穴位按压防治HIV母婴阻断新生儿喂养不耐受的疗效观察

Clinical study on the prevention and treatment of feeding intolerance in infants who were implemented prevention of mother-to-child transmission of HIV with pressing acupoints

目的观察穴位按压防治人类免疫缺陷病毒(HIV)母婴阻断新生儿喂养不耐受的临床效果。方法 2013年7月至2015年7月在广州市第八人民医院出生的HIV母婴阻断新生儿102例,随机分为观察组52例与对照组各50例。两组均出生后4h内即开始足月儿配方奶喂养,并于第一次吃奶同时开始给予奈韦拉平口服混悬液抗病毒阻断治疗,每次1.5mL,每日1次。根据新生儿的喂养耐受情况个体化调整奶量,期间常规监测血糖,如血糖偏低或经口喂养摄入能量不足者可联合静脉营养支持至经口喂养可满足其生长所需能量为止。观察组在对照组的基础上联合穴位按压。新生儿出生后24h且生命体征平稳,即可开始进行穴位按压,取穴:足三里、中脘、天枢、脾俞及胃俞,依次按压以上穴位(足三里及天枢为双侧同时按压),每个穴位按压时间先从每次1min开始,新生儿适应后,可逐渐延长至每次2min,每日2次。两组患儿在研究期间均不使用促胃肠动力药。观察喂养不耐受发生情况、每日奶量增加速度、完全经口喂养日龄及恢复出生体质量日龄。结果观察组奶量增加速度快于对照组,完全经口喂养日龄及恢复出生体质量日龄均早于对照组,差异均有统计学意义(P<0.05)。观察组呕吐、腹胀、胃潴留及奶量增加困难发生率均低于对照组,差异均有统计学意义(P<0.05)。结论穴位按压可有效防治HIV母婴阻断新生儿喂养不耐受的发生。

Objective To observe the clinical effect of pressing acupoints on feeding intolerance in in- fants who were implemented prevention of mother-to-child transmission of human immunodeficiency virus （HIV）. Methods A total of 102 cases of prevention of mother-to-child transmission of HIV in infants, who were treated in the Guangzhou Eighth People＇s Hospital from July 2013 to July 2015, were randomly divided into observation group（52 cases） and control group（50 cases）. The two groups began to be given formula feeding within 4 hours after birth, and were also given nevirapine suspension（1.5 mL/time, once a day）,for antiviral treatment to prevent mother-to-child transmission of HIV. The amount of formula milk would be adjusted individually according to the neonatal feeding tolerance. If the blood sugar was low or energy intake through mouth was insufficient, it was necessary to give intravenous nutrition treatment. Ine ooservauon group was added the treatment of pressing acupoints during the study period. If newborn babies in observa- tion group had stable vital signs, the treatment of pressing acupoints would begin 24 hours after birth. Acu- points selecting： Zusanli, Zhongwan, Tianshu, Pishu and Weishu. Press time of each acupoint started from 1 minute each time; when newborn babies were adaptive, it would be gradually extended to 2 minutes each time, 2 times a day. Two groups were not given gastrointestinal promoting medicine during the study peri- od. The observation indexes included the incidence of feeding intolerance, the speed to increase feeding quantity, the time for whole gastrointestinal feeding through mouth, and the time of returning to birth weight. Results Compared with the control group, the speed to increase feeding quantity was faster, the time for whole gastrointestinal feeding through mouth was shorter, the incidence of feeding intolerance was lower, and the time of returning to birth weight was shorter in the observation group, and these differences were statistically significant（P〈0.05）. The incidence rate of vomiting, abdominal distension, gastric reten- tion and difficulty in increase of milk volume was lower in the observation group than in the control group, and the difference was statistically significant（P〈0.05）. Conclusion Pressing acupoints is effective in the prevention and treatment of feeding intolerance in infants who were implemented prevention of mother-to- child transmission of HIV.