早產兒在口腔餵食早期之心率變異、心肺功能調節與其餵食成效的關係

其他題名: Relationships among heart rate variability cardiorespiratory modulation and feeding performance of preterm infants in the early period of oral feeding

作者: 張雅雯
Chang, Ya-Wen 貢獻者: 護理學系碩博士班
張瑩如
Chang, Ying-Ju 關鍵詞: cardiorespiratory modulation
heart rate variability
the early period of oral feeding
preterm infants
the transitional period of oral feeding
feeding performance
餵食成效
心肺?能調節
口腔餵食過渡期
心率變異
口腔餵食早期
早產兒 日期: 2006-09-18 上傳時間: 2009-05-08T06:43:14Z 摘要: 雖 然臨床上通常以早產兒矯正年齡大於32週時即可以開始嘗試口腔餵食，但每個早產兒吸吮、吞嚥、呼吸的協調性、生理的適應性及心肺?能調節能力有極大的差 異，有些過早口腔餵食反而容易出現壓力行為及心肺?能調節不良等危險徵象。由於迷走神經系統的成熟度是決定成?口腔餵食的重要因素，但目前少有針對口腔餵 食準備度與迷走神經活性及其心肺?能調節之關係的相關研究。本研究目的為探討早產兒在口腔餵食早期的心率變異（HRV）、心跳速率（HR）及血氧飽和濃度 （SpO2）與其餵食成效之關係，以做為將來建立評估早產兒在口腔餵食過渡期間餵食成效指標之參考。 本研究採相關性研究設計，以南部某醫學中心的新生兒加護病房及病嬰室目的取樣的47位早產兒為研究對象。收案條件為：出生時妊娠週數小於32週而矯正年齡 達32週以上、能由奶瓶口腔餵食、未罹患先天性異常及口咽疾病、並取得父母親同意書者。在早產兒口腔餵食早期測量其餵食成效及餵食前、中、後之HRV、 HR及SpO2。所收集資料以描述性統計、重複測量變異數分析、皮爾森積差相關、t檢定及複迴歸分析等統計方法進行分析。 研究結果發現：（1）餵食中正常R-R間期的平均值（RRI）降低，低高頻?率比值（LF/HF）會升高，而餵食後分別於第五及二十分鐘內回復至餵食前基 準值。（2）餵食中HR會升高，SpO2會降低，餵食後會在五分鐘內逐漸地回復至餵食前基準值。（3）餵食前、中、前至中HRV與餵食成效有顯著正相 關。（4）餵食前、中、前至中HR、SpO2與餵食成效無顯著相關性。（5）餵食前、中、後HRV與其HR呈顯著負相關；而餵食中HRV與餵食中SpO2 呈顯著負相關。（6）餵食前HRV與餵食中、後、前至中、中至後HR呈顯著負相關；餵食前HRV與餵食中、後、前至中、中至後SpO2無顯著相關 性。（7）餵食成效中的每分鐘平均吸吮量以餵食前至中LF/HF比值來進行預測之效果最佳，其解釋能力高達84 9%。 本研究結果已初步顯示早產兒口腔餵食早期的HRV、心肺?能調節與其餵食成效之關係，可提供未來進一步尋求適合口腔餵食時機的方向或依據，使護理人員能依 早產兒個別生理狀況來調整最佳的口腔餵食開始點，避免過早及強迫口腔餵食而導致的心肺負荷。
Generally premature infants start oral feeding as their postconceptional ages reach 32 weeks because of better coordination of suck swallow and breathing Even though some preterm infants demonstrate stress behavior and cardiorespiratory instabilities at the early period of oral feeding The maturation of parasympathetic nerve might play an important role of successful oral feeding However little is known what are the relationship among vagal activity feeding performance and cardiorespiratory modulation Purposes of this study were to (a) explore the relationships among heart rate variability (HRV) feeding performance heart rate (HR) and oxygen saturation (SpO2) of preterm infants in the early period of oral feeding and to (b) identify clinical indicators of feeding performance The correlative study was used in the neonatal intensive care unit (NICU) and sick baby room (SBR) of a Medical Center of southern Taiwan Forty-seven premature infants participated in this study They were (a) under 32 weeks gestational age at birth and greater than 32 weeks of postconceptional age at study (b) allowed for trying bottle-feeding by the physician (c) without congenital anomalies and oropharynx diseases and (d) with parental consents In the early period of oral feeding infants feeding performance and HRV HR and SpO2 of pre during and post-feeding periods were observed Data was analyzed using descriptive statistics repeated measure analysis of variance Pearson’s correlation Student t-test and multiple regressions Results showed that (a) the mean R-R interval (RRI) decreased and LF/HF ratio increased during feeding then returned to the baseline after 5 and 20 minutes of post-feeding periods respectively (b) HR increased and SpO2 decreased during feeding then returned to the baseline 5 minutes after feeding (c) significantly positive relationships were found among feeding performance and HRV of pre during and pre-to-during feeding periods (d) no significant relationship was found among feeding performance HR and SpO2 of pre during and post feeding periods (e) significantly negative relationships were found between HRV and HR of pre during and pre-to-during feeding periods Besides there was a negative relationship between HRV and SpO2 during feeding (f) pre-feeding HRV had significant relationships with HR of during post pre-to-during and during-to-post feeding periods There was no significant relationship among pre-feeding HRV and SpO2 of each period and (g) the ratio of LF/HF during feeding to LF/HF of pre-feeding accounted for 84 9% of the variance of feeding performance when indexed by the volume of transferred milk per minute Results of the present study showed significant relationships among HRV cardiorespiratory modulation and feeding performance of preterm infants in the early period of oral feeding These findings provide knowledge of specific clinical indicators of successful oral feeding and may facilitate protocols for safe feeding of premature infants in the future URI: http://nckur.lib.ncku.edu.tw/han