探討非營養性吸吮與口腔按摩措施合併介入對早產兒全口餵食之影響-以南部某醫學中心為例

To investigate the effect of combined intervention of non-nutritive sucking and oral massage measures on full mouth feeding in premature infants-a case study of a southern medical center

黃美惠(Mei-Hui Huang)

指導教授 ： 陳芬如

義守大學/醫學院/醫務管理學系/碩士(2022年)

摘要

研究背景：早產兒因為過早出生來到世界，器官尚未發育成熟，除了受死亡的威脅外，隨之而來的各項急慢性問題常會影響他們未來的生長與正常發育，醫療逐漸進步存活率不在是探討重點，如何維持神經學功能正常發展，已經逐漸替代存活率的探討。
研究目的：探討非營養性吸吮與口腔按摩措施合併介入對早產兒全口餵食之影響。
研究方法：本研究以南部某醫學中心新生兒加護病房出生32週以下早產兒為研究對象，排除條件包括先天性心臟病、腦室出血3度以上、壞死性腸炎、唇顎裂、放置氣管內管或使用鼻式正壓呼吸輔助器氧氣濃度40%以上等。研究過程主要以病歷資料回溯性分析進行，資料內容包括收案者基本資料(例如出生週數、出生體重、及口腔餵食/胃管留置天數、住加護病房天數等)，矯正年齡滿29週以口腔餵食準備評估量表（POFRAS；Preterm Infant Oral Feeding Readiness Assessment Scale）進行口腔餵食訓練評估，評估30分以上介入口腔按摩措施。對照組為提供非營養性吸吮之一般護理常規餵食照護，介入組同時提供非營養性吸吮及每日一次5分鐘口腔按摩措施，餵食訓練持續至全口餵食拔除胃管，使用IBM SPSS第22版進行統計分析。人口學差異採用卡方檢定，餵食訓練成效以獨立樣本 t 檢定、相關迴歸及存活分析進行。
結果：研究結果顯示非營養性吸吮與口腔按摩合併介入大部分有顯著影響餵食訓練成效，提早第一口餵食週數（P=0.033）、盡早達成全口餵食週數（P=0.028），全口餵食體重穩定成長（P=0.030），減少胃管留置天數（P=0.037），縮短2.79天住加護病房（P=0.379），口腔按摩措施降低口腔過度敏感，提升口腔進食吸吮能力，盡早達到全口餵食，脫離胃管留置，縮短住加護病房天數。
結論：本研究指出，早產兒非營養性吸吮與口腔按摩合併介入餵食照護訓練呈現高度相關性。有效改善早產兒的餵養表現增加體重，建議新生兒重症加護病房將早產兒口腔運動措施（PIOMI；premature infant oral motor intervention）作為日常早產新生兒照護的一部分，同時列入人員培訓計劃，改善早產兒的餵養進食能力。

關鍵字

早產兒 ； 口腔按摩 ； 非營養性吸吮 ； 口腔餵食準備評估量表

並列摘要

Background: The organs of premature infants are not yet mature for premature birth. In addition to the threat of death, the accompanying acute and chronic problems often affect their future growth and normal development. Medical treatment has gradually improved their survival rate. However, how to maintain the normal development of neurological function has gradually replaced the discussion of their survival rate.
Objective: To investigate the effect of combined intervention of non-nutritive sucking and oral massage measures on full mouth feeding in premature infants.
Methods: This study enrolled premature infants born under 32 weeks in the neonatal intensive care unit of a medical center in southern Taiwan. Exclusion criteria included congenital heart disease, ventricular hemorrhage of grade 3 or higher, necrotizing enteritis, cleft lip and palate, endotracheal tube placement, or under nasal positive pressure breathing aids with an oxygen concentration of more than 40%. The research analyzed medical records retrospectively for the basic information (such as birth weeks, birth weight, and duration of oral feeding/gastric tube placement, days in intensive care units, etc.). Oral Feeding Readiness Assessment Scale (POFRAS; Preterm Infant Oral Feeding Readiness Assessment Scale) was used to evaluate oral feeding training when their corrected age is over 29 weeks and to evaluate interventional oral massage measures if the score was 30 or more. The control group was provided with non-nutritive sucking and routine feeding care. The intervention group was provided with non-nutritive sucking and oral massage for 5 minutes once a day. Their feeding training was continuing and the gastric tube was removed until full mouth feeding. IBM SPSS version 22 was used for statistical analysis. Demographic differences were measured using chi-square tests. Feeding training effects were evaluated using independent-samples t-tests, correlation regression, and survival analyses.
Results: The study showed that the combined intervention of non-nutritive sucking and oral massage had a significant impact on the effectiveness of feeding training. The number of weeks for the first mouth feeding is reduced (P=0.033), the number of weeks for reaching the full mouth feeding is reduced (P=0.028), oral feeding increased the body weight steadily (P=0.030), the number of days of gastric tube placement is reduced (P=0.037), the days in intensive care unit is shortened by 2.79 days (P=0.379). Oral massage measures reduced oral hypersensitivity, improved oral feeding and sucking ability, achieved full mouth feeding to remove the gastric tube earlier, and shortened the number of days in intensive care unit.
Conclusions: This study indicates that non-nutritive sucking and oral massage combined with interventional feeding and care training in preterm infants are highly correlated to improve the feeding performance of premature infants effectively and increase their weight. We recommended that premature infant oral motor intervention (PIOMI; premature infant oral motor intervention) and personnel training plan for improving the feeding ability should be included as part of the daily care of premature infants in the neonatal intensive care unit.

並列關鍵字

Preterm infants ； Oral massage ； Non-nutritive sucking ； Oral Feeding Readiness Assessment Scale (POFRAS)

參考文獻

中文文獻

王淯汶、張瑩如（2013）．早產兒需求性餵食之實證探討．榮總護理，30（4），417-424。https://doi.org/10.6142/VGHN.30.4.417

台灣早產兒基金會（2012）．早產兒醫療資訊： 認識早產．檢自http://www.pbf.org.tw/resources/health-education/diseases/what-is-preemie

林貞秀、張瑩如、林佳霓、黃美智（2012）．發展性照護於早產兒餵食之應用．護理雜誌，59（3），107-112。https://doi.org/10.6224/JN.59.3.107

張雅雯、張瑩如（2008）．早產兒口腔餵食與心肺功能調節之關係．護理雜誌，55（3），5-10。https://doi.org/10.6224/JN.55.3.5