母乳嗅觉刺激干预与极低出生体质量儿预后的相关性研究

Relationship between Olfactory Stimulation of Breast Milk and Prognosis of Very Low Birth Weight Infants

目的探讨母乳嗅觉刺激对极低出生体质量儿预后的影响,为极低出生体质量儿的临床管理提供依据。方法采用随机数字表法将73例极低出生体质量儿分为试验组36例和对照组37例,对照组予以早产儿规范护理,试验组在早产儿规范护理的基础上予以母乳嗅觉刺激,即将浸润母乳的纱布放置于距离极低出生体质量儿鼻孔2 cm处,每次喂奶前及足跟采血前均予以母乳嗅觉刺激。观察指标主要包括:经口喂养时日龄、完全肠内营养时日龄、坏死性小肠结肠炎发病率、呼吸暂停次数及呼吸暂停伴心动过缓次数、足跟采末梢血时心脏恢复至基线心率的时间、早产儿疼痛评分、宫外发育指标、常见并发症及住院总天数。结果试验组在开始经口喂养时间及达全肠营养时间好于对照组,P<0.05;两组坏死性小肠结肠炎发生例数的比较无意义,P>0.05;试验组在体质量增长及头尾增长上好于对照组,P<0.05;两组在恢复到出生体质量时比较中无统计学差异,P>0.05;试验组在呼吸暂停及疼痛相关项目比较均好于对照组,均P<0.05;两组在常见并发症及住院时间的比较中无统计学差异,均P>0.05。结论母乳嗅觉刺激可以降低经口喂养及肠内全营养的时间,有助于头围的增长,降低了呼吸暂停时心动过缓的次数,有利于胆红素的排泄,并有一定镇痛的效果。

Objective To explore the effect of olfactory stimulation of breast milk on the prognosis of very low birth weight infants,in order to provide basis for clinical management of very low birth weight infants.Methods Seventy-three very low birth weight infants in NICU were randomly divided into experimental group(n=36)and control group(n=37).The control group was given routine nursing care.The experimental group was given breast milk olfactory stimulation on the basis of routine nursing care.That is,the gauze soaked in breast milk was placed 2 cm away from the nostrils of very low birth weight infants.Breast milk olfactory stimulation was given before each feeding and before heel blood collection.The main outcome measures included:the days of oral feeding,the days of complete enteral nutrition,the incidence rate of necrotizing enterocolitis,the times of apnea and apnea with bradycardia,the time when the heart recovered to the baseline heart rate when collecting peripheral blood from the heel,the pain score of preterm infants,extrauterine development indicators,common complications of preterm infants and the total days in hospital.Results The experimental group had better time to start oral feeding and full enteral nutrition than the control group,P<0.05;The comparison of the number of cases of necrotizing enterocolitis between the two groups was meaningless,P>0.05;the experimental group was better than the control group in body weight growth and head and tail growth,P<0.05;there was no significant difference between the two groups when they recovered to birth body weight,P>0.05;the experimental group was better than the control group in apnea and pain-related items,both P<0.05;there was no significant difference in the comparison of common complications and length of hospital stay between the two groups,both P>0.05.Conclusion Olfactory stimulation of breast milk can reduce the time of oral feeding and total enteral nutrition,contribute to the growth of head circumference,reduce the frequency of bradycardia during apnea,facilitate the excretion of bilirubin,and have a certain analgesic effect.