早期康复介入降低早产儿宫外生长发育迟缓的研究

Early rehabilitation intervention reduces the incidence of extrauterine growth retardation in preterm infants

目的探讨早期康复介入对早产儿宫外生长发育迟缓(EUGR)及早期疾病发生的影响。方法研究对象为生后24?h内入住新生儿重症监护室(NICU)、胎龄<34周、出生体重1?000?~?<2?000?g的适于胎龄早产儿。采用前瞻性、随机、对照研究法将研究对象分为康复干预组和对照组。康复干预组患儿在生命体征平稳后进行早期康复治疗,包括口部感觉及肌力训练和新生儿头部、胸部、腹部、四肢和手足的压力抚触。主要观察结果是两组早产儿达到独立经口喂养的时间、住院天数、EUGR发生率等。次要观察结果是两组早产儿疾病如呼吸暂停、喂养不耐受、败血症等发生情况。结果共有97例早产儿符合入组标准且资料完整。其中对照组48例,干预组49例。干预组达到独立经口喂养时间短于对照组(P<0.05)。干预组患儿的住院天数以及出院时纠正胎龄低于对照组(P<0.05)。干预组的EUGR发生率低于对照组(P<0.05)。干预组呼吸暂停、喂养不耐受和败血症的发生率低于对照组(P<0.05)。结论对NICU中的早产儿进行早期康复介入,可减少呼吸暂停和喂养不耐受的发生率,更早地完成独立经口喂养,降低EUGR的发生率。

Objective To investigate the effect of early rehabilitation intervention on the incidences of extrauterine growth retardation（EUGR） and early diseases in preterm infants. Methods The appropriate-for-gestational-age preterm infants with a gestational age of 34 weeks and a birth weight of 1 000 to 2 000 g who were admitted to the neonatal intensive care unit（NICU） within 24 hours after birth were enrolled in a prospective randomized controlled trial. These infants were randomly divided into rehabilitation intervention group and control group. The infants in the rehabilitation intervention group were given early rehabilitation after their vital signs became stable, including oral sensory and muscle strength training and pressure touching of the head, chest, abdomen, extremities, hands, and feet. The primary outcome measures were the time to independent oral feeding, length of hospital stay, and incidence rate of EUGR. The secondary outcome measures were the incidence rates of related diseases in preterm infants, such as apnea, feeding intolerance, and sepsis. Results A total of 97 preterm infants who met the inclusion criteria and had complete data were enrolled, with 48 in the control group and 49 in the rehabilitation intervention group. The rehabilitation intervention group had a shorter time to independent oral feeding than the control group（P〈0.05）. Compared with the control group, the rehabilitation intervention group had a shorter length of hospital stay and a lower corrected gestational age at discharge（P〈0.05）, as well as a lower incidence rate of EUGR（P〈0.05）. The rehabilitation intervention group had lower incidence rates of apnea, feeding intolerance, and sepsis than the control group（P〈0.05）. Conclusions Early rehabilitation intervention for preterm infants in the NICU may reduce the incidence rates of apnea, feeding intolerance, and EUGR and help them to achieve independent oral feeding early.