抚触联合早期微量喂养预防早产儿喂养不耐受的效果

目的探讨抚触联合早期微量喂养预防早产儿喂养不耐受的效果。方法方便性抽样选取2008年11月至2009年11月在山东大学附属省立医院新生儿重症监护室住院的早产儿93例。按随机数字表法随机分为三组:A组(31例)、B组(31例)、C组(31例)。A组早期给予微量喂养,同时给予抚触;B组早期给予微量喂养,C组为对照组,给予常规治疗和护理,24h以后开始喂养。观察三组早产儿的摄入奶量、体重、达足量肠内喂养时间及喂养不耐受发生情况。结果 A组、B组较C组每日摄入更多奶量及热卡(均P0.01),A组较B组每日摄入更多奶量及热卡(均P0.01);A组较B组、C组更快恢复出生体重(均P0.01);A组每日体重增长较B组、C组快(均P0.01),A组、B组胃肠外营养时间与C组相比明显缩短(均P0.01),A组达足量肠内喂养时间较C组更早(P0.01),A组喂养不耐受发生率(19.4%)较B组(51.6%)、C组(74.2%)低(均P0.01)。结论抚触配合早期微量喂养能促进早产儿胃肠功能更快地发育与成熟,改善胃肠动力,提高早产儿胃肠道喂养的耐受性。     

经口喂养困难早产儿行口腔运动护理干预的效果观察

目的探讨早产儿口腔运动的护理干预(prematrue infant oral motor intervention,PIOMI)用于存在经口喂养困难早产儿的干预效果。方法将60例存在经口喂养困难入住NICU的早产儿作为研究对象,采用随机数字表分为对照组和观察组各30例,对照组进行常规护理,观察组在常规喂养护理的基础上进行早产儿口腔运动的护理干预,应用新生儿口腔运动评估量表(Neonatal Oral Motor Assessment Scale,NOMAS)对早产儿进行评估。结果两组早产儿开始经口喂养时胎龄、体质量差异均无统计学意义。观察组达到完全经口喂养时胎龄显著低于对照组(P0.01);观察组从开始经口喂养过渡到完全经口喂养天数少于对照组(P0.05);但对照组达到完全经口喂养时的喂养效率高于观察组(P0.05)。达到完全经口喂养时,观察组喂养失调型态得分低于对照组(P0.05);障碍型态得分显著低于对照组(P0.01)。结论早产儿口腔运动的护理干预可以改善早产儿口腔运动功能,缩短喂养进,改善喂养表现。     

上海住院产妇婴儿喂养态度的现状及其影响因素

目的了解上海住院产妇婴儿喂养态度的现状,并分析其影响因素。方法采用便利抽样法选取2014年12月至2015年2月上海市一家三级甲等妇产专科医院和两家三级甲等综合医院分娩后住院3d的产妇作为研究对象,使用自制产妇基本情况调查表及简体中文版Iowa婴儿喂养态度量表(the Iowa infant feeding attitude scale,IIFAS)对分娩后3d的产妇进行横断面调查。结果产后3d的IIFAS总分最低36分,最高85分,平均(63.10±6.89)分。多元线性回归结果显示,产妇的IIFAS总分与家庭收入、母乳喂养技能自我评价以及计划出院6个月内采取的喂养方式有关(均P0.05)。结论上海地区住院产妇总体对母乳喂养持有较积极的观念与态度。在临床宣教工作中,护理人员应将家庭收入低者作为母乳喂养宣教的重点干预对象,孕期还应重视母乳喂养技能示范及指导,加强对其家属及长辈的宣教,向产妇宣教母乳喂养益处的最新研究结果,培养孕产妇正向的母乳喂养态度和意图,提高母乳喂养成功率。     

2种不同鼻饲法对重症患者胃肠内营养并发症的影响

目的比较间歇输注鼻饲法和推注鼻饲法对重症患者胃肠内营养并发症的影响。方法将118例经鼻留置胃管的重症患者随机分为2组。试验组59例,采用输液瓶装入温开水或纤维型能全力接输血器间歇（10～16h）滴注鼻饲法;对照组59例,采用注射器推注与试验组相同的营养液进行鼻饲,比较2组鼻饲后胃肠道并发症的发生率。结果试验组的并发症发生率低于对照组（P〈0．01）,差别有统计学意义。结论间歇输注鼻饲法较推注鼻饲法,可有效地减少胃肠内营养并发症的发生,值得临床推广。     

Proposal of indicators to evaluate complementary feeding based on World Health Organization indicators

This study compares complementary feeding World Health Organization (WHO) indicators with those built in accordance with Brazilian recommendations (Ten Steps to Healthy Feeding). A cross‐sectional study was carried out during the National Immunization Campaign against Poliomyelitis in Guarapuava‐Paraná, Brazil, in 2012. Feeding data from 1,355 children aged 6–23 months were obtained through the 24 h diet recall. Based on five indicators, the proportion of adequacy was evaluated: introduction of solid, semi‐solid, or soft foods; minimum dietary diversity; meal frequency; acceptable diet; and consumption of iron‐rich foods. Complementary feeding showed adequacy higher than 85% in most WHO indicators, while review by the Ten Steps assessment method showed a less favorable circumstance and a high intake of unhealthy foods. WHO indicators may not reflect the complementary feeding conditions of children in countries with low malnutrition rates and an increased prevalence of overweight/obesity. The use of indicators according to the Ten Steps can be useful to identify problems and redirect actions aimed at promoting complementary feeding.     

口腔运动干预对低出生体重儿喂养不耐受的作用

目的探讨口腔运动干预对低出生体重儿喂养不耐受的作用。方法便利抽样选择2014年2月至2015年3月合肥市第一人民医院收治的68例低出生体重儿,随机分成口腔运动干预组和对照组,每组34例。口腔运动干预组给予口周、口腔等按摩干预,对照组给予常规护理干预。比较两组的喂养不耐受发生率、体质量增长情况、恢复出生体质量时间、达成完全经口喂养时间及不良反应发生情况。结果口腔运动干预组喂养不耐受发生率低于对照组低(8.8%vs 35.3%,P0.05),每日增长体质量高于对照组[(14.78±3.26)g vs(10.36±3.13)g,P0.05],恢复出生体质量时间[(11.32±1.17)d vs(14.85±1.43)d,P0.05]及达全胃肠道喂养时间早于对照组[(13.25±2.72)d vs(15.36±2.38)d,P0.05],两组均未有明显不良反应事件发生。结论口腔运动干预可有效降低低出生体重儿的喂养不耐受发生率,并可促进其体质量增长,缩短体质量恢复时间。     

The Effect of Maternal Depressive Symptoms and Early Maternal Feeding Behavior on Later Infant Feeding Behavior

Adaptive maternal feeding behaviors are sensitive and responsive to the infant and support the infant's participation in feeding. Adaptive infant behaviors help the infant to participate in the feeding within developmental capacities and to interact in a positive manner with the mother. Therefore, the purpose of this study was to explore the contribution of the adaptiveness of early maternal feeding behavior to the adaptiveness of later infant feeding behavior, accounting for maternal depressive symptoms and neonatal health. Thirty-seven premature infants and their mothers were assessed in the special care nursery just before discharge and in their homes at 4 months postterm age. The adaptive quality of maternal and infant behavior was assessed using the Parent-Child Early Relational Assessment. Maternal depressive symptoms were assessed using the Center for Epidemiological Study–Depression Scale. Infant health was assessed using the Neonatal Health Index. Linear regression analyses revealed that the adaptiveness of maternal feeding behavior before special care nursery discharge contributed significantly to the adaptiveness of infant feeding behavior at 4 months postterm age, accounting for neonatal health and maternal depressive symptoms. Although further study of the relationship is needed, findings support development of interventions to enhance the adaptiveness of mothers' early feeding behaviors.     

肠内联合肠外营养治疗早产儿的疗效观察

【目的】探讨肠内联合肠外营养及全肠内营养治疗早产儿的临床疗效。【A-法】选择2009年1月1日～12月31日在本院治疗的56例早产儿作为观察组,应用奶内联合肠外喂养;另选择同期因家庭经济困难的36例早产儿作为对照组,应用全肠内营养。分别比较两组出院体重、住院天数及并发症情况。【结果】与对照组比较,观察组住院时间明显缩短,出院体重明显增加,各种并发症如低血糖、低蛋白血症、喂养不耐受等发生率明显减少（均P〈0．05）。【结论】肠内联合肠外营养治疗可使早产儿获得更多营养支持,减少并发症的发生。     

极低出生体质量儿早期微量喂养的效果评价

目的探讨极低出生体质量儿(VLBW)早期微量喂养的有效性和安全性。方法将72例VLBW作为研究对象分两组,36例为常规喂养组,36例为早期微量喂养组,对两组胃肠内营养达足量时间、吸吮吞咽功能建立时间、每日体质量增长量进行比较、分析。结果微量喂养组胃肠内营养达足量时间、吸吮吞咽功能建立时间均比常规喂养组明显缩短,每日体质量增长量比常规喂养组大,具有显著性差异(P<0.01)。两组均未发生坏死性小肠结肠炎。结论早期微量喂养对VLBW减少喂养困难,提高存活率、存活质量有重要的意义和价值,是安全有效的喂养方法。     

家庭支持对母乳喂养的影响

目的研究家庭支持对母乳喂养的影响,探讨提高母乳喂养率的有效途径。方法方便性抽样选取某三级甲等医院产科100例初产妇,采用问卷调查及电话随访相结合的方法,获得其家庭支持及母乳喂养情况,所得数据采用SPSS 16.0进行分析。结果初产妇的母乳喂养率低,家庭支持度得分为中度水平,不同喂养方式初产妇的家庭支持得分的差异具有统计学意义(F=29.28,P<0.01)。结论家庭支持与母乳喂养密切相关,护士应重视家庭支持系统对提高母乳喂养率的作用,有针对性地开展对孕产妇及其家属的健康教育,以提高母乳喂养的成功率。     

Infant feeding attitudes of expectant parents: breastfeeding and formula feeding

BACKGROUND: Research has indicated that parental attitudes are strong predictors of choice of infant feeding. Identification and understanding of the infant feeding attitudes of mothers and their social networks should be an early step in the design and implementation of breastfeeding interventions. AIM: To compare the infant feeding attitudes of parents of breastfed infants with those of parents of formula fed infants. METHODS: A survey was carried out with a convenience sample of pregnant women (gestational age 8-12 weeks) attending three maternity clinics in Scotland in 2000. Expectant mothers and their partners (n = 108 couples) completed the 17 item Iowa Infant Feeding Attitude Scale. Demographic information was collected by face-to-face interview and the method of feeding at discharge from hospital was obtained from medical records. RESULTS: Parents of breastfed infants had more positive attitudes towards breastfeeding than parents of formula fed infants, and were more knowledgeable about the health benefits and nutritional superiority of breastfeeding. Fathers of both breastfed and formula fed infants were more likely than their partners to disapprove of women breastfeeding in public. Parents considered their chosen method of feeding to be the more convenient alternative. Mothers of formula fed infants were more likely to think that women who occasionally drink alcohol should not breastfeed. CONCLUSION: Parents of formula fed infants had several misconceptions about breastfeeding. Use of the Iowa Infant Feeding Attitude Scale could help health professionals identify and address these in infant feeding discussions in the early antenatal period. Efforts should be made to include fathers in these infant-feeding discussions.     

2种添加配方奶的喂养方式对新生儿乳头错觉的影响

目的探讨2种添加配方奶的喂养方式对新生几乳头错觉的影响。方法将出生3d内的80例新生儿分为2组：观察组（40例）新生几用瓶喂养,对照组（40例）新生儿用勺喂养;比较新生儿产生乳头错觉的情况。结果新生儿产生乳头错觉方面观察组低于对照组（P〈0．000）。结论用瓶喂养优于用勺喂养,产生乳头错觉低,可促进母乳喂养,有利于新生儿健康的生长发育。     

Ethnomethodologic Analysis of Accounts of Feeding Demented Residents in Long-Term Care

To describe the self-organizing activities and the unspoken knowledge that nursing assistants employ in performing the work of feeding as a routine part of their activities. In U.S. long-term care facilities, activities related to medical and nursing care are frequently based on the ability of nursing assistants to successfully accomplish the work of feeding. Nurses are not always aware of the difficulties involved in feeding nor the means by which food is offered and intake calculated.

Design:

Qualitative phenomenologic.

Methods:

Observations were conducted during 12 weekday mealtimes, October and November 1994. Data were collected using participant observation of mealtimes in the congregate dining room of one licensed long-term care facility. Data were analyzed using the framework of ethnomethodology to indicate the methods nursing assistants used to make sense of their interactions with demented residents.

Findings:

Nursing assistants used several common behaviors: grouping the "difficult feeders" together; "marking the borders" by maintaining a tidy tray; and "loading the spoon" to maximize the amount of food given at one time. Estimations of the quantity of intake varied according to ideas about the nutritional content of various foods.

Conclusions:

Unsuccessful feeding interactions have implications for the quality of life for the demented. When inadequate intake leads to significant weight loss, medical and nursing interventions should be implemented.     

Infant feeding responsiveness: a conceptual analysis

BACKGROUND: The phenomenon of infant responsiveness to the caregiver during feeding interactions has been of interest to researchers for many years, because of its associated implications for child growth and development. Although many studies have examined feeding responsiveness in caregiver-infant dyads, it is infrequently and inconsistently defined in the literature. SPECIFIC AIMS: The purpose of this paper is to clarify the concept of infant feeding responsiveness through the provision of a working definition of the concept for further study and usage. METHODS: Medline, CINAHL, and PschInfo databases from the year 1970 to the present were searched for English articles containing the keywords 'infant', 'feeding', 'responsiveness', 'synchrony', and/or 'interaction'. Articles were selected for inclusion according to whether or not the phenomenon of infant feeding responsiveness was defined or assessed. Walker and Avant's (1995) method for concept analysis was employed for the development of defining attributes, case examples, antecedents, and consequences for further clarification of the concept of infant feeding responsiveness. FINDINGS: Infant feeding responsiveness was defined as the manifestation of physiologically influenced visual, expressive, vocal and motor reactive behaviours expressed by an infant in reaction to a caregiver's feeding attempts, indicating a readiness to feed. CONCLUSIONS: Implications for nursing are explored as well as the need for refinement of measures of this concept.     

两种鼻饲方案在危重患者肠内营养中的应用比较

目的 比较两种鼻饲方案对重症患者肠内营养的影响,为临床选择肠内营养方案提供依据.方法 选择重症监护病房医嘱经鼻胃管采用鼻饲泵进行肠内营养的患者53例,对每例患者实施1周的持续鼻饲后改l周的间歇鼻饲,记录两个阶段患者腹胀、腹泻、误吸、反流等并发症的发生次数以及胃液pH值.结果 两种鼻饲方案在腹胀、腹泻、误吸、反流等并发症的发生率差异无统计学意义(P<0.05),两种方案患者胃液平均pH值差异有统计学意义(P<0.05),间歇鼻饲方案时患者胃液pH值更接近生理值.结论 应用鼻饲泵间歇鼻饲不会增加患者并发症的发生率,且对患者胃液pH值的影响程度小于持续鼻饲方案.