摘要
早产儿由于吸吮反射、吞咽反射的不成熟和吸吮-吞咽-呼吸(SSWB)模式的不协调,导致喂养过程中容易发生呛咳、误吸、喂养困难等问题。因此,应针对早产儿喂养困难开展规范评估,并尽早介入康复治疗。本研究对国内外早产儿喂养困难的临床特点与现状、评估及康复治疗等内容进行综述,以期为早产儿喂养困难和早期康复介入提供思路。早产儿喂养困难的评估包括吸吮模式、吞咽模式、呼吸模式和SSWB模式评估。吸吮模式评估包括营养性吸吮与非营养性吸吮评估;吞咽模式评估包括口腔准备期、吞咽期与食管期评估;呼吸模式评估包括Ⅰ、Ⅱ、Ⅲ型呼吸模式评估;SSWB模式评估主要是对早产儿喂养过程吸吮、吞咽、呼吸3个方面的协调能力进行评估。主要评估方法包括影像学及量表评估方法。影像学评估方法主要包括X线荧光透视吞咽造影检查(VFSS)、纤维喉镜吞咽功能评估(FEES)、超声成像检查和高分辨率咽腔测压(HRM)等。量表评估主要包括早产儿经口喂养评估量表(PIOFRA)、新生儿口腔运动评估量表(NO⁃MAS)、经口喂养技能评估(OFS)量表。影像学评估方法多是针对吞咽、吸吮模式进行客观评估,较为准确,但目前缺少对呼吸和SSWB模式的影像学评估方法。量表评估多是针对吸吮、吞咽、呼吸及SSWB进行全方面评估,但主观性较强。早产儿常用的康复治疗方法主要从吸吮、吞咽、呼吸3个方面介入。吸吮干预包括非营养性吸吮、感觉运动刺激;吞咽治疗包括吞咽功能训练、个体化吞咽治疗;呼吸治疗主要为呼吸模式干预。此外,还应关注喂养的状态及体位。
The immaturity of the sucking reflex and swallowing reflex in preterm infants,and the incoordination of suck-swallow-breath(SSWB)patterns lead to feeding problems,such as cough,aspiration,feeding difficulties etc.Therefore,standardized assessment should be carried out for feeding difficulties in preterm infants,and rehabilitation should be involved as early as possible.This article reviewed the studies on the clinical characteristics,current status,evaluation and rehabilitation treatment of feeding difficulties in preterm infants at home and abroad,to provide evaluation and treatment ideas for feeding difficulties in preterm infants.Evaluation of feeding difficulties in preterm infants includes sucking,swallowing,respiratory and SSWB patterns.Sucking pattern assessments include nutritional and non-nutritive sucking assessments;swallowing pattern assessments include oral preparation,swallowing,and esophageal phases assessments;respiratory pattern assessments include typeⅠ,typeⅡ,and typeⅢrespiratory pattern assessments.SSWB mainly assesses the coordination of sucking,swallowing,and breathing during the feeding process in premature infants.The main evaluation methods include imaging and scale assessment methods.The imaging assessments include video fluoroscopic swallowing study(VFSS),fiberoptic endoscopic evaluation of swallowing(FEES),ultrasound imaging and high-resolution manometry(HRM).The scales assessment includes preterm infant oral feeding readiness assessment(PIOFRA),neonatal oral-motor assesment scale(NOMAS)and oral feeding skills(OFS)scale.Most imaging assessment methods focus on swallowing and sucking patterns,which are more objective and accurate.However,there is a lack of imaging assessment methods in respiratory and SSWB patterns.The scale assessments can provide comprehensive evaluation of sucking,swallowing,respiration and SSWB patterns but are highly subjective.The rehabilitation treatments commonly used in premature infants mainly involve three aspects:sucking,swallowing and respiration.The sucking intervention includes non-nutritive sucking and sensorimotor stimulation,swallowing therapy includes swallowing function training and individualized swallowing therapy,respiratory therapy mainly involves respiratory pattern intervention.In addition,the feeding state and position of feeding should be noted.
作者
关韩月
陈玲
黄锦玉
唐新群
柳彩蔚
朱如乔
曾庆
GUAN Hanyue;CHEN Ling;HUANG Jinyu;TANG Xinqun;LIU Caiwei;ZHU Ruqiao;ZENG Qing(Zhujiang Hospital of Southern Medical University,Guangzhou,Guangdong 510280,China)
出处
《康复学报》
CSCD
2023年第4期367-374,共8页
Rehabilitation Medicine
基金
国家自然科学基金青年项目(82002380)
广东省卫生健康适宜技术推广项目(202206252011533513)
2022年广东省大学生创新训练项目(S202212121168)。
关键词
喂养困难
吞咽功能障碍
早产儿
喂养评估
康复治疗
feeding difficulty
swallowing dysfunction
preterm infant
feeding assement
rehabilitation therapy
