本文選題：推拿 + 早產(chǎn)兒　； 參考：《廣州中醫(yī)藥大學(xué)》2012年碩士論文

【摘要】：目的： 本課題根據(jù)中醫(yī)脾胃論,予健脾益氣推拿治療早產(chǎn)兒胃食管反流,探討健脾益氣推拿治療早產(chǎn)兒胃食管反流的療效及對其血清胃泌素、血漿胃動素水平的影響,并評價健脾益氣推拿治療的安全性。 方法： 采用前瞻性隨機對照臨床試驗設(shè)計方法,將2011年1月至2011年12月在廣州中醫(yī)藥大學(xué)附屬南海婦產(chǎn)兒童醫(yī)院新生兒重癥監(jiān)護中心住院的出生胎齡32-36周胃食管反流早產(chǎn)兒64例,隨機分成試驗組和對照組各32例。對照組按《早產(chǎn)兒管理指南》治療,胃食管反流治療期間,每次喂奶前予非營養(yǎng)性吸吮10分鐘；喂奶后采用仰臥位抬高頭肩部30。體位；必要時加用多潘立酮混懸液,無效時加用小劑量紅霉素(EM)治療；試驗組給予對照組相應(yīng)治療,并加用健脾益氣推拿(補脾經(jīng)、推中脘、摩腹),10分鐘／次,一日2次,7天為一療程。結(jié)合量表觀察兩組患兒胃食管反流治療前后的臨床癥狀與體征,監(jiān)測食管24小時pH值各項指標,并應(yīng)用放射免疫法(RIA)檢測血清胃泌素(gastrin, GAS)、血漿胃動素(motilin, MOT),進行自身前后對照與組間對照統(tǒng)計學(xué)分析；并對健脾益氣推拿治療的安全性進行觀察。 結(jié)果： 1、早產(chǎn)兒胃食管反流臨床上以嘔吐、呼吸暫停為主要表現(xiàn)；部分病例在以嘔吐為主要表現(xiàn)的基礎(chǔ)上出現(xiàn)呼吸暫停、電解質(zhì)紊亂、貧血、腹脹、發(fā)紺、吸入性肺炎等并發(fā)癥；療程結(jié)束后治療組較對照組臨床癥狀明顯好轉(zhuǎn),兩組間差異有統(tǒng)計學(xué)意義(P＜0.05)；2、經(jīng)食管24小時pH值檢測,療程結(jié)束后治療組早產(chǎn)兒pH(4的反流總時間、pH＜4長于5min的次數(shù)、最長反流持續(xù)時間等均明顯低于對照組,兩組差異有統(tǒng)計學(xué)意義(P＜0.05)。3、兩組病例血清GAS、血漿MOT平均水平療程結(jié)束后比治療前明顯升高(P＜0.01),治療組升高幅度明顯大于對照組(P＜0.05)；4、治療前后監(jiān)測患兒生命體征無明顯異常；健脾益氣推拿治療中無一例出現(xiàn)皮膚損傷及暈推。 結(jié)論： 健脾益氣推拿能明顯改善早產(chǎn)兒胃食管反流的臨床癥狀,減輕反流程度；健脾益氣推拿可促進胃食管反流早產(chǎn)兒GAS、MOT的分泌,有利于改善早產(chǎn)兒的胃腸動力,促進抗反流機制的成熟；健脾益氣推拿安全可靠。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R272

【參考文獻】

相關(guān)期刊論文 前10條

1 李金虎;推拿治療功能性消化不良50例[J];安徽中醫(yī)臨床雜志;2000年02期

2 胡筱娟,喬富渠;近十年對脾虛實質(zhì)研究的概況[J];中國醫(yī)藥學(xué)報;1991年05期

3 賈波,李曉紅,梁煜,黃秀深;白術(shù)茯苓湯對脾虛大鼠胃腸激素的影響[J];成都中醫(yī)藥大學(xué)學(xué)報;2001年04期

4 任平,夏天,張忠兵,胡家露,李彩寧,苗繼延;脾虛泄瀉與血漿及腸組織中胃動素的關(guān)系[J];第四軍醫(yī)大學(xué)學(xué)報;1991年05期

5 王寶力;大環(huán)內(nèi)酯類抗生素的非抗菌作用[J];國外醫(yī)學(xué)(兒科學(xué)分冊);2001年04期

6 黃瑛;新生兒胃腸道動力與疾病[J];國外醫(yī)學(xué)(兒科學(xué)分冊);1998年01期

7 劉瑞霞;嬰兒猝死綜合征[J];國外醫(yī)學(xué).婦產(chǎn)科學(xué)分冊;1998年01期

8 李仲榮,佘亞雄;胃食管返流發(fā)生機制的研究近展[J];國外醫(yī)學(xué)(消化系疾病分冊);1989年01期

9 王鑒;陳曉霞;王莉;黃康;任雪云;朱清碧;;早產(chǎn)兒胃腸功能與胃泌素、胃動素的相關(guān)性研究[J];貴陽醫(yī)學(xué)院學(xué)報;2007年04期

10 宋力闖;;新生兒胃食管反流38例臨床分析[J];遼寧醫(yī)學(xué)院學(xué)報;2009年02期

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