小兒推拿應用于早產兒胃腸外營養相關性膽汁淤積的臨床研究

李愷 向建文

【摘要】 目的：研究小兒推拿應用于早產兒胃腸外營養相關性膽汁淤積（parenteral nutrition associated cholestasis，PNAC）的臨床療效。方法：研究分為預防和治療兩部分，預防部分為接受胃腸外營養（PN）的早產兒，治療部分為確診PNAC的早產兒。選取2018年1-12月廣東省婦幼保健院NICU收治的早產兒120例，其中預防部分60例，隨機分為預防對照組（30例，常規治療）和預防推拿組（30例，常規治療+小兒推拿治療）。治療部分60例，隨機分為治療對照組（30例，常規治療）及治療推拿組（30例，常規治療+小兒推拿治療）。對比預防部分兩組患兒的黃疸消退時間、喂養情況、PN持續時間、出院時體重、住院時間、日平均體重增長、PNAC發生率。對比治療部分兩組患兒的PN持續時間、出院時體重、住院時間、日平均體重增長及血液生化指標。結果：治療后，預防推拿組的黃疸消退時間、喂養不耐受發生率、達到全量喂養時間、PN持續時間、開始喂養日齡、住院時間、出院時體重均優于預防對照組，差異均有統計學意義（P<0.05）;預防推拿組PNAC發病率低于預防對照組，差異有統計學意義（P<0.05）。治療推拿組的PN持續時間、出院時體重、住院時間、日平均體重增長均優于治療對照組，差異均有統計學意義（P<0.05）。治療后，治療推拿組的血液生化指標均明顯優于治療對照組，差異均有統計學意義（P<0.05）。結論：小兒推拿可改善早產兒發生PNAC癥狀，縮短胃腸外營養的時間，對于促進早產兒的生長發育、加快胃腸道功能的建立具有重要意義。

【關鍵詞】 早產兒 胃腸外營養相關性膽汁淤積 小兒推拿

[Abstract] Objective： To study the clinical efficacy of infantile massage in infants with parenteral nutrition associated cholestasis. Method： The study was divided into prevention and treatment for premature infants receiving parenteral nutrition （PN） and treatment for parenteral nutrition associated cholestasis （PNAC）. 120 premature infants admitted to the NICU of Guangdong Maternal and Child Health Hospital from January 2018 to December 2018 were selected， among them， 60 cases were randomly divided into the prevention control group （30 cases， routine treatment） and the prevention massage group （30 cases， routine treatment + infantile massage treatment）. 60 cases were randomly divided into the treatment control group （30 cases， routine treatment + infantile massage treatment） and the treatment massage group （30 cases， routine treatment + infantile massage treatment）. The prevention time of jaundice， feeding status， PN duration， weight at discharge， length of hospitalization， daily average weight gain and incidence of PNAC in the prevention part of the two groups of children were compared. The PN duration， weight at discharge， length of hospital stay， average daily weight gain， and blood biochemical indicators were compared between the two groups in the treatment group. Result： After treatment， the jaundice subsided time， the incidence of feeding intolerance， the time to reach full feeding， the duration of PN， the age at the beginning of feeding， the length of hospitalization， and the weight at discharge from the preventive massage group were better than those in preventive control group， the differences were statistically significant （P<0.05）. The incidence of PNAC in the preventive massage group was lower than that in the preventive control group， the difference was statistically significant （P<0.05）. The PN duration， weight at discharge， length of hospital stay， and average daily weight gain in the treatment massage group were better than those in the treatment control group， the differences were statistically significant （P<0.05）. After treatment， the blood biochemical parameters of the treatment massage group were significantly better than those of the treatment control group， the differences were statistically significant （P<0.05）. Conclusion： Pediatric massage can improve the symptoms of PNAC in preterm infants， shorten the time of parenteral nutrition， and has important significance for promoting the growth and development of preterm infants and accelerating the establishment of gastrointestinal function.[Key words] Premature infant Parenteral nutrition associated cholestasis Infantile massageFirst-authors address： Guangdong Maternal and Child Health Care Center， Guangzhou 510000， China

胃腸外營養是救治早產兒，特別是極低體重兒的主要措施，然而胃腸外營養相關性膽汁淤積（parenteral nutrition associated cholestasis，PNAC）是胃腸外營養常見的一種并發癥，其發病率可達7.4%～84.0%，且部分會發展為肝衰竭而死亡[1]。新生兒期膽汁淤積屬新生兒黃疸，其在傳統中醫學屬“胎黃”范疇，主要原因是感受濕熱，寒濕阻滯，瘀積發黃，病機為脾胃濕邪內蘊，肝失疏泄，膽汁外溢而致發黃。目前對早產兒PNAC的治療方法，主要包括熊去氧膽酸和腺苷蛋氨酸等藥物治療，新近的研究治療藥物包括苯基丁酸、非單純豆油類脂肪乳等，該類藥物治療，療程長，患者住院時間長，加重了患者的經濟負擔，患者認可度不高?！?br>