早產兒臥位對胃排空及胃餘量之影響

Effects of position on gastric emptying anf gastric residual volume in preterm infants

陳曉詩(Shiau-Shr Chen)

指導教授 ： 郭碧照

中山醫學大學/護理學院/護理研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00116

摘要

本研究目的在探討早產兒的臥位對胃排空及胃餘量的影響，採重複測量設計，選取中部某醫學中心早產兒共36名。收案標準為妊娠週數23-37週之早產兒且醫囑每3小時胃管灌食的早產兒，排除標準為有嚴重之先天異常、心臟畸形者及壞死性腸炎患者。參與研究之早產兒以亂數隨機分派方式，決定早產兒先採取仰臥（俯臥）姿勢下灌食，3小時後再採取俯臥（仰臥）姿勢下灌食，並且於灌食後每隔30分鐘測定胃餘量。當受試者在灌食量達20cc/kg/day開始進行測量，並且在灌食量每增加10cc/kg/day時進行重複測量直到灌食量達150cc/kg/day停止。研究結果為：早產兒在腸道營養建立初期(灌食量20-50cc/kg/day)採仰臥姿勢下灌食，較進食一段時間後(灌食量大於100cc/kg/day)測得較多的胃餘量；然而採俯臥姿勢灌食則無此關係。與仰臥比較，早產兒施予俯臥後灌食所測得的胃餘量較少、胃排空速度較快，俯臥姿勢下測得胃餘量之迴歸方程式為：Y(p) = 4.59 - 0.88 t + 0.003 t2，50%胃排空速率約為28分鐘；仰臥姿勢下測得胃餘量之迴歸方程式為：Y(s) = 85.02-0.41t，50%胃排空速率約為85分鐘。本研究結果可以運用於早產兒照護上，當早產兒在建立腸道營養的初期及病況需求時採取俯臥姿勢以促進胃排空速度，減少餵食不耐的情形發生。

關鍵字

早產兒 ； 擺位 ； 胃餘量 ； 胃排空

並列摘要

The purpose of this research is to investigate the effect of body position on gastric emptying and gastric residual volume in preterm infants. A crossover design in one medical center in Taichung was adopted. Infants were entered into the study if they fulfilled the following criteria: preterm delivery( gestational age between 23-37 week); receiving enteral feeds by tube feeding every 3 hour, except for a preterm infant who had congenital anomalies, congenital heart disease, and necrotizing enterocolitis disease. Thirty-six infants were randomly assigned into different position sequences, and each of them was putting in following position and stay in each position for 3 hours: neither supine to prone nor prone to supine. During each position period, gastric residual were valued every 30 minute. The experiment began with feeding volume more than 20cc/kg/day, repeated by feeding volume increasing every 10cc/kg/day, until feeding volume up to 150cc/kg/day. Results: In supine position, there is more gastric residual detected in the beginning of enternal feeding (feeding volume were 20-50cc/kg/day) than feeding volume up to 100cc/kg/day. In prone position, there is no relationship between feeding volume and gastric residual. During the same time span, the gastric residual in prone position is significant lesser than in supine position. The linear regression equation for predicting gastric residual in prone position was found to be Y(p) = 4.59 - 0.88 t + 0.003 t2 , and the 50% gastric empting rate was 28 minute. The linear regression equation for predicting gastric residual in supine position was found to be Y(s) = 85.02-0.41t, and the 50% gastric empting rate was 85 minute. The finding of this research might provide reference in caring preterm neonate in choosing and changing position. When the beginning of enteric feeding or the clinical condition needed, nurses can apply prone position for accelerating gastric emptying.

並列關鍵字

preterm infant ； positioning ； gastric residual ； gastric emptying

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