早期干預(yù)在治療早產(chǎn)兒黃疸中的作用

論文編號(hào):HL160  論文字?jǐn)?shù):11285.頁(yè)數(shù):26

論文題目：早期干預(yù)在治療早產(chǎn)兒黃疸中的作用
摘　要
 目的：探討按摩灌腸應(yīng)用于早產(chǎn)兒黃疸的療效，并分別與腹部按摩、普通灌腸、雙面光療及對(duì)照組進(jìn)行比較，探討分析預(yù)防早產(chǎn)兒黃疸的各種早期干預(yù)措施臨床應(yīng)用的優(yōu)缺點(diǎn)，旨在尋找一種療效好、創(chuàng)傷少而又簡(jiǎn)單易行的具有臨床價(jià)值及社會(huì)效益的護(hù)理措施，預(yù)防早產(chǎn)兒黃疸，減少并發(fā)癥。
 方法：將125例早產(chǎn)兒隨機(jī)分為A、B、C、D、E組，五組均采用相同的營(yíng)養(yǎng)方案及黃疸藥物治療。A、B、D組早產(chǎn)兒早期分別給予腹部按摩、普通灌腸和按摩灌腸，C組為雙面光療組，E組為對(duì)照組。當(dāng)經(jīng)皮黃疸 (transcutaneous bilirubin，TCB)檢測(cè)指數(shù)達(dá)到18．0(11 mg/dl)時(shí)，A、B、D、E組早產(chǎn)兒常規(guī)采用單面光療24 h，C組給予雙面光療24 h。C、E組不予按摩或灌腸。觀察五組早產(chǎn)兒的黃疸、排便及喂養(yǎng)情況。采用方差分析和χ2檢驗(yàn)分析數(shù)據(jù)。
 結(jié)果：按摩灌腸組早產(chǎn)兒的黃疸持續(xù)天數(shù)和光療天數(shù)較其它四組明顯縮短 (P<O．05)。住院滿兩周的早產(chǎn)兒中，按摩灌腸組早產(chǎn)兒第12天、第14天TCB值明顯低于腹部按摩組、普通灌腸組和對(duì)照組(P<O．05)，與雙面光療組組問差異無顯著性(P>o．05)。按摩灌腸組病理性黃疸發(fā)生率明顯低于對(duì)照組，兩周內(nèi)黃疸消退率明顯高于對(duì)照組和腹部按摩組(P<0．005)。按摩灌腸組胎糞排盡時(shí)間較普通灌腸組、雙面光療組和對(duì)照組縮短(P<0．01)，前5天、前7天總便次及住院滿2周早產(chǎn)兒2周內(nèi)的總便次明顯多于其它四組(P<O．05)。按摩灌腸組早產(chǎn)兒喂養(yǎng)不耐受發(fā)生率明顯低于普通灌腸組和對(duì)照組(P<0．005)，便秘發(fā)生率顯著低于其它四組(P<0．001)。
 結(jié)論：早產(chǎn)兒生后盡早實(shí)行按摩灌腸可促進(jìn)胎糞較多較快排出，促進(jìn)膽紅素排泄，協(xié)助早產(chǎn)兒黃疸盡早消褪，縮短光療時(shí)間，降低病理性黃疸發(fā)生率。按摩灌腸還能促進(jìn)腸道蠕動(dòng)，增加喂養(yǎng)的耐受性。
 關(guān)鍵詞: 早產(chǎn)兒；黃疸；早期干預(yù)
 
Title: Effects of Implementing Early Nursing Interventions Oil Jaundice in Premature Infants
ABSTRACT
Objective
 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
 1 25 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 1 8．0，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 1 8，0． 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 j aundice 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 j aundice 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 ofjaundice 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 if,<0．0 1)．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 conniption ofthose in group D was lower than other four groups①<0．00 1)．
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：remature infants；neonatal jaundice；early intervention
 
目  錄
 
1 緒論 1
1.1 背景及意義 1
1.2 目的…………………………………………………………………………………2
1.3 關(guān)鍵詞及定義………………………………………………………………………2
1.4 文獻(xiàn)回顧……………………………………………………………………………2
2 研究設(shè)計(jì) 5
2.1研究設(shè)計(jì) 5
2.2研究對(duì)象 5
2.3研究工具 5
2.4研究步驟 6
2.5統(tǒng)計(jì)分析 7
3 研究結(jié)果 8
3．1 五組早產(chǎn)兒黃疸情況比較 8
3．1．1 TCB值 8
3．1．2病理性黃疸發(fā)生率和兩周內(nèi)黃疸消退率 8
3．2五組早產(chǎn)兒排便情況比較 9
3．2．1排便次數(shù) 9
4 討論 10
5 推論及建議 11
5．1 結(jié)論 11
5．2 建議 11
5．3 本研究局限性及展望 11
致    謝 12
參考文獻(xiàn) 13