极低出生体重儿腹部按摩联合肛门刺激通便法的临床观察

Effectiveness of ventral massage combined with anal stimulation defecation in very low birth weight infants

目的:探讨腹部按摩联合肛门刺激通便法在极低出生体重儿(VLBWI)中的应用。方法:将新生儿重症监护病房收住的极低出生体重儿65例,随机分为观察组32例和对照组33例,两组新生儿在同等喂养方式和肠道外营养下,观察组新生儿予生后24 h内腹部按摩联合肛门刺激通便,1次/d至出院;对照组新生儿靠自身肠蠕动排便,若出现严重腹胀或≥48 h未排便给予开塞露回流灌肠通便,比较并分析两组新生儿主要观察指标。结果:与对照组新生儿比较,观察组胎粪排净时间短、开始喂养的时间早、光疗时间短、恢复出生体重时间早、达到完全胃肠内喂养时间早、平均住院时间短、喂养不耐受比例少、肠粘膜损伤比例少(P <0. 05)。结论:腹部按摩联合肛门刺激通便法能促进VLBWI胃肠道成熟,喂养耐受性好,减少灌肠,奶量顺利增加,缩短平均住院时间,且操作简单、相对安全。

Objective： To investigate the effectiveness of ventral massage combined with anal stimulation defecation in VLBWI（ Very Low Birth Weight Infant）. Methods： 65 VLBWI in neonatal intensive care unit（ NICU） were randomly divided into two groups,the observation group（ n= 32） and the control group（ n = 33）. On the same feeding condition and parenteral alimentation,the observation group was given ventral massage combined with anal stimulation defecation within 24 hours after birth,1 time/d till discharge. And the control group’s defecation relayed on their own intestinal peristalsis,but when severe abdominal distention or 48-hour no defecation happens,they were given Enema Glycerini reflux enema catharsis. The main observation indexes of the two groups were compared and analyzed. Results： Compared with the control group,the observation group took less time to empty meconium,less time to start feeding,less time to have phototherapy,less time to recover to the birth weight,less time to achieve full enteral feeding,less hospital stays in average,less feeding intolerance rate,and less intestinal mucosa damage rate（ P 〈0. 05）. Conclusion： Ventral massage combined with anal stimulation defecation can improve VLBWI’s gastrointestinal tract and feeding tolerance,reduce clysis,with milk feeding increasing smoothly,and shorten the hospital stays,which can be manipulated easily and safely.