三级医院早产儿出院后随访现状及影响因素分析  

Preterm infant follow up rate and influencing factors in a tertiary neonatal intensive care unit

作　　者：程亚颖[1,2] 冯琪[1] 王颖[1] 张欣[1] 李星[1] 茹喜芳[1] 宋秀婷[1] 郝波[3] 

机构地区：[1]北京大学第一医院儿科,100034 [2]河北省人民医院儿科,石家庄050051 [3]北京大学第一医院妇产科,100034

出　　处：《中国新生儿科杂志》2015年第6期401-407,共7页Chinese Journal of Neonatology

基　　金：卫生计生委早产(儿)综合管理项目

摘　　要：目的 调查早产儿出院后随访现状,分析随访依从性及其影响因素。方法 单中心回顾性调查2011年1月1日至2013年5月31日北京大学第一医院NICU收治的胎龄〈37周、入院日龄〈24 h、住院时间≥7天、统计时校正年龄（CA）满3个月、临床资料完整的早产儿随访情况。随访方式包括常规预约随访和就诊时间前医务人员电话督促、提醒家长的强化随访。分析早产儿随访率现状及随访方式改变带来的影响。多因素分析影响早产儿随访依从性的因素。结果 共623例早产儿纳入研究,常规随访组483例,强化随访组140例。胎龄〈32周早产儿143例,胎龄≥32周早产儿480例。出院后随访率随年龄增加逐渐降低（χ2=667.799,P〈0.001）。胎龄〈32周的极早产儿随访频度高于胎龄34-36周的早产儿（χ2=10.115,P=0.006）。在所有随访时段,强化随访组随访率均高于常规随访组（P均〈0.05）。强化随访组及常规随访组出院后2-3周、CA 3.0±1.5月、6.0±1.5月、9.0±1.5月、12.0±1.5月随访率分别为95.7%比72.3%,77.9%比49.5%,49.6%比39.2%,50.6%比27.2%,32.2%比15.6%（P均〈0.05）。Logistic回归分析显示,出生胎龄及体重越低、随访距离越近、住院期间坚持母乳喂养、强化随访、合并症多以及出院时体重低的患儿随访依从性好。结论 早产儿出院后随访现状不容乐观,校正年龄半岁后随访率降低明显。增加随访前的再次提醒可有效提高随访率。Objective To study the current preterm infant follow up （F/U） situation, in order to ascertain the factors which influence the preterm infant post discharge follow up rate. Methods Follow up data of preterm infants who were discharged from Neonatal Intensive Care Unit （ NICU ） of Peking University First Hospital was surveyed retrospectively. Inclusion criteria were： preterm infant, admitted in first 24 h of age, hospitalized longer than 7 d, older than 3mo of corrected age （CA） at data collecting time, and with completed clinical information. Regular parental communication before discharge and appointment after each hospital visit was defined as regular F/U （regular group）. Special reminder call added to the regular group was defined as enhanced F/U （enhanced group ）. Factors influencing hospital visit were analyzed by chi-square, rank test and logistic regression analysis. Results Six hundred and twenty-three preterm infants were involved, 483 in regular group and 140 in enhancedgroup. The F/U rate decreased gradually with babies growing up, X2 = 667. 799, P 〈0. 001. Compared with gestational age （GA） 34 N 36 wk infants, the frequency of F/U was higher in GA 〈 32 wk infants （X2 = 10. 115, P =0. 006）. In general the F/U rate in enhanced group was higher than that in regular group at all F/U appointments （ P 〈 0. 05 ）. Detailed results were as follows ： F/U rate at 2 - 3 wk post-discharge, CA 3.0± 1.5 mo, 6.0 ± 1.5 mo, 9.0 ± 1.5 mo, 12.0 ± 1.5 mo were 95.7% vs. 72.3%, 77.9% vs. 49.5%, 49.6% vs. 39.2% 50.6% vs. 27.2%, 32.2% vs. 15.6% in enhanced and regular group respectively, P all 〈 0. 05. Logistic regression analysis showed that very premature, lower birth weight, living close to hospital, critical clinical complications at early age, enhanced F/U were promoting factors of preterm infant F/U compliance. Conclusions There is great scope for improving the preterm infant post discharge follow up, especially in second haft of the 1 st year. Enhanced F/U mode is an effe

关 键 词：婴儿 早产 随访研究 出院管理 影响因素分析 

分 类 号：R722.6[医药卫生—儿科]