一种新的泌乳干预策略-产后集束泌乳干预对母婴分离早产儿母亲泌乳的影响  

Effects of care bundles on lactation of mothers of preterm infants

作　　者：刘金凤[1] 赵敏慧[1] 余慧[1] 庄薇[1] 贲晓明[1] 

机构地区：[1]同济大学附属第一妇婴保健院产科,上海201202

出　　处：《中华围产医学杂志》2016年第7期502-505,共4页Chinese Journal of Perinatal Medicine

基　　金：上海申康医院发展中心临床管理优化项目（SHDC20136036）

摘　　要：目的：探讨集束泌乳干预对提高母婴分离早产儿母亲泌乳的效果。方法选择2015年1月至6月在同济大学附属第一妇婴保健院早产分娩并住院、且早产儿生后转入新生儿重症监护病房的产妇，随机分为干预组（n=25）和对照组（n=22）。对照组产妇接受常规泌乳方法指导，干预组接受集束泌乳干预，即协助产妇确定泌乳目标、指导并帮助产妇产后6 h内开始泵奶/挤奶、指导产妇通过“泌乳日记”记录每天泵奶/挤奶和送奶情况。观察并记录2组产妇产后初次泵奶/挤奶的时间，及产后第1～7、14、21、42天泵奶/挤奶次数和每天泌乳总量，以及产后第42天喂养方式。组间数据比较采用两独立样本t检验、χ^2检验及非参数检验。结果干预组开始泵奶/挤奶的时间为产后（6.1＆#177;3.4） h，早于对照组[（10.7＆#177;9.3）h]（t=－2.301，P=0.026）。产后第1～3天干预组产妇每天泵奶/挤奶次数分别为（4.2＆#177;2.2）、（6.2＆#177;1.1）和（7.1＆#177;1.9）次，多于对照组[分别为（3.0＆#177;1.6）、（4.7＆#177;1.9）和（5.9＆#177;1.9）次]（t值分别为2.083、2.564和2.194，P值均＜0.05）。产后第2天开始，干预组产妇每日泌乳量高于对照组[M（全距）为10.0（25.0）与2.0（5.0），Z=－2.879，P=0.005]；到产后第21天，干预组产妇泌乳量达到800.0（295.0） ml，依然高于对照组[300.0（155.0） ml]（Z=－3.179，P=0.001）。产后第42天干预组主要母乳喂养率（每日添加配方奶≤2次）高于对照组[68%（17/25）与41%（9/22），χ^2=5.874，P=0.045]。结论集束泌乳干预能够有效促进母婴分离早产儿母亲泌乳。ObjectiveTo investigate the effects of care bundles on the lactation of mothers of preterm infants.MethodsFrom January to June 2015, postpartum women who had preterm deliveries in First Maternity and Infant Hospital Affiliated to Tongji University with the neonates hospitalized in neonatal intensive care unit were enrolled in this study. They were randomly divided into intervention group （n=25） receiving bundle care （assist the mothers to determine lactation target; pump/express breastmilk within six hours after birth and keep a lactation diary to record the times and volume of pumped/expressed milk） and control group （n=22） given normal mammary guidance only. The time of the first pumped/expressed milk, the times for pumping/expressing milk a day, the total milk volume per day and rate of breastfeeding were compared between the two groups. Statistical analyses were conducted using two independent samplest-test,Chi-square test and nonparametric test.ResultsThe initial time of pumped/expressed milk of the intervention group was （6.1＆#177;3.4） h after delivery, significantly earlier than the control group [（10.7＆#177;9.3） h]（t=-2.301,P=0.026）. The times for pumping/expressing milk per day were significantly more in the intervention group than in the controlgroup on the 1st, 2nd and 3rd day after delivery [（4.2＆#177;2.2） vs （3.0＆#177;1.6）; （6.2＆#177;1.1） vs （4.7＆#177;1.9）; and （7.1＆#177;1.9） vs （5.9＆#177;1.9） times, respectively]（t=2.083, 2.564 and 2.194, allP〈0.05）. From the second postpartum day, the milk volume of the intervention group was more than the control group [M（range） were 10.0（25.0） vs 2.0（5.0） ml] （Z=-2.879,P=0.005）; and on the 21st day, the milk volume of the intervention mothers reached 800.0（295.0） ml, still higher than the control group [300.0（155.0） ml]（Z=-3.179,P=0.001）. The primarily breastfeeding （adding formula milk≤2 times a day） rate in the intervention group was significantly higher than

关 键 词：泌乳障碍 母乳喂养 奶排出 婴儿 早产 母婴护理 

分 类 号：R473.71[医药卫生—护理学]