基于循证的多感官刺激对住院早产儿脑功能发育的影响

doi:10.12372/jcp.2025.24e0491

摘要/Abstract

摘要：

目的探讨多感官刺激对住院早产儿脑功能发育的效果，为临床实践提供参考。方法将80例30~33⁺⁶周的住院早产儿随机分为两组，对照组仅对早产儿实施常规护理，包括严密观察、营造适宜环境、保暖与预防感染等措施；干预组在常规护理基础上每日接受包括播放母亲的声音、抚触、红球视觉刺激和舌前部滴喂母乳在内的多感官刺激，干预周期为14天。结果两组早产儿和母亲的基线资料差异无统计学意义（P>0.05），将干预前后的两组早产儿行为神经评估（NBNA）评分、振幅整合脑电图（aEEG）结果进行比较，差异有统计学意义（P<0.05）。结论对早产儿进行多感官刺激可有效改善患儿脑功能发育。

关键词: 多感官刺激, 早产儿, 脑功能发育, 发育支持性护理

Abstract:

Objective To investigate the effect of multisensory stimulation on the brain function development of hospitalized preterm infants and provide references for clinical practice. Methods preterm infants with a gestational age of 30 to 33⁺⁶ weeks were randomly divided into two groups. The control group was only given routine care for preterm infants, including close observation, creating a suitable environment, maintaining warmth, and preventing infections. The intervention group received multi-sensory stimulation daily on the basis of routine care, including playing the mother's voice, touching, red ball visual stimulation, and droplet feeding of breast milk on the anterior part of the tongue. The intervention period was 14 days. Results There was no statistically significant difference between the baseline data of preterm infants and mothers in the two groups (P >0.05), and the comparison of the NBNA scores and aEEG results before and after the intervention showed statistically significant differences (P<0.05). Conclusion Multisensory stimulation for preterm infants can effectively improve the brain function development of the infants.

Key words: multisensory stimulation, premature infants, brain function, development supportive care

雷青, 雷小平, 李娜, 王娅鑫, 佘桂芳, 孙鸿燕. 基于循证的多感官刺激对住院早产儿脑功能发育的影响[J]. 临床儿科杂志, 2025, 43(4): 257-263.

LEI Qing, LEI Xiaoping, LI Na, WANG Yaxin, SHE Guifang, SUN Hongyan. The effect of evidence-based multisensory stimulation on brain function development in hospitalized premature infants[J]. Journal of Clinical Pediatrics, 2025, 43(4): 257-263.

图/表 6

表1

多感官刺激干预方案"

干预主题	干预内容
实践者培训	1. 在干预开始前，参与人员需经过系统的培训，包括随机分组人员、干预实施者、结局指标收集者，培训结束后进行理论和操作考核，由专科护士带教老师、医师进行实践指导。
人员分工	2. 1名成员负责与家属联系，邀请家属参与并配合本研究，详细介绍研究目的、意义并签署知情同意书，指导并收集母亲的录音音频、母乳，并将母乳进行统一冷冻保存。
	3. 1名受培训的干预实施者专门负责触觉刺激，确保干预一致性。
干预时间	4. 选择12∶00喂奶前的30 min，避开护理操作，共干预14 d。
干预前准备	5. 环境准备。室内应保持安静清洁，光线柔和，室温在24~26 ℃，湿度为55%~65%，按摩时做好早产儿的保暖工作。
	6. 人员准备。干预人员放松心情，穿着清洁衣物、佩戴口罩；按摩时手部需保持温暖并消毒。
	7. 用物准备。避免交叉感染，播放设备、玩具均消毒处理。
操作方法	8. 听觉刺激。为早产儿播放母亲的录音音频（唱儿歌、讲故事或轻柔的说话声），将播放设备放于距离早产儿20 cm处，于耳处测量音量为45~55 dB，且背景噪声<45 dB，持续15 min。
	9. 触觉刺激。干预操作者手部保持温暖并消毒双手，按头面部、胸腹部、上肢、下肢和背部的顺序，每个部位持续10 s，采用中等压力（颜色由粉红轻微变白），干预8 min。
	10. 视觉刺激。早产儿安静觉醒时，用红球进行视觉追视或人脸视觉接触，距离早产儿20 cm处，间歇性引导患儿目光在水平或前后方向移动，不超过3 min。（注：视觉刺激时不会持续对患儿进行刺激，红球和目光接触交替进行）
	11. 味觉刺激。母乳使用前水浴加热至38~40℃，用无菌注射器注射1 mL缓慢滴于舌前部。
注意事项	12. 干预过程需人员在场监护，若出现呕吐或有呕吐迹象、拱背、哭闹、肤色改变等不耐受情况要及时停止干预。
	13. 音乐设备需提前测试，确保不会对监护仪和呼吸机等设备造成干扰。

表1

表2

表3

表4

图1

表5

参考文献 27

[1]	Ohuma EO, Moller AB, Bradley E, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis[J]. Lancet, 2023, 402(10409): 1261-1271. doi: 10.1016/S0140-6736(23)00878-4 pmid: 37805217
[2]	Kanagasabai PS, Mohan D, Lewis LE, et al. Effect of multisensory stimulation on neuromotor development in preterm infants[J]. Indian J Pediatr, 2013, 80: 460-464. doi: 10.1007/s12098-012-0945-z pmid: 23288407
[3]	国家卫生计生委办公厅关于印发早产儿保健工作规范的通知[EB/OL]. [2023-11-26]. http://www.nhc.gov.cn/fys/s3585/201703/d5656db4e43a49ff9d14470864b0fb16.shtml.
	Notice of the General Office of the National Health and Family Planning Commission on Issuing the Norms for the Health Care of Premature Infants[EB/OL]. [2023-11-26]. http://www.nhc.gov.cn/fys/s3585/201703/d5656db4e43a49ff9d14470864b0fb16.shtml.
[4]	Aranha VP, Chahal A, Bhardwaj AK. A randomized controlled trial protocol in modifying neuromotor behavior of hospitalized preterm neonates using multi-modal stimulations: MMS trial[J]. J Pediatr Rehabil Med, 2022, 15(3): 459-468.
[5]	Aranha VP, Chahal A, Bhardwaj AK. Short-term effects of multimodal stimulation on neuromotor behaviour and neonatal pain among hospitalized preterm infants: A feasibility, non-blinded randomized controlled trial[J]. J Neonatal Perinatal Med, 2023, 16(2): 325-337.
[6]	郑倩倩. 五行音乐疗法联合袋鼠式护理对早产儿体格发育和神经发育的影响[D]. 华北理工大学, 2022.
	Zheng QQ. Effects of Five-element music therapy combined with kangaroo care on physical development and behavioral neurodevelopment in premature infants[D]. North China University of Science and Technology, 2022.
[7]	雷青, 雷小平, 佘桂芳, 等. NICU中住院早产儿多感官刺激的最佳证据总结[J]. 护理学报, 2024, 31(10): 48-52.
	Lei Q, Lei XP, She GF, et al. Best evidence summary of multi-sensory stimulation in hospitalized premature infants[J]. Huli Xuebao, 2024, 31(10): 48-52.
[8]	新生儿行为神经研究协作组, 鲍秀兰, 虞人杰, 等. 新生儿20项行为神经测定在窒息儿的临床应用[J]. 中国优生优育, 1992(3): 116-119.
	Collaborative Group for Neonatal Behavioral and Neurological Research, Bao XL, Yu RJ, et al. Clinical application of the 20-item neonatal behavioral neurological assessment in asphyxiated infants[J]. Zhongguo Yousheng Youyu, 1992(3): 116-119.
[9]	Burdjalov VF, Baumgart S, Spitzer AR. Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates[J]. Pediatrics, 2003, 112(4): 855-861. pmid: 14523177
[10]	姚丽平, 李燕, 韦秋芬, 等. 早期神经发展计划对早产儿神经发育影响的前瞻性研究[J]. 中华妇幼临床医学杂志(电子版), 2020(5): 590-596.
	Yao LP, Li Y, Wei QF, et al. Early neurodevelopment plan for premature infants has positive effects on neurodevelopment: a prospective study[J]. Zhonghua Fuyou Linchuang Yixue Zazhi(Dianziban), 2020(5): 590-596.
[11]	Benders MJ, Palmu K, Menache C, et al. Early brain activity relates to subsequent brain growth in premature infants[J]. Cereb Cortex, 2015, 25(9): 3014-3024. doi: 10.1093/cercor/bhu097 pmid: 24867393
[12]	Wikström S, Pupp IH, Rosén I, et al. Early single-channel aEEG/EEG predicts outcome in very preterm infants[J]. Acta Paediatr, 2012, 101(7): 719-726.
[13]	Bonjorn JM, Manrique PM, Grau AL, et al. Reduction of visual and auditory stimuli to reduce pain during venipuncture in premature infants. Study protocol for a randomized controlled trial[J]. J Adv Nurs, 2020, 76(4): 1077-1081. doi: 10.1111/jan.14300 pmid: 31865625
[14]	Zhang D, Liu Y, Hou X, et al. Reference values for amplitude-integrated EEGs in infants from preterm to 3.5 months of age[J]. Pediatrics, 2011, 127(5): e1280-e1287.
[15]	Soubasi V, Mitsakis K, Nakas CT, et al. The influence of extrauterine life on the aEEG maturation in normal preterm infants[J]. Early Hum Dev, 2009, 85(12): 761-765. doi: 10.1016/j.earlhumdev.2009.10.004 pmid: 19919892
[16]	Provasi J, Blanc L, Carchon I. The importance of rhythmic stimulation for preterm infants in the NICU[J]. Children (Basel), 2021, 8(8): 660.
[17]	王瑜. 袋鼠式护理对早产儿脑功能、行为神经发育、反复操作性疼痛的影响[D]. 西南医科大学, 2020.
	Wang Y. The effect of Kangaroo mother care on brain function, neurobehavior and repeated procedural pain in premature infants[D]. Southwest Medical University, 2020.
[18]	周麟, 吴作天, 王高华, 等. 母婴分离对神经发育和抑郁症发生发展的影响及相关机制研究[J]. 临床精神医学杂志, 2021, 31(1): 3.
	Zhou L, Wu ZT, Wang GH, et al. Effects of maternal separation on neurodevelopment and depression and its related mechanisms[J]. Linchuang Jingshen Yixue Zazhi, 2021, 31(1): 3.
[19]	Mota-Rojas D, Bienboire-Frosini C, Marcet-Rius M, et al. Mother-young bond in non-human mammals: Neonatal communication pathways and neurobiological basis[J]. Front Psychol, 2022, 13: 1064444.
[20]	Yu W, Chiang M, Lin K, et al. Effects of maternal voice on pain and mother-infant bonding in premature infants in Taiwan: a randomized controlled trial[J]. J Pediatr Nurs, 2022, 63: e136-e142.
[21]	Pineda R, Wallendorf M, Smith J. A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant[J]. Early Hum Dev, 2020, 144: 105000.
[22]	Tang X, Sha S, Shen N, et al. Multisensory stimulation bundles on sleep and neurobehavioral development in the first year after birth in very preterm infants: a randomized crossover controlled study protocol[J]. Trials, 2023, 24(1): 732. doi: 10.1186/s13063-023-07753-8 pmid: 37964365
[23]	聂玲, 孙小玲, 蒋玲, 等. NICU早产儿睡眠保护的最佳证据总结[J]. 中华护理杂志, 2023, 58(12): 1449-1455. doi: 10.3761/j.issn.0254-1769.2023.12.006
	Nie L, Sun XL, Jiang L, et al. Summary of best evidence of sleep protection for premature infants in NICU[J]. Zhonghua Huli Zazhi, 2023, 58(12): 1449-1455.
[24]	Sharma N, Samuel AJ. Multisensory stimulation and soft tissue therapy on pain and neurodevelopment among preterm neonates[J]. Pediatr Phys Ther, 2022, 34(2): 277-282. doi: 10.1097/PEP.0000000000000887 pmid: 35385466
[25]	Neel ML, Yoder P, Matusz PJ, et al. Randomized controlled trial protocol to improve multisensory neural processing, language and motor outcomes in preterm infants[J]. BMC Pediatr, 2019, 19(1): 81. doi: 10.1186/s12887-019-1455-1 pmid: 30890132
[26]	Kostandy RR, Ludington-Hoe SM. The evolution of the science of kangaroo (mother) care (skin-to-skin contact)[J]. Birth Defects Res, 2019, 111(15) :1032-1043. doi: 10.1002/bdr2.1565 pmid: 31419082
[27]	刘维民, 鲍秀兰, 马磊, 等. 早期干预降低极低出生体重儿脑瘫发生率的临床研究[J]. 中国儿童保健杂志, 2015, 23(4): 360-363. doi: 10.11852/zgetbjzz2015-23-04-08
	Liu WM, Bao XL, Ma L, et al. Clinical study on early intervention to reduce cerebral palsy incidence in very low birth weight children[J]. Zhongguo Ertong Baojian Zazhi, 2015, 23(4): 360-363.

项目	对照组（n=35）	干预组（n=36）	统计量	P
男[n(%)]	20（57.14）	22（61.11）	0.12	0.734
单胎[n(%)]	26（74.29）	24（66.67）	0.50	0.482
出生胎龄( x±s)/d	221.69±6.09	220.83±7.97	0.51	0.615
出生体重( x±s)/g	1 573.80±243.93	1 569.50±262.72	0.07	0.943
入组日龄( x±s)/d	2(1,3)	2(1,3)	0.15	0.883
5分钟Apgar评分[M(P₂₅~P₇₅)]/分	9（8~9）	9（9~9）	1.31	0.191
使用PS治疗[n(%)]	23（65.71）	18（50.00）	1.80	0.180

项目	对照组（n=35）	干预组（n=36）	统计量	P
年龄( x±s)/岁	29.71±5.68	30.67±4.76	0.77	0.446
受孕方式[n(%)]			0.66	0.417
自然受孕	29（82.86）	27（75.00）
人工受孕	6（17.14）	9（25.00）
分娩方式[n(%)]			1.13	0.288
阴道分娩	17（48.57）	13（36.11）
剖宫产	18（51.43）	23（63.89）
产前使用青霉素[n(%)]			0.68	0.411
是	19（54.29）	23（63.89）
否	16（45.71）	13（36.11）
产前使用糖皮质激素[n(%)]			0.84	0.358
是	25（71.43）	22（61.11）
否	10（28.57）	14（38.89）
定期产检[n(%)]			0.13	0.717
是	28（80.00）	30（83.33）
否	7（20.00）	6（16.67）
妊娠期并发症[n(%)]	10（28.57）	8（22.22）	0.38	0.539
有	10（28.57）	8（22.22）
无	25（71.43）	28（77.78）

组别	例数	第1天	第7天	第14天
对照组	35	29.83±1.42	30.97±1.34	32.34±1.14
干预组	36	29.64±1.44	32.25±1.25	33.92±1.20
t值		0.56	4.16	5.66
P		0.578	<0.001	<0.001

组别	例数	aEEG总分	上边界/mV	下边界/mV	带宽
对照组	35	10.37±1.29	25.34±1.28	9.03±0.82	16.31±1.47
干预组	36	11.33±1.24	24.86±1.48	9.56±0.91	15.31±1.74
t值		3.21	1.47	2.56	2.64
P		0.002	0.147	0.013	0.010