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系統識別號 U0026-2312200909324200
論文名稱(中文) 比較母乳成份與早產兒餵食新鮮母乳及解凍母乳反應之差異
論文名稱(英文) Changes of components between fresh and frozen-thawed human milk and physiological-behavior parameters in premature infants feeding with fresh and frozen-thawed human milk.
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 98
學期 1
出版年 98
研究生(中文) 洪筱瑩
研究生(英文) Hsiao-Ying Hung
電子信箱 i2488133@hotmail.com
學號 t2696406
學位類別 碩士
語文別 中文
論文頁數 95頁
口試委員 指導教授-張瑩如
口試委員-許玉雲
口試委員-陳淵國
中文關鍵字 母乳  早產兒  酸敗  酸價  游離脂肪酸  進食暗示行為 
英文關鍵字 human milk  premature infants  acidification  free fatty acid  acid degree value  feeding cues 
學科別分類
中文摘要 母乳是早產兒最佳的營養來源,但臨床上發現,新鮮母乳與解凍母乳有風味之差異,當早產兒進食解凍母乳時出現無法全量口腔進食的情形,此種現象雖常被發現,但過去少有研究探討。故本研究目的分成兩部份,(1)探討新鮮母乳與冷凍7天、30天解凍母乳成份差異(2)比較早產兒進食新鮮母乳與解凍母乳時之生理與行為反應差異。
第一部份研究為比較性研究設計,以滾雪球方式收集10位健康母親母乳,以進行新鮮與解凍母乳脂肪、蛋白質、酸價和游離脂肪酸成份分析比較。第二部份研究為自我交叉研究設計,以立意取樣,選取自南部某醫學中心中符合收案條件早產兒共18名,在其出院前ㄧ週任選一天隨機分配新鮮母乳與解凍母乳於連續兩餐給予餵食,餵食過程中收集嬰兒進食暗示行為、心跳及血氧飽和濃度。
研究結果發現解凍母乳隨著儲存時間其酸價、游離脂肪酸有上升趨勢,
解凍母乳出現酸敗現象,冷凍7天之解凍母乳其酸價含量已達酸敗風味感官閾值,冷凍30天之解凍母乳其游離脂肪酸含量更高,且解凍母乳發生上下分層的情形,脂肪多分佈於上層、蛋白質分佈於下層;並發現早產兒餵食解凍母乳其壓力暗示行為發生次數大於餵食新鮮母乳時(p=.007),而矯正週數大於36週之早產兒餵食解凍母乳其心跳總變化事件發生次數大於餵食新鮮母乳時(p=.021)。
母乳隨著冷凍儲存時間而產生酸敗的現象,且早產兒進食解凍母乳會出現更多的壓力暗示行為與心跳變化事件,故建議衛教母親學習辨識早產兒進食暗示行為,而當發現早產兒出現拒食解凍母乳之行為時,建議改以乳房哺育、或建議冷凍母乳儘量於7天內食用,並避免冷凍儲存超過30天,或將母乳進行熱處理後再冷凍儲存,以促進早產兒餵食之舒適愉悅感,避免增加不必要之壓力。
英文摘要 Human milk is the optimal nutrient for premature infants. From clinical observation, however, infants might refuse the frozen-thawed breast milk because of altered odor. Nurses might be misled with infants’ stress cues resulted from unpleasant odor of human milk and consider them as responses of disorganized suck-swallow-breathe patterns. Little study has investigated this phenomenon. Therefore, purposes of this study were a) to compare the differences of composition between fresh and frozen-thawed human milk, and b) to compare the differences of physiological and behavior parameters of premature infants when fed with fresh and frozen-thawed human milk respectively.
Two studies were conducted. The first study was a comparative design. The human milk gathering from ten volunteer healthy mothers recruited from snowball sampling were divided into three groups of fresh, frozen for 7 days, and frozen for 30 days. The concentration of fat, protein, acid degree value, and free fatty acid were analyzed in a laboratory. The second study used a cross-over design. Eighteen stable premature infants ready for discharge were recruited by purposive sampling in a level II nursery of a tertiary care center of southern Taiwan Infants were fed with fresh and frozen-thawed human milk randomly in two consecutive meals. The infant cues, heart rate, and oxygen saturation (SpO2) during feeding were recorded.
Results of this study showed that 1) the concentration of free fatty acid and acid degree value increased during frozen storage. The acid degree value of 7-day frozen-thawed human milk has reached the threshold of unpleasant lipolyzed flavor. The concentration of free fatty acid was even higher in 30-day frozen-thawed human milk. Meanwhile, the frozen-thawed human milk showed two layer, fat rose up and protein agglutinated down. 2) premature infants revealed more stressful feeding cues when fed with frozen-thawed human milk than fresh ones (p=.007). Moreover, as to the postmenstrual age greater than 36 weeks, the total counts of heart rate change in feeding with frozen-thawed human milk were higher than fresh ones (p=.021).
This study showed that the human milk progressed acidification by frozen time, and premature infants with the postmenstrual age greater than 36 weeks revealed more stressful responses and heart rate changes when taking frozen-thawed human milk. We suggest that when the preterm infants showed stressful cues during feeding, and mother should alter ways to feed human milk, such as direct breastfeeding, or feed the human milk frozen no more than 7 days. The human milk should prevent from frozen over 30 days. Frozen milk after heat treatment could be an alternative strategy to prevent increase of free fatty acid and acid degree value.
論文目次 中文摘要 Ⅰ
英文摘要 Ⅱ
致謝 Ⅳ
目錄 Ⅵ
表目錄 Ⅶ
圖目錄 Ⅷ

第一章 研究動機與重要性 1
第二章 文獻查證 3
第一節 早產兒嗅覺、味覺之發展 3
第二節 乳品味道的改變 7
第三章 研究方法 13
壹、新鮮母乳與解凍母乳成分之差異 13
第一節 研究問題與目的 13
第二節 研究架構 14
第三節 研究設計 14
第四節 研究對象與場域 15
第五節 研究工具 16
第六節 資料收集過程 20
第七節 倫理考量 23
第八節 資料處理與分析方法 24
貳、早產兒進食新鮮母乳與解凍母乳時行為與生理反應之差異 25
第一節 研究問題與目的 25
第二節 研究架構 26
第三節 研究設計 27
第四節 研究對象與場域 27
第五節 研究工具 28
第六節 資料收集過程 34
第七節 倫理考量 36
第八節 資料處理與分析方法 38
第四章 研究結果 41
壹、新鮮母乳與解凍母乳成分之差異 41
貳、早產兒進食新鮮母乳與解凍母乳時生理與行為反應之差異 49
第五章 討論 63
第六章 結論與建議 78
第七章 參考資料 81
表目錄

表一 早產兒進食暗示譯碼系統 31
表二 新鮮、冷凍7天與30天母乳粗脂肪、粗蛋白、酸價及游離脂肪酸成份組成 42
表三 不同冷凍天數母乳上下層粗脂肪含量百分比之比較 42
表四 新鮮母乳與冷凍母乳上層粗脂肪含量百分比之比較 43
表五 不同冷凍天數母乳上下層粗蛋白含量百分比之比較 44
表六 新鮮母乳與冷凍母乳酸價之比較 45
表七 新鮮母乳與冷凍母乳游離脂肪酸之比較 46
表八 新鮮母乳與不同冷凍天數母乳游離脂肪酸各成份組成 47
表九 新鮮母乳與不同冷凍天數母乳游離脂肪酸之葵酸比較 47
表十 新鮮母乳與不同冷凍天數游離脂肪酸之月桂酸比較 48
表十一 早產兒個案基本資料 49
表十二 早產兒餵食新鮮母乳與解凍母乳生理反應之比較 50
表十三 不同矯正年齡週數早產兒餵食新鮮母乳與解凍母乳生理反應之比較51
表十四 早產兒餵食新鮮母乳與解凍母乳之進食暗示行為表現 54
表十五 早產兒餵食新鮮母乳與解凍母乳進食暗示行為之比較 56
表十六 不同矯正年齡週數早產兒餵食新鮮母乳與解凍母乳進食暗示行為之比較 57
表十七 早產兒餵食新鮮母乳與解凍母乳暫停吸奶及間歇-斷續吸奶動作之比較 58
表十八 不同餵食順序早產兒餵食新鮮母乳與解凍母乳生理反應之比較 60
表十九 不同餵食順序早產兒餵食新鮮母乳與解凍母乳行為反應之比較 61
圖目錄
圖一 母乳成份改變之研究架構圖 14
圖二 GC儀器設備簡圖 20
圖三 母乳資料收集流程圖 22
圖四 早產兒餵食反應之研究架構圖 26
圖五 早產兒餵食反應資料收集流程圖 36
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