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                      • 小兒推拿網(小兒按摩網)
                      • 育兒教育與服務,小兒推拿第一品牌
                      您的位置:首頁 >> 小兒推拿療效報告--新生兒推拿 >> 經絡穴位推拿對新生兒黃疸影響的臨床觀察

                      經絡穴位推拿對新生兒黃疸影響的臨床觀察


                      《浙江臨床醫學》     2008年第10期

                       

                      小兒推拿網LOGO

                      育兒教育與服務   小兒推拿領導品牌

                      浙江省中醫院 江海淵

                      【關鍵詞】新生兒黃疸 經絡穴位按摩

                      新生兒黃疸分生理性黃疸和病理性黃疸。生理性黃疸大多在生后2~3天出現,4~6天達高峰,7~10天消退。若黃疸出現早,并日漸加深或兼有其他癥狀者,則為病理性黃疸,嚴重者可致膽紅素腦病。延遲喂養、胎糞排出較晚等可加重生理性黃疸,因此早期干預治療十分重要。

                      作者對2007年6月至12月出生的足月正常新生兒進行經絡穴位推拿,以觀察對新生兒黃疸的影響。報告如下。

                      1、臨床資料

                      1.1 一般資料

                      120例新生兒中男64例,女56例;胎齡37~42周,出生體重2450~4230g,出生時Apgar評分8~10分。按出生時間順序隨機分為干預組(經絡穴位推拿組、A組)和對照組(B組),兩組性別、體重、胎齡各項指標比較均無顯著性差異,具有可比性。

                      1.2 方法

                      A組新生兒在生后第1天開始進行經絡穴位推拿,每日由經過陪訓的護理人員進行操作,2次/天。

                      (1)推拿應在哺乳前30分鐘或哺乳后60分鐘,室溫控制在26~28℃。

                      (2)要求手法輕柔,定位準確,力度合適。

                      (3)經絡推拿手法:補脾經、清肝經、清大腸、揉腹各200次。

                      補脾經:位于拇指末節羅紋面,順時針方向旋推;清肝經:位于食指末節羅紋面,食指伸直,由指端向指根方向直推;清大腸:位于食指橈側緣,自食指端至虎口呈一直線,由虎口向食指端直推;揉腹:順時針繞臍周按揉腹部。  

                      若大便干,則補脾經減少,清肝經增加,清大腸增加。若大便爛,則補脾經增加,清肝經減少,補大腸增加(清大腸反向操作即為補大腸),并逆時針揉腹。出院后由經過培訓的家屬繼續操作,護士遠期隨訪,觀察和記錄,B組不做任何按摩。

                      1.3 觀察指標

                      使用寧波戴維醫療器械有限公司生產的JH20-1經皮黃疸儀,每天上午由專人負責測定,測定時取新生兒前額正中,眉上方1cm處為測定點,連測3次,取平均值[經皮測膽紅素(TCB)讀數與血清膽紅素(SB)濃度呈密切正相關,TCB與SB之間有良好的相關關系][1]。同時觀察新生兒開始排胎便時間、排便次數、排黃便時間。并與未做經絡穴位按摩的B組比較。

                      1.4 統計學處理

                      計量資料以(x±s)表示,采用χ2檢驗和t檢驗。

                      2、結果 

                      A組TCB值、胎便排空時間、每日排便次數與B組比較均有顯著性差異,見表1。

                      表1  兩組新生兒排便情況比較(略)

                      表2  兩組新生兒出生6d內經皮測黃疸指數比較(略)

                      3、討論    

                      新生兒黃疸是新生兒最常見的一種臨床現象,由于膽紅素產生過多,肝臟攝取或結合膽紅素功能低下,膽汁排泄障礙,腸肝循環增加等多種因素所致。中醫稱之為“胎黃”,“胎疸”,臨床上以“陽黃”多見,由于孕母素蘊濕熱之毒,遺于胎兒,或因小兒稟賦不足,脈絡阻滯,或濕熱蘊結肝經日久,氣血郁阻,脾運不健,以致蘊生黃疸[2]。如《張氏醫通·黃疸》說:“諸黃雖多濕熱,然經脈久病,不無瘀血阻滯也。”     

                      經絡是人體運行氣血的通路。它“內屬于臟腑,外絡于肢節”,遍布全身[3]。通過對新生兒進行補脾經、清肝經、清大腸、揉腹的經絡穴位推拿,刺激機體表面的感受器,滋陰清熱、消除積滯。通過兩組新生兒的比較,可見A組的新生兒皮測黃疸指數明顯低于B組,有統計學意義(P<0.05,P<0.01)。

                      結果說明,經絡穴位推拿可顯著降低新生兒黃疸指數,促進新生兒排出胎便,明顯降低新生兒高膽紅素血癥的發生率。盡早地讓新生兒接受經絡穴位推拿,能使新生兒生理性黃疸時間明顯縮短,對新生兒腹脹,大便不解等問題也有很好的作用。

                      同時,經絡穴位推拿能促進新生兒免疫系統的發育,使新生兒防病能力增加。

                      【參考文獻】  

                      1 辛建梅,趙曉艷,秦仲達. 經皮測膽紅素對新生兒黃疸的臨床分析. 西北民族大學學報,2004,25(53):83.

                      2 汪受傳主編. 中醫兒科學. 北京:人民衛生出版社,2007.237;239.

                      3 孫秋華,沈勤,主編. 中醫護理健康教育. 杭州:浙江科學技術出版社,2005.37.

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