The Clinical Studies Of Point Massage To Preventing And Treating Parenteral Nutrition Associated Cholestasis In Premature Infant

Objective:To Observe the influence of point massage to preventing and treating parenteral nutrition associated cholestasis in premature infant.Infants and Methods:1. InfantsPreterm infants from Neonatal Intensive Care Unit of fuzhou general hospital of nanjing military command between March2013and January2014were chosen.The gestational age these infants were28-33weeks,birth weight were1000-1499g,all of these infants need parenteral nutrition support.2. Parenteral nutrition (PN) support methodsAll infants were feed through mouth after admission,some of which intoleranting gastrointestinal nutrition or feeding through mouth can not meet the required calories for body70%of total calories or total calories less than100kcal/(kg·d),were given PN nutrition liquid. Parenteral nutrient solution contains glucose,pediatric compound amino acids,medium and long chain fat emulsion,water-soluble vitamins and fat-soluble vitamins,electrolytes,a variety of trace elements,using"all-in-one"with intravenous infusion pumps to maintain daily around20h above uniform input.The starting dose is80-100ml/(kg-d),the infants who placed in the infrared radiation or warmers blue light treatment adding10-20ml/kg on the base,according to the urine,skin elasticity and mental reaction,the dose was increased10-30ml/(kg-d) everyday,until140-180ml/kg.Born after24hours were injected with glucose,the infusion speed was increased gradually from3.5-4g/(kg-d) to8-10g/(kg-d),and the concentration of glucose was no more than12.5%;The initial dose of amino acid was lg/(kg-d),and increased gradually to3-3.5g/(kg-d);The fat milk was added in the second day,increased gradually from0.5-lg/(kg-d) to3g/(kg-d).According to the situation of infants with gastrointestinal tolerance,some were gradually transited to completely through the mouth to feed.3. Point massage methodPoint massage was done in the seventh day after admission,the operationtime was an hour later after feeding,15minutes per time,2times a day,10days for a period of treatment,treatment1course of treatment. In the supine position,before operation on the operation parts with cod liver oil as a lubricant,tonifying the spleen channel,liver channel,knead the Acu-point Laogong,Erma point,and Zusanli point.4. Observation targetThe observation target contained as follows,age,sex,gestational age,hospital days of age, birth weight,diagnosis,complications,mechanical ventilation,hepatitis series,TORCH,feeding and PN related content(fasting time,duration of PN,accumulation of amino acid dosage,the dosage of the lipid accumulation,calorie intake).Recording admission,the6th d,9th d,12th d,15th d,18th d,23rd d,28th d of biochemical indicators,including serum creatinine,blood urea nitrogen,total protein,albumin,serum TBIL,DBIL,TBA,GGT,ALP,AST, ALT.Results1. The incidence of premature PNAC was lower in observation group than control group,and duration of parenteral nutrition in observation group was shorter than the control group.Also in observation group the accumulation of amino acid dosage,the dosage of the lipid accumulation,calorie intake were less than the control group.2. Two groups of liver function were compared as follows,dynamic monitoring the index of biochemical detection,the peak of serum TBIL,DBIL,TBA,ALP,GGT,AST and ALT in observation group were lower than the control group.Through the analysis of variance of repeated measurement data:time factor to influence TBIL,DBIL and AST (P<0.01),and the point massage can reduce premature DBIL,GGT,ALP,AST and ALT, statistically significant (P<0.05),and interactions of the group was influential to TBA,DBIL and ALP (P<0.05).3. The growth and development indexes in in observation group were better than the control group.4. There were not skin damage,shock or other adverse reactions in the process of point massage. Conclusions1. Point massage can reduce the PN time and the occurrence of premature PNAC.2. Point massage can promote the mature of premature infants gastrointestinal function and establish, promote growth and development.3. Point massage was security and effective in premature infants.