基于IMB模型的中医摩腹疗法联合穴位贴敷对早产儿母乳性腹胀的防控效果研究

Study on the Prevention and Control Effect of Traditional Chinese Medicine Abdominal Massage Therapy Combined with Acupoint Application Based on IMB Model on Breast Milk-Induced Bloating in Premature Infants

摘要: 目的：本研究旨在系统评估基于信息–动机–行为技巧(Information-Motivation-Behavior, IMB)模型的中医摩腹疗法联合穴位贴敷对早产儿母乳性腹胀的防控效果，探索其在改善早产儿胃肠功能、提升喂养效率及优化护理实践中的应用价值。方法：选取2018年1月至2022年12月我院新生儿重症监护室(NICU)收治的母乳喂养早产儿120例为研究对象。采用计算机随机分组法将患儿分为对照组和观察组，每组60例。对照组接受常规护理干预，包括体位管理、标准化母乳微量喂养、每日两次腹部按摩及必要时肛管排气；观察组在常规护理的基础上，实施基于IMB模型的综合干预方案：1) 信息支持：通过视频及图文手册向家长宣教母乳性腹胀的病理机制及干预原理；2) 动机强化：每日记录喂养日志，由专科护士反馈患儿胃肠功能改善数据以增强家长依从性；3) 行为训练：由经统一培训的护理团队执行标准化操作，包括中医摩腹疗法及穴位贴敷。主要观察指标为腹胀发生率及缓解时间；次要指标包括日均喂养量、喂养耐受性、住院时间及家长护理满意度。结果：干预7天后，观察组腹胀发生率显著低于对照组(P = 0.004)，腹胀缓解时间较对照组缩短(P < 0.001)。观察组日均喂养量较对照组显著增加(P < 0.001)，喂养耐受性指标改善：胃潴留发生率(P = 0.039)、呕吐发生率(P = 0.042)。观察组平均住院时间较对照组缩短(P < 0.001)。观察组家长满意度评分显著优于对照组(P < 0.001)。安全性方面，两组患儿均未出现皮肤破损、过敏等不良事件，其中穴位贴敷局部皮肤反应发生率仅为1.67%，为1例轻微红斑，24小时内消退，这表明该综合干预方案具有较高的安全性，适用于NICU早产儿的临床护理实践。结论：基于IMB模型的中医摩腹疗法联合穴位贴敷通过信息赋能、动机强化与行为规范的三维干预，可显著降低早产儿母乳性腹胀的发生率，其机制可能与促进胃肠动力(摩腹疗法通过机械刺激激活肠神经丛)、调节肠道微生态(中药贴敷经皮吸收发挥行气导滞作用)及改善喂养模式(IMB模型提升家长照护能力)密切相关。

Abstract: Objective: This study aims to systematically evaluate the preventive and therapeutic effects of traditional Chinese medicine abdominal massage therapy combined with acupoint application based on the Information-Motivation-Behavior (IMB) model on breast milk-induced bloating in premature infants, and explore its application value in improving gastrointestinal function, enhancing feeding efficiency, and optimizing nursing practice in premature infants. Method: 120 breastfed premature infants admitted to the Neonatal Intensive Care Unit (NICU) of our hospital from January 2018 to December 2022 were selected as study subjects. The children were randomly divided into a control group and an observation group using computer randomization, with 60 cases in each group. The control group received routine nursing interventions, including position management, standardized breastfeeding, twice daily abdominal massage, and necessary anal emptying; on the basis of routine nursing, the observation group implemented a comprehensive intervention plan based on the IMB model: 1) Information support: Educating parents about the pathological mechanism and intervention principles of breast milk-induced bloating through videos and graphic manuals; 2) Motivation reinforcement: Daily feeding logs are recorded, and specialized nurses provide feedback on the improvement of gastrointestinal function in children to enhance parental compliance; 3) Behavioral training: Standardized procedures, including traditional Chinese medicine abdominal massage therapy and acupoint application, are performed by a nursing team that has undergone unified training. The main observation indicators are the incidence and relief time of abdominal distension; secondary indicators include daily feeding volume, feeding tolerance, length of hospital stay, and parental care satisfaction. Result: After 7 days of intervention, the incidence of abdominal distension in the observation group was significantly lower than that in the control group (P = 0.004), and the relief time of abdominal distension was shortened compared to the control group (P < 0.001). The daily average feeding amount in the observation group was significantly higher than that in the control group (P < 0.001), and the feeding tolerance index was improved: the incidence of gastric retention (P = 0.039), and the incidence of vomiting (P = 0.042). The average hospitalization time of the observation group was shorter than that of the control group (P < 0.001). The satisfaction score of parents in the observation group was significantly better than that in the control group (P < 0.001). In terms of safety, both groups of children did not experience adverse events such as skin damage or allergies. The incidence of local skin reactions after acupoint application was only 1.67%, which was one case of mild erythema that disappeared within 24 hours. This indicates that the comprehensive intervention plan has high safety and is suitable for clinical nursing practice of NICU for premature infants. Conclusion: The combination of traditional Chinese medicine abdominal massage therapy and acupoint application based on the IMB model can significantly reduce the incidence of breast milk-induced bloating in premature infants through a three-dimensional intervention of information empowerment, motivation enhancement, and behavioral norms. The mechanism may be closely related to promoting gastrointestinal motility (abdominal massage therapy activates the intestinal nerve plexus through mechanical stimulation), regulating intestinal microbiota (traditional Chinese medicine application exerts a promoting effect on qi conduction through transdermal absorption), and improving feeding patterns (IMB model enhances parental care ability).