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系統識別號 U0026-0812200913335425
論文名稱(中文) 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
論文名稱(英文) Relationships among heart rate variability, cardiorespiratory modulation, and feeding performance of preterm infants in the early period of oral feeding
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 95
學期 1
出版年 96
研究生(中文) 張雅雯
研究生(英文) Ya-Wen Chang
學號 t2693111
學位類別 碩士
語文別 中文
論文頁數 126頁
口試委員 口試委員-吳晉祥
口試委員-林其和
指導教授-張瑩如
中文關鍵字 餵食成效  心肺功能調節  口腔餵食過渡期  心率變異  口腔餵食早期  早產兒 
英文關鍵字 cardiorespiratory modulation  heart rate variability  the early period of oral feeding  preterm infants  the transitional period of oral feeding  feeding performance 
學科別分類
中文摘要 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功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功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功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功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,低高頻功率比值(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、心肺功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。
英文摘要 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.
論文目次 中文摘要...................................................................Ⅰ
英文摘要...................................................................Ⅲ
致謝.......................................................................Ⅴ
目錄.......................................................................Ⅵ
表目錄.....................................................................Ⅷ
圖目錄.....................................................................Ⅸ
附錄.......................................................................Ⅹ
第一章 緒論
第一節 研究動機及重要性..................................................1
第二節 研究問題..........................................................3
第三節 研究目的............................................................3
第二章 文獻查證
第一節 早產兒口腔餵食過渡期及影響餵食成效之因素..........................5
第二節 迷走神經活性.....................................................15
第三節 自主神經活性指標-心率變異.......................................18
第四節 自主神經系統與口腔餵食之關係.....................................25
第五節 早產兒心肺功能調節與口腔餵食之關係...............................29
第六節 研究架構.........................................................36
第七節 研究假設.........................................................37
第三章 研究方法
第一節 研究設計.........................................................38
第二節 名詞界定.........................................................38
第三節 研究對象.........................................................39
第四節 研究工具.........................................................40
第五節 資料收集過程.....................................................47
第六節 資料處理與統計分析方法...........................................52
第七節 倫理考量.........................................................55
第四章 研究結果
第一節 研究對象基本資料.................................................57
第二節 餵食過程的心率變異及心肺功能調節之變化...........................59
第三節 餵食過程的心率變異與餵食成效之相關...............................63
第四節 餵食過程的心肺功能調節與餵食成效之相關...........................66
第五節 餵食過程的心率變異與心肺功能調節之相關...........................67
第六節 餵食成效與心率變異之複迴歸分析...................................75
第五章 討論
第一節 餵食過程的心率變異及心肺功能調節之變化...........................80
第二節 餵食過程的心率變異與餵食成效之相關...............................82
第三節 餵食過程的心肺功能調節與餵食成效之相關...........................85
第四節 餵食過程的心率變異與心肺功能調節之相關...........................86
第五節 餵食成效與心率變異之複迴歸分析探討...............................92
第六章 結論與建議
第一節 結論.............................................................94
第二節 臨床應用.........................................................97
第三節 研究限制.........................................................99
第四節 未來研究方向.....................................................99
第七章 參考文獻..........................................................102
表 目 錄
表4-1-1 本研究對象的基本資料表............................................58
表4-2-1 口腔餵食過程期間(餵食前基準值、餵食中、餵食後)的HRV重複測量變異數
分析......................................................................60
表4-2-2 口腔餵食過程期間(餵食前基準值、餵食中、餵食後)的心肺功能調節重複
測量變異數分析............................................................60
表4-3-1 餵食前的HRV與餵食成效之Pearson相關係數............................63
表4-3-2 餵食中的HRV與餵食成效之Pearson相關係數............................64
表4-3-3 餵食前至中的HRV變化情形與餵食成效之Pearson相關係數................65
表4-4-1 餵食過程的心肺功能調節與餵食成效之Pearson相關係數.................66
表4-5-1 餵食前的HRV與其心肺功能調節之Pearson相關係數......................67
表4-5-2 餵食中的HRV與其心肺功能調節之Pearson相關係數......................68
表4-5-3 餵食後30分鐘內平均HRV與其平均心肺功能調節之Pearson相關係數........68
表4-5-4 餵食前HRV與餵食中心肺功能調節之Pearson相關係數....................69
表4-5-5 餵食前HRV與餵食後心肺功能調節之Pearson相關係數....................70
表4-5-6 餵食前HRV與餵食前至中、中至後心肺功能調節變化情形之Pearson相關係數71
表4-5-7早產兒疾病特性或不同外在環境等變數下其餵食中的SpO2、HRV指標之t檢定.73
表4-5-8 有、無呼吸道疾病早產兒的餵食中HRV與餵食中SpO2之Pearson相關係數....74
表4-6-1 餵食成效與HRV指標之Pearson相關係數................................75
表4-6-2 口腔餵食時間的逐步迴歸分析........................................76
表4-6-3 修正後口腔餵食時間的逐步迴歸分析..................................76
表4-6-4 總吸吮量百分比的逐步迴歸分析......................................77
表4-6-5 每分鐘平均吸吮量的逐步迴歸分析....................................78
表4-6-6 修正後每分鐘平均吸吮量的逐步迴歸分析..............................78
表4-6-7 餵食成效之複迴歸方程式............................................79
表6-1-1 本研究假設與研究結果對照表........................................96
圖 目 錄
圖2-6-1 早產兒在口腔餵食早期之HRV、心肺功能調節與其餵食成效的關係研究概念架
構圖......................................................................36
圖3-5-1 資料收集流程......................................................51
圖4-2-1 口腔餵食前、中、後的RRI、LF/HF量測平均值之變化圖..................61
圖4-2-2 口腔餵食前、中、後的HR、SpO2量測平均值之變化圖....................62
附 錄
附錄一 人體試驗委員會同意臨床試驗證明書..................................115
附錄二 早產兒之基本資料表................................................116
附錄三 研究記錄表........................................................118
附錄四 新生兒疾病嚴重度評估表............................................122
附錄五 早產兒行為狀態量表................................................124
附錄六 研究過程中出現危險徵象的緊急保護措施..............................126
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