健脾益气推拿治疗早产儿胃食管反流的临床观察

发布时间：2018-05-11 07:11

本文选题：推拿 + 早产儿　；参考：《广州中医药大学》2012年硕士论文

【摘要】：目的：本课题根据中医脾胃论,予健脾益气推拿治疗早产儿胃食管反流,探讨健脾益气推拿治疗早产儿胃食管反流的疗效及对其血清胃泌素、血浆胃动素水平的影响,并评价健脾益气推拿治疗的安全性。方法：采用前瞻性随机对照临床试验设计方法,将2011年1月至2011年12月在广州中医药大学附属南海妇产儿童医院新生儿重症监护中心住院的出生胎龄32-36周胃食管反流早产儿64例,随机分成试验组和对照组各32例。对照组按《早产儿管理指南》治疗,胃食管反流治疗期间,每次喂奶前予非营养性吸吮10分钟；喂奶后采用仰卧位抬高头肩部30。体位；必要时加用多潘立酮混悬液,无效时加用小剂量红霉素(EM)治疗；试验组给予对照组相应治疗,并加用健脾益气推拿(补脾经、推中脘、摩腹),10分钟／次,一日2次,7天为一疗程。结合量表观察两组患儿胃食管反流治疗前后的临床症状与体征,监测食管24小时pH值各项指标,并应用放射免疫法(RIA)检测血清胃泌素(gastrin, GAS)、血浆胃动素(motilin, MOT),进行自身前后对照与组间对照统计学分析；并对健脾益气推拿治疗的安全性进行观察。结果： 1、早产儿胃食管反流临床上以呕吐、呼吸暂停为主要表现；部分病例在以呕吐为主要表现的基础上出现呼吸暂停、电解质紊乱、贫血、腹胀、发绀、吸入性肺炎等并发症；疗程结束后治疗组较对照组临床症状明显好转,两组间差异有统计学意义(P＜0.05)；2、经食管24小时pH值检测,疗程结束后治疗组早产儿pH(4的反流总时间、pH＜4长于5min的次数、最长反流持续时间等均明显低于对照组,两组差异有统计学意义(P＜0.05)。3、两组病例血清GAS、血浆MOT平均水平疗程结束后比治疗前明显升高(P＜0.01),治疗组升高幅度明显大于对照组(P＜0.05)；4、治疗前后监测患儿生命体征无明显异常；健脾益气推拿治疗中无一例出现皮肤损伤及晕推。结论：健脾益气推拿能明显改善早产儿胃食管反流的临床症状,减轻反流程度；健脾益气推拿可促进胃食管反流早产儿GAS、MOT的分泌,有利于改善早产儿的胃肠动力,促进抗反流机制的成熟；健脾益气推拿安全可靠。
[Abstract]:Objective: According to the theory of spleen and stomach of traditional Chinese medicine, the treatment of gastroesophageal reflux in premature infants with invigorating spleen and invigorating qi massage was studied. The effect of invigorating spleen and supplementing qi massage on gastroesophageal reflux in premature infants and the effect on serum gastrin and plasma motilin levels were discussed. The safety of massage therapy for invigorating spleen and supplementing qi was evaluated. Methods: From January 2011 to December 2011, 64 premature infants with gastroesophageal reflux (GERF) were enrolled in the neonatal intensive care center of Nanhai Gynecology and Childhood Hospital affiliated to Guangzhou University of traditional Chinese Medicine by a prospective randomized controlled clinical trial. They were randomly divided into two groups: the experimental group and the control group. In the control group, during gastroesophageal reflux treatment, non-nutritional sucking was given for 10 minutes before each feeding, and the supine position was used to raise head and shoulder 30 minutes after feeding. Body position; when necessary, with domperidone suspension, and when ineffective with small dose of erythromycin (EMM); in the experimental group, the control group was given corresponding treatment, and the control group was treated with tonifying spleen and supplementing qi with massage (tonifying the spleen meridian, pushing the middle epigastric vein, and rubbing the abdomen with the stomach for 10 minutes). Two times a day for 7 days as a course of treatment. The clinical symptoms and signs of gastroesophageal reflux before and after treatment were observed with the scale, and the indexes of 24 hour esophageal pH were monitored. Serum gastrin, plasma motilinand MOTX were detected by radioimmunoassay. Results: 1. The main clinical manifestations of gastroesophageal reflux in premature infants were vomiting and apnea, and some cases had complications such as apnea, electrolyte disturbance, anemia, abdominal distension, cyanosis, aspiration pneumonia and so on. The clinical symptoms of the treatment group were significantly improved than that of the control group after the end of the course of treatment. The difference between the two groups was statistically significant (P < 0.05). The total reflux time of pH(4 in the treatment group was longer than that of 5min after 24 hours of esophageal pH detection. The longest reflux duration was significantly lower than that in the control group. There was a significant difference between the two groups (P < 0.05). After the end of the course of treatment, the average level of plasma MOT in the two groups was significantly higher than that before treatment (P < 0.01), and the increase in the treatment group was significantly higher than that in the control group (P < 0.05). There was no significant abnormality in the vital signs of the children before and after treatment. No skin injury or dizziness occurred in the treatment of invigorating spleen and tonifying qi. Conclusion: Jianpi Yiqi massage can obviously improve the clinical symptoms of gastroesophageal reflux in premature infants and alleviate the degree of reflux, and invigorate spleen and invigorate qi massage can promote the secretion of GASMOT in preterm infants with gastroesophageal reflux, which is helpful to improve the gastrointestinal motility of preterm infants. To promote the maturity of anti-reflux mechanism and to strengthen spleen and replenish qi massage is safe and reliable.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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