口腔运动干预改善早产儿脑功能发育的随机对照研究

Effect of oral motor intervention in improving brain function development in preterm infants: a randomized controlled trial

摘要:

目的 探讨口腔运动干预（oral motor intervention，OMI）对早产儿脑功能发育的影响。方法 采用分层随机分组方法，将112例早产儿按胎龄分为小胎龄（30~31⁺⁶周）及大胎龄（32~33⁺⁶周）两层，再随机分为对照组（分别23、22例）和干预组（分别24、23例）。对照组予以常规治疗，干预组在此基础上增加OMI。分别于入组第1、7、14天使用振幅整合脑电图（amplitude-integrated electroencephalogram，aEEG）及新生儿行为神经测定（Neonatal Behavioral Neurological Assessment，NBNA）进行评估，比较各组患儿脑功能发育水平。结果 OMI第7天，小胎龄干预组窄带和宽带的上界电压和电压差低于小胎龄对照组，aEEG评分高于小胎龄对照组（P < 0.05）。OMI第14天，小胎龄干预组窄带和宽带的下界电压、成熟睡眠-觉醒周期比例、aEEG及NBNA评分高于小胎龄对照组，窄带电压差低于小胎龄对照组（P < 0.05）。OMI第7、14天，大胎龄干预组窄带和宽带的上界电压和电压差低于大胎龄对照组，窄带和宽带的下界电压及aEEG评分高于大胎龄对照组（P < 0.05）。OMI第7天，大胎龄干预组NBNA评分高于大胎龄对照组（P < 0.05）。结论 OMI能促进早产儿aEEG背景活动成熟，改善行为神经表现，加快脑功能发育。

Abstract:

Objective To study the effect of oral motor intervention (OMI) on brain function development in preterm infants. Methods A total of 112 preterm infants were stratified into small-gestational-age (30-31+6 weeks) and large-gestational-age (32-33+6 weeks) according to gestational age at birth. The preterm infants were randomly divided into a control group and an intervention group, with 56 infants in each group. The infants in the control group were given routine treatment and nursing, while those in the intervention group were given OMI in addition to the treatment and nursing in the control group. Amplitude-integrated EEG (aEEG) and Neonatal Behavioral Neurological Assessment (NBNA) were performed on days 1, 7, and 14 of enrollment, and the level of brain function development was compared before and after intervention. Results On day 7 of OMI, the small-gestational-age intervention group had lower upper bounds of voltage and bandwidth and a higher aEEG score than the small-gestational-age control group (P < 0.05). Compared with the small-gestational-age control group, the small-gestational-age intervention group had higher upper bound of voltage, percentage of mature sleep-wake cycle, aEEG score, and NBNA score and a lower narrow bandwidth on day 14 of OMI (P < 0.05). Compared with the large-gestational-age control group, the large-gestational-age intervention group had lower upper voltage and voltage difference and higher lower bound of voltage and aEEG score on days 7 and 14 of OMI (P < 0.05). On day 7 of OMI, the large-gestational-age intervention group had a higher NBNA score than the large-gestational-age control group (P < 0.05). Conclusions OMI can promote the maturation of aEEG background activities, improve neurobehavioral manifestations, and accelerate brain function development in preterm infants.