口腔刺激组29例，在管饲喂养前15 min进行12 min 的口腔刺激，1次/d；非营养性吸吮和口腔刺激联合使用组33例,在管饲喂养之前15 min进行12 min 的口腔刺激和3 min的非营养性吸吮，1次/d；对照组32例，接受新生儿重症监护室喂养护理常规。记录4组早产儿从开始经口喂养过渡到完全经口喂养所需要的时间，并对4组早产儿的喂养表现进行测定。结果非营养性吸吮组、口腔刺激组和两者联合使用组从管饲喂养过渡到完全经口喂养所需要的过渡时间差异无统计学意义（P＆gt;0.05），但均小于对照组，差异具有统计学意义（P＜0.05）；开始经口喂养时，非营养性吸吮组、口腔刺激组和两者联合使用组之间喂养效率差异无统计学意义（P＞0.05），但均高于对照组（P＜0.05）；达到完全经口喂养时，两者联合使用组早产儿喂养效率高于对照组（P＜0.05），其他3组差异无统计学意义（P＞0.05）；开始经口喂养时，两者联合使用组的喂养成效和摄入奶量比高于对照组，差具有统计学意义（P＜0.05），其他3组差异无统计学意义（P＞0.05）；达到完全经口喂养时，4组早产儿的喂养成效和摄入奶量比差异均无统计学意义（P＞0.05）。结论口腔运动干预能够缩短早产儿从开始经口喂养过渡到完全经口喂养所需要的时间，能够增加喂养效率，非营养性吸吮和口腔刺激联合使用有助于喂养成效和摄入奶量比的提高。

Objective To evaluate the effectiveness of non-nutritive sucking （NNS） and oral stimulation （OS）, either applied alone or in combination, on the improvement of oral feeding performances in preterm infants and provide suggestion for clinical nursing in facilitating the oral feeding. Methods Preterm infants （n=122） born between 29 and 34 weeks gestational age were randomly assigned to one of three intervention groups （NNS n=28;OS n=29;NNS＋OS n=33） or a control group （n=32）. The NNS group received non-nutritive sucking by a pacifier, the OS group received stroking of the oral structure, and the combined group received both. The control group received standard care without oral motor interventions. The time from introduction of nipple feeding to independent oral feeding and oral feeding performances were recorded. Results Transition time was significantly reduced in three intervention groups compared with that in control group （P＆lt;0.05）. The milk transfer rate in three intervention groups was significantly greater than that in control group （P＆lt;0.05） and proficiency and volume transfer in the NNS group and OS group were better and greater than those in control group at the stage when the infants initiated oral feeding （P＆lt;0.05）. Conclusion Non-nutritive sucking and oral stimulation reduced the transition time from introduction to independent oral feeding and the combined intervention has an additive beneficial effect on proficiency and volume transfer and oral motor intervention is beneficial to the oral feeding in preterm infants .