小儿推拿应用于早产儿胃肠外营养相关性胆汁淤积的临床研究

Application of Infantile Massage in Clinical Study of Parenteral Nutrition Associated Cholestasis in Premature Infants

目的:研究小儿推拿应用于早产儿胃肠外营养相关性胆汁淤积(parenteral nutrition associated cholestasis,PNAC)的临床疗效。方法:研究分为预防和治疗两部分,预防部分为接受胃肠外营养(PN)的早产儿,治疗部分为确诊PNAC的早产儿。选取2018年1-12月广东省妇幼保健院NICU收治的早产儿120例,其中预防部分60例,随机分为预防对照组(30例,常规治疗)和预防推拿组(30例,常规治疗+小儿推拿治疗)。治疗部分60例,随机分为治疗对照组(30例,常规治疗)及治疗推拿组(30例,常规治疗+小儿推拿治疗)。对比预防部分两组患儿的黄疸消退时间、喂养情况、PN持续时间、出院时体重、住院时间、日平均体重增长、PNAC发生率。对比治疗部分两组患儿的PN持续时间、出院时体重、住院时间、日平均体重增长及血液生化指标。结果:治疗后,预防推拿组的黄疸消退时间、喂养不耐受发生率、达到全量喂养时间、PN持续时间、开始喂养日龄、住院时间、出院时体重均优于预防对照组,差异均有统计学意义(P<0.05);预防推拿组PNAC发病率低于预防对照组,差异有统计学意义(P<0.05)。治疗推拿组的PN持续时间、出院时体重、住院时间、日平均体重增长均优于治疗对照组,差异均有统计学意义(P<0.05)。治疗后,治疗推拿组的血液生化指标均明显优于治疗对照组,差异均有统计学意义(P<0.05)。结论:小儿推拿可改善早产儿发生PNAC症状,缩短胃肠外营养的时间,对于促进早产儿的生长发育、加快胃肠道功能的建立具有重要意义。

Objective:To study the clinical efficacy of infantile massage in infants with parenteral nutrition associated cholestasis.Method:The study was divided into prevention and treatment for premature infants receiving parenteral nutrition(PN)and treatment for parenteral nutrition associated cholestasis(PNAC).120 premature infants admitted to the NICU of Guangdong Maternal and Child Health Hospital from January 2018 to December 2018 were selected,among them,60 cases were randomly divided into the prevention control group(30 cases,routine treatment)and the prevention massage group(30 cases,routine treatment+infantile massage treatment).60 cases were randomly divided into the treatment control group(30 cases,routine treatment+infantile massage treatment)and the treatment massage group(30 cases,routine treatment+infantile massage treatment).The prevention time of jaundice,feeding status,PN duration,weight at discharge,length of hospitalization,daily average weight gain and incidence of PNAC in the prevention part of the two groups of children were compared.The PN duration,weight at discharge,length of hospital stay,average daily weight gain,and blood biochemical indicators were compared between the two groups in the treatment group.Result:After treatment,the jaundice subsided time,the incidence of feeding intolerance,the time to reach full feeding,the duration of PN,the age at the beginning of feeding,the length of hospitalization,and the weight at discharge from the preventive massage group were better than those in preventive control group,the differences were statistically significant(P<0.05).The incidence of PNAC in the preventive massage group was lower than that in the preventive control group,the difference was statistically significant(P<0.05).The PN duration,weight at discharge,length of hospital stay,and average daily weight gain in the treatment massage group were better than those in the treatment control group,the differences were statistically significant(P<0.05).After treatment,the blood biochemical parameters of the treatment massage group were significantly better than those of the treatment control group,the differences were statistically significant(P<0.05).Conclusion:Pediatric massage can improve the symptoms of PNAC in preterm infants,shorten the time of parenteral nutrition,and has important significance for promoting the growth and development of preterm infants and accelerating the establishment of gastrointestinal function.