Page 48 - 2023-02-中国全科医学

2023年1月 第26卷 第2期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·169·

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Corresponding author：WEI Qin，Chief superintendent nurse；E-mail：weiqin103@126.com
【Abstract】 Background The prevalence of neurodevelopmental disorders in premature infants is high，and
there is an urgent need to improve neurodevelopmental outcomes of them. There are few reports on amplitude-integrated
electroencephalography （aEEG）-assessed effect of multisensory （MS） interventions on brain function of premature infants
by aEEG. Objective To evaluate the effect of MS interventions on improving brain function of premature infants. Methods A
single-center，randomized controlled trial was conducted. One hundred and twenty-six premature infants who were admitted to
Department of Pediatrics，the First Affiliated Hospital of Guangxi Medical University from October 2020 to September 2021 were
selected and randomly divided into control group （n=63） and intervention group （n=63）by random numbers according Excel.
Both groups received routine treatment and nursing care，the intervention group additionally received MS interventions developed
by our team （including auditory，tactile，visual and vestibular interventions），twice a day，15 minutes each time. The time
of intervention lasted for at least 7 days for both groups. Before and 7 days after the intervention，the lower boundary voltage，
bandwidth，and aEEG score during the quiet sleep （QS） period and active sleep（AS） period，average time and total time
of QS period were monitored by AEEG. The Neonatal Behavioral Neurological Assessment （NBNA） was used to evaluate the
neurobehavior. The Gesell Developmental Schedules （GDS） was used to evaluate the development quotient at the corrected age
of one month. Results 119 premature infants completed the study，including 59 cases in the control group and 60 cases in the
intervention group. Seven days after intervention，intervention group had higher lower boundary voltage〔（5.47±0.92）μV
vs（5.10±0.87）μV〕and narrower bandwidth〔（18.90±1.90）μV vs （19.78±2.50）μV〕 during QS period than the
control group（P<0.05）. Moreover，intervention group also demonstrated higher lower boundary voltage〔（7.63±0.97）μV
vs（7.21±1.00）μV〕 and narrower bandwidth〔（13.93±2.61）μV vs（14.94±2.58）μV〕 during AS period（P<0.05）.
After 7 days of intervention，intervention group had higher total score of aEEG 〔（10.45±2.18）vs（9.53±1.91）〕，and
higher item score of sleep-awakening cycle〔 （4.17±0.85）vs（3.80±0.85）〕，and broadband score 〔（2.90±0.75）
vs （2.59±0.72）〕 than control group（P<0.05）. However，there was no significant difference in item continuity and
lower boundary score between two groups in aEEG score（P>0.05）. Moreover，intervention group had longer average time of
QS period 〔（25.67±6.95） min vs（23.29±4.87） min〕 and longer total time of QS period 〔（62.80±18.89） min vs
（55.27±20.65） min〕 than control group （P< 0.05）. Intervention group also had higher total score of NBNA 〔（34.82±2.97）
vs （33.12±3.49）〕 （P< 0.05）. At the corrected age of one month，intervention group had higher developmental quotient
scores in terms of gross motor 〔（52.83±10.93） vs（48.83±10.11）〕，fine motor〔（51.67±11.05） vs （47.71±9.15）〕，
adaptive development 〔（55.28±11.65）vs（50.31±10.14）〕，language 〔（53.40±11.29） vs （49.41±9.82）〕 and
personal-social〔（53.57±10.57）vs（49.51±9.35）〕 than the control group （P<0.05）. Conclusion MS intervention
could facilitate the rise of lower boundary voltage，narrow the bandwidth and improve aEEG scores of preterm infants in QS period
and AS period，thus promoting the maturation of aEEG background activity and improving brain development. MS intervention
could also prolong the time of QS period and promote the development of brain function，improve the total scores of NBNA and
GDS，suggesting that the intervention could improve neurobehavioral development of preterm infants.
【Key words】 Brain diseases；Premature birth；Multisensory intervention；Neurodevelopmental disorders；Amplitude
integrated electroencephalogram；Electroencephalography；Neurobehavioral signs and symptoms；Randomized controlled trial

近年来，我国早产儿发生率呈逐年上升趋势，由 MS 干预能促进早产儿神经行为、经口喂养、体质量增
［1］
20世纪90年代的4%~5%逐渐上升至目前的7%~10% 。 长等 ［7-8］ ，但其对早产儿大脑功能发育、短期神经发育
随着新生儿医学的发展，早产儿生存率得到显著提高， 结局的影响仍未知。因此，本研究采用振幅整合脑电图
但发育迟缓、行为和社会问题以及感知障碍的发生率仍 （amplitude-integrated electroencephalogram，aEEG） 评
很高 ［2］ 。我国江苏省一项调查发现早产儿脑损伤患病 价 MS 干预后的脑电特征变化，期望 MS 干预改善早产
率高达 27.22% ［3］ 。早产儿神经发育问题将严重影响其 儿脑功能发育。
远期生活质量，给社会和家庭带来了沉重的心理及经济 1 资料与方法
负担 ［4］ 。多感官（multisensory，MS）干预以新生儿发 1.1 研究对象 选取 2020 年 10 月至 2021 年 9 月入住
育支持护理为理论基础，同时对两种或两种以上的感官， 广西医科大学第一附属医院新生儿科且符合研究条件的
如听觉、触觉、视觉等进行干预，旨在改善早产儿神经 早产儿为研究对象。纳入标准：（1）出生后 24 h 内转
发育结局 ［5］ 。早产儿仅出生几个小时就具备了识别多 入新生儿科；（2）32 周≤胎龄 <36 周；（3）1 500 g
［6］
种感官刺激的能力 ，其大脑发育具有可塑性和代偿性， ≤出生体质量 <2 500 g；（4）双耳通过听力筛查；（5）
这为早期 MS 干预奠定了神经生物学基础。研究表明， 双眼通过眼底检查；（6）早产儿父母年龄符合要求（父