基于本体感觉训练为主的综合干预法治疗早产儿功能性吞咽障碍的疗效观察

The short-term and long-term efficacy of proprioception training for pre-term infants with functional dysphagia

目的对早产儿功能性吞咽障碍的临床干预研究,观察其近期和远期疗效,拟探索并优化其康复方法。方法采取随机数字表法,将符合纳入条件的70例功能性吞咽障碍早产儿分为对照组和观察组,每组35例,但最终失访8例,有30例对照组和32例观察组完成全程研究。除一般早产儿诊疗常规外,对照组采取婴儿抚触及被动操训练等常规干预措施;观察组在对照组基础上,采用基于本体感觉训练为主的综合干预法进行康复训练。2组患儿均从入院病情平稳后开始干预至出生3月龄,每日2次,每次约20 min。于出生28 d时,对2组患儿的吞咽障碍临床表现及并发症进行近期疗效评估;并于患儿3月龄时,对2组患儿的体质量及发育商(DQ)进行远期疗效对比。结果2组患儿均干预至出生28 d时,经口喂养后口腔奶液残留(χ^2=9.255,P=0.002)和引起呛咳或口鼻返流(χ^2=4.623,P=0.032)的症状发生例数对比,差异有统计学意义(P<0.05);2组患儿吸入性肺炎(χ^2=2.619,P=0.106)和喂奶后呼吸困难(Fisher精确概率法,P=0.230)并发症的发生例数对比,差异无统计学意义(P>0.05),但发生并发症的总例数对比(χ^2=4.982),差异有统计学意义(P<0.05)。干预至3月龄时,2组患儿的体质量(t=2.192,P=0.029)和DQ值(t=2.104,P=0.036)组间比较,观察组明显优于对照组(P<0.05)。结论基于本体感觉训练为主的综合干预法治疗早产儿功能性吞咽障碍具有良好的临床疗效,可提高早产儿近远期的生活质量。

Objective To explore the short-term and long-term curative effects of proprioception training for pre-term infants with functional dysphagia. Methods Seventy premature infants with functional dysphagia were randomly divided into a control group and an observation group, each of 35. Thirty infants of the control group and 32 from the observation group completed the whole study. Both groups were given routine medication and interventions such as touching and passive exercise training. The observation group additionally received a comprehensive intervention based on proprioception training. The intervention lasted from the initial stabilization of their condition to the age of 3 months. They were trained twice a day, about 20 minutes each time. The clinical manifestations and complications of dysphagia were evaluated on the 28th day after their birth. At the age of 3 months, the average body mass and development quotient (DQ) were compared between the two groups. Results At the age of twenty-eight days there were significant differences between the two groups in the average number of cases of oral milk residue and coughing or oral-nasal reflux after feeding, as well as in the total number of infants with complications. However, no significant differences were found in the incidence of aspiration pneumonia or dyspnea after feeding. The average body mass and developmental quotient of the observation group were significantly better than those of the control group at the age of 3 months. Conclusion The comprehensive intervention based on proprioception training has a good clinical effect on functional dysphagia among premature infants. It can improve their life quality in both the near and longer term, and it is worth popularizing.