口腔刺激联合非营养吸吮改善早产儿喂养的Meta分析

Oral stimulation combined with non-nutritional sucking to improve feeding in preterm infants:a meta-analysis

目的系统评价口腔刺激联合非营养吸吮改善早产儿喂养的效果。方法计算机检索PubMed、Embase、Cochrane图书馆和中国生物医学文献数据库、中国知网、万方数据库,收集有关口腔刺激联合非营养吸吮应用于早产儿喂养的随机对照试验(randomized controlled trial,RCT),检索时间自建库至2020年12月14日,纳入研究对象为胎龄≥26周且<37周的早产儿,对照组进行常规护理或假治疗,干预组在常规护理基础上接受口腔刺激联合非营养吸吮干预,干预方案主要包括口腔运动干预和口腔感觉运动干预。提取研究资料并进行质量评价,应用RevMan 5.3软件对纳入的临床研究进行Meta分析。结果共纳入20项RCT,合计1316例早产儿(胎龄26~36周)。结果显示,干预组住院时间短于对照组(WMD=-3.45,95%CI-4.41~-2.50,P<0.001),出院时校正胎龄(WMD=-0.68,95%CI-1.10~-0.26,P=0.001)、全经口喂养时日龄(WMD=-5.22,95%CI-9.04~-1.40,P=0.007)、全经口喂养时校正胎龄(WMD=-1.02,95%CI-1.40~-0.64,P<0.001)和全经口喂养时体重(WMD=-59.75,95%CI-114.55~-4.95,P=0.030)小于对照组,差异有统计学意义。结论口腔刺激联合非营养吸吮可加速早产儿完全经口喂养的实现,缩短住院时间,应标准化该程序并推广,使其成为早产儿护理的常规和标准操作。

Objective To systematically evaluate the effects of oral stimulation combined with non-nutritional sucking on premature infants feeding.Methods From the establishment of the databases to December 14,2020,PubMed,Embase,Cochrane Library and SinoMed,CNKI,Wanfang databases were searched for randomized controlled trials(RCT)on oral stimulation combined with non-nutritive sucking in preterm infants.The gestational age(GA)of the infants was 26~37 w.The control group received routine nursing or sham treatment and the intervention group received oral stimulation and non-nutritional sucking on the basis of routine nursing.The intervention strategy included infant oral motor intervention and oral sensorimotor intervention.The literature were reviewed and the quality of RCTs evaluated.RevMan 5.3 software was used for meta-analysis.Results A total of 20 RCTs were included,including 1316 premature infants(GA 26~36 w).Compared with the control group,the intervention group had significantly shorter duration of hospital stay(WMD=-3.45,95%CI-4.41~-2.50,P<0.001).Significant differences existed in the corrected GA of discharge(WMD=-0.68,95%CI-1.10~-0.26,P=0.001),the age of total oral feeding(TOF)(WMD=-5.22,95%CI-9.04~-1.40,P=0.007),corrected GA of TOF(WMD=-1.02,95%CI-1.40~-0.64,P<0.001)and the body weight on TOF day(WMD=-59.75,95%CI-114.55~-4.95,P=0.030).Conclusions Oral stimulation combined with non-nutritive sucking can accelerate TOF and shorten hospital stay in premature infants.The procedure should be standardized and promoted as routine and standard care for premature infants.