口腔運動干預對促進早產兒神經行為發育有效性的Meta分析

Effectiveness of oral motor intervention in promoting neurobehavioral development of premature infants：a Meta-analysis

CHEN Xia，WU Nana，ZHOU Hong，WANG Yuan，DING Liwen，FU JieThe Affiliated Women and Children′s Hospital，School of Medicine，University of Electronic Science and Technology of China;Chengdu Women and Children′s Central Hospital，Sichuan 610000 ChinaCorresponding Author ZHOU Hong，E-mail：506596616@qq.com

Abstract Objective：To systematically evaluate the effectiveness of oral motor intervention in promoting the neurobehavioral development of premature infants.Methods： The randomized controlled trials （RCT） on the effects of oral motor intervention on the neurobehavioral development of premature infants were retrieved from PubMed，EMbase，Web of Science，the Cochrane Library，CNKI，WanFang Database，Chinese Medical Journal Full Text Database，and VIP.The time limit was from the establishment of the database to April 14，2023.According to the inclusion and exclusion criteria of the literature，two researchers independently screened the literature，extracted data，and evaluated the risk of bias in the included studies.Meta-analysis was performed using RevMan 5.3 software.Results：A total of 7 RCTs were included，involving 746 premature infants.Meta-analysis results showed that the intervention group′s Neonates Behavioral Nerve Assessment（NBNA） score was （MD=2.32，95%CI 1.13-3.51，Plt;0.001）.The intervention group′s score on the Psychomotor Development Index （PDI） was （MD=6.44，95%CI 1.62-11.26，P=0.009），which was higher than that of the control group.At 3 months of corrected gestational age and 6 months of corrected gestational age，the proportion of normal nervous system development in the intervention group was higher than that of the control group （corrected to 3 months of age（OR=2.17，95%CI 1.38-3.41，Plt;0.001）;corrected to 6 months of age（OR =2.80，95%CI 1.69-4.64），Plt;0.001）.Conclusions：The existing evidence shows that oral motor intervention can promote the neurobehavioral development of premature infants and improve short-term developmental outcomes effectively.

Keywords oral motor intervention;premature infants;neurobehavioral development;Meta-analysis;evidence-based nursing

摘要 目的：系統評價口腔運動干預對促進早產兒神經行為發育的有效性。方法：計算機檢索PubMed、EMbase、Web of Science、the Cochrane Library、中國知網、萬方數據庫、中華醫學期刊全文數據庫、維普數據庫，搜集關于口腔運動干預對早產兒神經行為發育影響的隨機對照研究（RCT），檢索時限為建庫至2023年4月14日。根據文獻納入與排除標準，由2名研究者獨立篩選文獻、提取數據并評價納入研究的偏倚風險，使用RevMan 5.3軟件進行Meta分析。結果：共納入7個RCT，涉及746例早產兒。Meta分析結果顯示：干預組新生兒行為神經測定NBNA量表得分［MD=2.32，95%CI（1.13，3.51），Plt;0.001］、心理運動發育指數（PDI）得分［MD=6.44，95%CI（1.62，11.26），P=0.009］高于對照組，至矯正胎齡3月齡和矯正胎齡6月齡時，干預組神經系統發育正常的比例高于對照組［矯正至3月齡：OR=2.17，95%CI（1.38，3.41），Plt;0.001；矯正至6月齡：OR=2.80，95%CI（1.69，4.64），Plt;0.001］。結論：當前證據顯示，口腔運動干預可促進早產兒神經行為發育，有效改善近期發育結局。

關鍵詞 口腔運動干預;早產兒;神經行為發育;Meta分析;循證護理

doi：10.12102/j.issn.2095-8668.2024.13.002

胎兒吸吮-吞咽功能的發展是一個程序化的過程。孕13周時胎兒出現早期吸吮能力，27～28周時開始出現有節律的非營養性吸吮（non-nutritive sucking，NNS），33～34周時出現高頻低壓的吸吮模式，34周后開始建立協調的吸吮-吞咽功能，直至40周時該功能才達到穩定平衡狀態［1］。因此，出生胎齡lt;34周的早產兒常由于吸吮-吞咽-呼吸功能不協調，出現喂養困難或吞咽障礙［2-3］。除了喂養問題，早產兒還面臨神經發育相關挑戰，存活早產兒神經發育高障礙率已成為全球主要的公共衛生問題［4］。研究顯示，出生胎齡越小的早產兒，神經發育障礙的風險越高［5］。……