目的:探讨新生儿重症监护室(Neonatal intensive care unit, NICU)中实施家庭参与式护理(Family integrated care, FICare)对晚期早产儿的影响。方法:前瞻性研究纳入2017年1月至2018年1月日照市妇幼保健院入住NICU胎龄34周~36周7天的晚期早产儿70例,随机分为观察组、对照组各35例。观察组在传统NICU护理模式基础上给予每日不少于4 h家庭参与式护理干预,对照组实施传统NICU护理模式。比较两组患儿母乳喂养情况、体重增长速度、院内感染率、平均住院天数、父母紧张焦虑评分量表(Parent Stress Scale, PSS)评分、矫正胎龄40周新生儿行为神经测定(Neonatal Behavioral Neurological Assessment, NBNA)评分。结果:观察组患儿母乳喂养率、体重增长速度、矫正胎龄40周NBNA评分明显高于对照组,差异有统计学意义(P < 0.05)。两组院内感染率、平均住院天数比较,差异无统计学意义(P > 0.05)。观察组出院时PSS评分下降程度显著高于对照组,差异有统计学意义(P < 0.05)。结论:NICU实施FIC干预可以提高晚期早产儿母乳喂养率,促进体重增长及行为发育,并能降低患儿父母的紧张焦虑情绪。 Objective: The purpose of this study was to investigate the effect of Family integrated care (FIC) in Neonatal intensive care unit (NICU) on late preterm infants. Methods: In this prospective study, 70 late preterm infants with gestational age of 34 weeks to 36 weeks and 7 days admitted to NICU in Rizhao Maternal and Child Health Hospital from January 2017 to January 2018 were randomly divided into control group (n = 35) and observation group (n = 35). The control group was given traditional NICU nursing mode, and the observation group was given family participation nursing intervention of no less than 4 hours a day on the basis of traditional NICU nursing mode. The breastfeeding, weight gain rate, hospital infection rate, average length of stay, Parent Stress Scale PSS score and Neonatal Behavioral Neurological Assessment (NBNA) score of 40 weeks of gestational age were compared between the two groups. Results: Breastfeeding rate, weight growth rate and corrected gestational age at 40 weeks NBNA score in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). There was no significant difference in the rate of nosocomial infection and average length of stay between the two groups (P > 0.05). PSS score at discharge was lower than that at admission, and the difference was statistically significant (P < 0.05). The degree of decline of PSS score in the observation group was significantly higher than that in the control group at discharge, and the difference was statistically significant (P < 0.05). Conclusion: The implementation of FIC intervention in NICU can improve the breast-feeding rate of late premature infants, promote weight gain and behavioral development, and reduce the tension and anxiety of the parents of infants.
目的:探讨新生儿重症监护室(Neonatal intensive care unit, NICU)中实施家庭参与式护理(Family integrated care, FICare)对晚期早产儿的影响。方法:前瞻性研究纳入2017年1月至2018年1月日照市妇幼保健院入住NICU胎龄34周~36周7天的晚期早产儿70例,随机分为观察组、对照组各35例。观察组在传统NICU护理模式基础上给予每日不少于4 h家庭参与式护理干预,对照组实施传统NICU护理模式。比较两组患儿母乳喂养情况、体重增长速度、院内感染率、平均住院天数、父母紧张焦虑评分量表(Parent Stress Scale, PSS)评分、矫正胎龄40周新生儿行为神经测定(Neonatal Behavioral Neurological Assessment, NBNA)评分。结果:观察组患儿母乳喂养率、体重增长速度、矫正胎龄40周NBNA评分明显高于对照组,差异有统计学意义(P < 0.05)。两组院内感染率、平均住院天数比较,差异无统计学意义(P > 0.05)。观察组出院时PSS评分下降程度显著高于对照组,差异有统计学意义(P < 0.05)。结论:NICU实施FIC干预可以提高晚期早产儿母乳喂养率,促进体重增长及行为发育,并能降低患儿父母的紧张焦虑情绪。
NICU,家庭参与式护理,晚期早产儿,父母紧张焦虑评分量表,新生儿行为神经测定
Wei Wu1,2, Hong Jiang3
1Medical College of Qingdao University, Qingdao Shandong
2Rizhao Maternal and Child Health Care Hospital, Rizhao Shandong
3Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Sep. 29th, 2021; accepted: Oct. 19th, 2021; published: Oct. 29th, 2021
Objective: The purpose of this study was to investigate the effect of Family integrated care (FIC) in Neonatal intensive care unit (NICU) on late preterm infants. Methods: In this prospective study, 70 late preterm infants with gestational age of 34 weeks to 36 weeks and 7 days admitted to NICU in Rizhao Maternal and Child Health Hospital from January 2017 to January 2018 were randomly divided into control group (n = 35) and observation group (n = 35). The control group was given traditional NICU nursing mode, and the observation group was given family participation nursing intervention of no less than 4 hours a day on the basis of traditional NICU nursing mode. The breastfeeding, weight gain rate, hospital infection rate, average length of stay, Parent Stress Scale PSS score and Neonatal Behavioral Neurological Assessment (NBNA) score of 40 weeks of gestational age were compared between the two groups. Results: Breastfeeding rate, weight growth rate and corrected gestational age at 40 weeks NBNA score in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). There was no significant difference in the rate of nosocomial infection and average length of stay between the two groups (P > 0.05). PSS score at discharge was lower than that at admission, and the difference was statistically significant (P < 0.05). The degree of decline of PSS score in the observation group was significantly higher than that in the control group at discharge, and the difference was statistically significant (P < 0.05). Conclusion: The implementation of FIC intervention in NICU can improve the breast-feeding rate of late premature infants, promote weight gain and behavioral development, and reduce the tension and anxiety of the parents of infants.
Keywords:Neonatal Intensive Care Unit, Family Integrated Care, Late Preterm, Parent Stress Scale, Neonatal Behavioral Neurological Assessment
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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胎龄34周至36周7天的新生儿定义为晚期早产儿(Late Preterm Infant, LPI) [
选取2017年1月至2018年1月出生于日照市妇幼保健院产科,生后12小时内入住NICU,符合纳入标准的70例晚期早产儿为研究对象,随机分为观察组、对照组,各35例。纳入标准:1) 胎龄34周~36周7天;2) 生命体征稳定24小时以上;3) 胃肠内喂养时间 > 24 h且无喂养不耐受;4) 患儿父母知情同意。排除标准:1) 患儿存在先天性遗传代谢性疾病或先天性发育畸形;2) 患儿父母知情后拒绝合作;3) 患儿父母既往有精神病史;4) 母亲产后病情危重。经医学伦理学委员会批准,签署知情同意书。
两组晚期早产儿的一般资料比较,差异均无统计学意义(P < 0.05),具备可比性。见表1。
项目 | 变量 | 观察组(n = 35) | 对照组(n = 35) | 统计量(t/Z/χ2) | P值 |
---|---|---|---|---|---|
性别 | 男 | 14 | 22 | 2.807 | 0.092 |
女 | 21 | 17 | |||
胎龄(d) | 245 ± 3.9 | 248±7.5 | −1.065 | 0.270 | |
APgar评分 | 9 (8~10) | 8 (7~9) | −1.770 | 0.074 | |
出生体重(g) | 2464 ± 452 | 2435 ± 475 | 0.908 | 0.366 | |
分娩方式 | 经阴分娩 | 29 | 28 | 0.094 | 0.500 |
剖宫产 | 6 | 7 | |||
双胎 | 是 | 5 | 9 | 1.297 | 0.254 |
居住地 | 城市/农村 | 23/12 | 21/14 | 0.253 | 0.614 |
父亲年龄(岁) | 33 ± 4.6 | 31 ± 5.2 | 1.779 | 0.081 | |
母亲年龄(岁) | 31.2 ± 4.2 | 30 ± 5.0 | 1.688 | 0.097 | |
合并症 | 新生儿肺炎 | 20 | 24 | 3.150 | 0.367 |
败血症 | 3 | 6 | |||
低血糖 | 4 | 0 | |||
新生儿呼吸窘迫综合征 | 8 | 5 |
表1. 两组一般资料对比
干预方式
观察组在传统护理模式基础上实施每日不少于4 h的FIC干预。首先对医护人员进行有效培训,随后对患儿父母进行足够指导,以此为前提,允许患儿父母进入NICU承担每日不少于4 h非医疗性常规生活护理。对照组采用传统护理方案,NICU内护理人员负责住院期间全部护理工作,对患儿父母进行常规健康宣教,患儿父母每周探视1次。
记录两组患儿母乳喂养情况、体重增长速度、院内感染率、平均住院天数;采用PSS [
采用SPSS 22.0进行统计学分析,P < 0.05表示差异有统计学意义。计量资料统计采用均数和标准差描述,计数资料采用频数和百分比描述。两组间多个时间点的测量资料采用了重复测量差分析。计量资料组间比较采用两独立样本t检验,秩和检验,χ2检验等。
观察组母乳喂养率、体重增长速度、纠正胎龄40周NBNA评分均高于对照组,差异有统计学意义(均P < 0.05)。两组院内感染率、平均住院天数进行比较,存在差异,但差异无统计学意义(P > 0.05)。见表2。
项目 | 观察组(n = 35) | 对照组(n = 35) | t/χ2值 | P值 |
---|---|---|---|---|
母乳喂养n (%) | 35 (100) | 21 (60) | 15.960 | P < 0.001 |
非母乳喂n (%) | 0 (0) | 14 (40) | ||
体重(g/d) | 19.07 ± 7.72 g | 15.53 ± 7.55 | −2.121 | 0.036 |
院内感染N (%) | 2 (5.7) | 3 (8.6) | 0.677 | 0.821 |
住院天数(天) | 18.22 ± 9.62 | 17.81 ± 9.87 | 0.518 | 0.597 |
NBNA评分 | 36.91 ± 1.65 | 36.12 ± 1.27 | 2.614 | 0.01 |
表2. 两组患儿住院期间观察指标比较
观察组和对照组患儿父母入院时PSS评分无明显差异,无统计学意义(P > 0.05);观察组患儿父母出院时PSS评分显著低于对照组,差异有统计学意义(P < 0.05)。见表3。
组别 | 观察组 | 对照组 | t值 | P值 |
---|---|---|---|---|
干预前 | 125.79 ± 20.45 | 126.7 ± 17.80 | 0.089 | 0.915 |
干预后 | 56.59 ± 20.87a | 113.79 ± 18.2b | 76.630 | 0.000 |
表3. 两组患儿父母焦虑情况比较
尽管国内NICU近年来诊疗水平与硬件设施与欧美等发达国家的差距在迅速缩短,但封闭无陪护的管理模式改变甚微,家长拥有的仅仅是短时间的探视 [
早产儿与足月出生的婴儿相比,更易出现神经发育障碍的风险 [
院内感染是所有NICU持续关注的焦点问题之一。国外研究资料表明,在手卫生到位的前提下,NICU的开放性探视制度并不会增加医院获得性感染的发生率 [
FIC是诞生于NICU的一种新型的管理模式,以照护患儿为主要目的,转换父母的被动角色,在NICU内赋予父母照顾患儿的权利,给予父母与医护人员沟通的机会,组建人性化、个性化的护理措施。此次研究表明,FIC在NICU内实施是有益于患儿的,但国内FIC的实施缺乏统一的标准,需要进一步发展。我们必须要注意到FIC在NICU发展的关键点:1) 医疗机构NIUC的规模,布局以及流程。2) 患儿父母的支持度。3) 必须拥有掌握实施FIC的团队。4) FIC实施的科学依据。而这种模式的成功有赖于NICU团队政策观念引导的成功和专业知识的积累,从而与整个患儿家庭建立良性伙伴关系。随着FIC在世界范围内的采用和持续研究的进行,该模式在所有NICU内的患儿以及其他住院病人群体中的应用将是一个新的前景和机遇。值得临床推广使用。
武 伟,姜 红. NICU家庭参与式护理对晚期早产儿的临床效果估计Evaluation of the Effects of Family Participatory Care in NICU on Late Preterm Infants[J]. 临床医学进展, 2021, 11(10): 4817-4822. https://doi.org/10.12677/ACM.2021.1110706