物理治療對新生兒加護病房中早產兒的早期介入治療－台北榮民總醫院早期介入治療之病例報告

Physical Therapy Early Intervention Program for Prematurely Born Infants in Neonatal Intensive Care Unit-Case Report of the Early Intervention Program in Veteran General Hospital, Taipei

白偉男(Woei-Nan Bair) ； 凌汶(Wen Ling) ； 楊翠芬(Tsui-Fen Yang) ； 徐道昌(Tao-Chang Hsu)

《中華民國物理治療學會雜誌》 16卷1期 (1991/03) Pp. 80-89

https://doi.org/10.29616/JPTAROC.199103.0010

摘要

近二十年來，早產兒照護之進步使其死亡率和罹病率都有明顯之下降。目前早產兒死亡的主要原因是呼吸衰竭。而口腔動作和感覺動作協調不良也是常見的問題。
物理治療師儘早在新生兒加護病房中介入治療的目的，便是在協助上述問題之處理。早期介入治療的項目包含有胸腔物理治療，口腔動作和感覺動作之刺激。當早產兒轉至新生兒病房後，上述之治療計劃仍繼續進行。出院前則必須對父母作詳細之衛教。
胸腔物理治療的項目有：擺位、姿位引流、拍擊振動手法和呼吸運動，其目的是緩解胸腔症狀，協助減少呼吸器協助而至獨立呼吸之過程，以及拔管前彼之處理。
口腔動作之檢查包含了影響其控制能力的一些機制。如果有進食問題時，將教箏護士及家長，以正確的抱持姿勢，口腔週圍或內部之刺激手法，來改善餵食問題。
感覺動作之刺激包含了穩定的觸覺刺激，有規律的搖動，正確的擺位等，以增加情緒行為的控制能力，進而加速感覺動作之發展。
筆者將介紹如何組成早期介入治療計劃的團隊，建立治療計劃之步驟，選取病患之標準，初次治療的時機，治療的禁忌症和應特別注意的情況。詳細的治療手法，則在一位有呼吸窘迫症候群的早產兒病例中討論。
最後，筆者提供讀者一些實際的建議，以利早期介入治療計劃的實施。

關鍵字

早期介入治療計劃 ； 早產兒 ； 加護病房

並列摘要

The mortality and morbidity of the prematurely born infants have been significantly reduced within the past two decades due to the improvement of neonatal care. Presently, the leading mortality cause of prematurlely born infants is respiratory failure. Oral-motor, Sensory-motor dysfunctions are common problems in the prematurely born population.
The physical therapy intervention in the neonatoal intensive care unit intended to manage these dysfunctions as early as possible. The early intervention program includes chest physical therapy program, oral-motor stimulation and sensory-motor stimulation. The program should be continued after the prematurely born infant is transferred to new-born room (NBR). Later, a detailed discharge plan should be given to parents.
Chest physical therapy program incoporates positioning, postural drainage, percusion, vibration and breathing exercises. The program is aimed to relieve acute pulmonary symptoms, and to assist weaning process, preextubation, postextubation management.
Oral-motor evaluation should examine the underlying mechanism of sound oral-motor control. If difficulties present in oral-motor function, proper carrying posture for feeding, perioral, intraoral stimulation techniques are taught.
Sensory-motor program includes deep and firm tactile stimulation, rhythmical rocking, proper positioning to promote state control behavior and to accelerate sensory-motor development.
Discharge plan includes semierect positon to reduce respiratory distress. Flexed carrying posture and head position to provide proper feeding position and to reduce overactive extensor tone. Tactile, proprioceptive and vestibular stimulations are provided to facilitate sensory-motor development.
The organization of the early intervention team, procedures to set up this program, criteria for referral, timing to initiate treatment, contraindications and precautions for intervention are presented. Detailed treatment techniques are presented regarding a prematurely born infant with respiratory distress syndrome.
Finally, some practical suggestions are provided for the readers to set up an early intervention program.

並列關鍵字

early intervention program ； prematurely born infants ； intensive care unit