早产儿黄疸早期干预的研究

论文编号:HL213 论文字数:11226,页数:30

论文题目：早产儿黄疸早期干预的研究
摘　要
 研究背景：由于多种因素的影响，我国目前早产儿的出生率逐年增加。且随着围生医学的发展，新生儿监护治疗技术的提高，早产儿的存活率已明显提高。但如何提高早产儿的生存质量、减少后遗症的发生，是医务工作者面临的迫切任务。特别是对于如何减少早产儿黄疸引起的脑损伤，已成为医护人员研究的热点。
 研究目的：探讨按摩灌肠应用于早产儿黄疸的疗效，并分别与腹部按摩、普通灌肠、双面光疗及对照组进行比较，探讨分析预防早产儿黄疸的各种早期干预措施临床应用的优缺点。
 研究方法：将125例早产儿随机分为A、B、C、D、E组，五组均采用相同的营养方案及黄疸药物治疗。A、B、D组早产儿早期分别给予腹部按摩、普通灌肠和按摩灌肠，C组为双面光疗组，E组为对照组。当经皮黄疸(transcutaneous bilirubin，TCB)检测指数达到18.0(11mg/dl)时，A、B、D、E组早产儿常规采用单面光疗24h，C组给予双面光疗24h。C、E组不予按摩或灌肠。观察五组早产儿的黄疸、排便及喂养情况。采用方差分析和检验分析数据。
 研究结果：按摩灌肠组早产儿的黄疸持续天数和光疗天数较其它四组明显缩短 (P<0.05)。住院满两周的早产儿中，按摩灌肠组早产儿第12天、第14天TCB值明显低于腹部按摩组、普通灌肠组和对照组(P<0.05)，与双面光疗组组间差异无显著性(P>0.05)。按摩灌肠组病理性黄疸发生率明显低于对照组，两周内黄疸消退率明显高于对照组和腹部按摩组(P<0.005)。按摩灌肠组胎粪排尽时间较普通灌肠组、双面光疗组和对照组缩短(P<0.01)，前5天、前7天总便次及住院满2周早产儿2周内的总便次明显多于其它四组(P<0.05)。按摩灌肠组早产儿喂养不耐受发生率明显低于普通灌肠组和对照组(P<0.005)，便秘发生率显著低于其它四组(P<0.001)。
 结论：早产儿生后尽早实行按摩灌肠可促进胎粪较多较快排出，促进胆红素排泄，协助早产儿黄疸尽早消褪，缩短光疗时间，降低病理性黄疸发生率。按摩灌肠还能促进肠道蠕动，增加喂养的耐受性。
 关 键 词：早产儿；黄疸；早期干预
 论文类型：应用研究
 
 
 Title: Effects of Implementing Early Nursing Interventions on Jaundice in Premature Infants
Abstract
 Background：Clinical advantages and disadvantages of these early interventions for preventing neonatal jaundice and reducing complications were analyzed to find out a simple, It can also help jaundice extinction, shorten the time of phototherapy as well as lower the incidence of Hyperbilirubinemia.
 Objectives: To explore the effects of implementing enema combined with massage on jaundice in premature infants. Differences were compared among enema combined with massage, abdominal massage, and routine enema as well as double-side phototherapy and so was the control group. Clinical advantages and disadvantages of these early interventions for preventing neonatal jaundice and reducing complications were analyzed to find out a simple, effective and woundless nursing intervention which also has clinical values and social effects.    
 Methods: 125 premature infants were randomly assigned into group A, B, C, D and E. All infants in the five groups received identical nutrition and drug therapy. The infants in group A, B and D were given early abdominal massage, routine enema and enema combined with massage respectively. Group C was the double-side phototherapy group and group E was the control group. When transcutaneous bilirubin (TCB) indexes counted more than 18.0, group A, B, D and E were given routine single-side phototherapy for 24 hours. Double-side phototherapy was applied in group C when TCB indexes were over 18.0. Neither enema nor abdominal massage was given to group C and E. Neonatal jaundice, defecation and feeding were recorded. ANOVA, test were used to analyze the data.
 Results: The time for jaundice lasting and phototherapy were significantly shorter in group D than other four groups (P<0.05). Transcutaneous bilirubin (TCB) indexes of those hospitalized for at least two weeks were lower in group D than those in group A, B and E (P<0.05). The incidence of Hyperbilirubinemia and the rate of jaundice extinction in the first two weeks showed significant differences in the 5 groups (P<0.01).The incidence of Hyperbilirubinemia in group D was remarkably lower than those in group E, and the rate of jaundice extinction in the first two weeks of infants in group D was lower than those in group A and E (P<0.005). The time for meconium exhaustion in group D was shorter than group B, C and E (P<0.01).In group D, total defecation times in the first five days, first seven days and the first two weeks were obviously more than other four groups (P<0.05). The incidences of constipation and feeding intolerance showed significant differences in the five groups (P<0.01).The incidence of feeding intolerance of those in group D was lower than those in group B and E (P<0.005), and the incidence of constipation of those in group D was lower than other four groups (P<0.001).
 Conclusion: Implementing enema combined massage early on premature infants after birth can encourage more meconiums exhaustion and promote excretion of bilirubin. It can also help jaundice extinction, shorten the time of phototherapy as well as lower the incidence of Hyperbilirubinemia. Still, it can promote the intestinal movement and enhance feeding intolerance.
 
 Key Words: premature infants； neonatal jaundice；early intervention
 Type Of Thesis: Applied；Research

 
 目  录
1绪  论 1
1.1背景及意义 1
1.2研究目的及目标 1
1.3关键词及定义 1
1.4文献回顾 2
1.4.1 国内外新生儿高胆红素血症发生现状 2
1.4.2 新生儿黄疸的临床资料 2
1.4.3 新生儿黄疸早期干预的相关因素分析 2
2 研究设计 3
2.1研究设计 3
2.1.1干预方法 3
2.1.2临床观察指标及判断标准 4
2.2研究对象 4
2.3 研究步骤 4
2.3.1营养方案和药物治疗 4
2.3.2护理干预 5
3 研究结果 7
3.1一般资料 7
3.1.1黄疸持续天数和光疗天数 7
3.1.2 TCB值 7
3.1.3病理性黄疸发生率和两周内黄疸消退率 8
3.2研究结果 8
3.2.1首次胎粪时间和胎粪排尽时间 8
3.2.2排便次数 9
3.3五组早产儿喂养耐受情况比较 10
4 讨  论 11
4.1早产儿黄疸的致病机理 11
4.2按摩灌肠的作用及临床实用性 11
4.2.1按摩灌肠能促进胎粪较快较多地排出 11
4.2.2按摩灌肠能降低病理性黄疸发生率 12
4.2.3按摩灌肠能增加喂养耐受性 12
3.2.4按摩灌肠能减轻护理的工作量 12
5 推论及建议 13
5.1推论 13
5.2建议 13
致  谢 15
参考文献 16
附    录 19