新生儿重症监护病房家庭参与式管理模式中的母乳喂养结局研究  

Breastfeeding outcomes in family integrated care model in neonatal intensive care units

作　　者：黑明燕[1] 高翔羽 李占魁 张谦慎[4] 李佳[5] 夏世文[6] 农绍汉[7] 高红霞[8] 张爱民[9] 李颖[1] ShooK.Lee 

机构地区：[1]中南大学湘雅三医院儿科新生儿亚专科,长沙410013 [2]东南大学附属徐州医院儿科,221009 [3]西北妇女儿童医院新生儿科,西安710061 [4]深圳市妇幼保健院新生儿科,518028 [5]昆明市妇幼保健院新生儿科,650031 [6]湖北省妇幼保健院新生儿科,武汉430070 [7]广东省人民医院新生儿科,广州510080 [8]甘肃省妇幼保健院新生儿科,兰州730050 [9]湖南省人民医院儿科新生儿亚专科,长沙410005 [10]西奈山医院加拿大健康卫生研究院母婴健康部,多伦多

出　　处：《中华新生儿科杂志（中英文）》2018年第1期27-33,共7页Chinese Journal of Neonatology

基　　金：加拿大健康卫生研究院课题（CTP87518）;美国中华医学基金会公开竞标课题（CMBOC13-162）志谢感谢湖南省“225人才工程”及中南大学湘雅三医院“新湘雅人才工程”的政策支持;感谢湘雅三医院护理部的理解与配合.

摘　　要：目的探讨在新生儿重症监护病房（neonatal intensive care unit，NICU）中实施家庭参与式综合管理（family integrated care, FICare）对住院早产儿母乳喂养率的影响。方法多中心群组随机对照临床干预与预后研究，纳入中国大陆8个省市的9家三级甲等医院胎龄28～35周的早产儿，分为FICare组与对照组。FICare组早产儿家长在患儿住院期间进入NICU每日连续陪护3 h或以上，并在专科护士指导下学习和完成六步洗手法、摆放婴儿体位、换尿片、估算尿量、脐带和口腔护理、袋鼠式皮肤接触等13项非侵入性护理技能。主要研究指标为母乳喂养率，次要研究指标包括喂养指标、FICare相关指标等。应用SPSS 20.0统计软件对数据进行处理。结果（1）FICare组和对照组分别有212例和215例早产儿纳入分析。两组性别、胎龄、出生体重、出生体重Z值、单胎比例、产前激素使用情况、新生儿疾病、开始肠内喂养日龄等临床资料差异均无统计学意义（P〉0.05）。（2）两组达到全肠道喂养的日龄差异无统计学意义（P〉0.05）。开始母乳喂养的中位日龄均为出生第4天。FICare组202例（87.3%）、对照组80例（34.9%）成功达到本研究的母乳喂养标准，FICare组配方奶喂养率、医院感染发生率显著低于对照组，恢复出生体重日龄短于对照组，恢复出生体重后体重增长速度显著大于对照组，体重ΔZ值下降程度小于对照组，差异均有统计学意义（P〈0.05）。（3）实施FICare和产前足量使用激素是达到母乳喂养的独立保护性因素（OR＝27.703，95%CI 14.531～52.816，P〈0.001；OR＝9.496，95%CI 4.768～18.912，P〈0.001），医院感染和开始母乳喂养日龄晚是达到母乳喂养的独立危险性因素（OR＝0.380，95%CI 0.182～0.795，P＝0.010；OR＝0.847，95%CI 0.734～0.977，P＝0.022）。结论FICare对提高NICU住院早产儿母乳喂养率具有明显促进ObjectiveTo understand the influence of family integrated care （FICare） model to the human breastfeeding rate of preterm infants in neonatal intensive care units （NICUs）.MethodIt is a multicenter cluster randomized controlled trail for intervention and prognosis. According to inclusion and exclusion criteria, preterm infants with gestation age 28~35 weeks in 9 NICUs of tertiary hospitals in 8 provinces in China were enrolled and divided into FICare and control group. Mothers of FICare infants were invited to stay in NICU ward at bedside for no less than 3 hours per day. Under the supervision of nurses, FICare infants′mothers complete 13 items of infants′caring skills including Six-step Hand Washing and hand hygiene, positioning the baby, changing diapers and estimating urine output, skin and mouth caring, kangaroo care and so on. The primary outcome is the human breastfeeding rate. Secondary outcomes include feeding parameters and FICare-related parameters. SPSS 20.0 software is used for the data analysis.Result（1） There were 212 infants and 215 infants enrolled in FICare group and control group, respectively. There was no significant difference between 2 groups in gender, gestational age, birth weight （BW）, Z-score of BW, singleton percentage, antenatal steroid completion, diagnosis, day of life （DOL） for starting feeds （P〉0.05）. （2） There was no significant difference between 2 groups in DOL for full feeding （P〉0.05）. The median age of starting breastfed in both groups was DOL 4. There were 202 cases （87.3%） in FICare group and 80 cases （34.9%） in control group be successfully breastfed. The rate of formula feeding, incidence of nosocomial infection, DOL for regaining BW, decrease of BW ΔZ score in FICare group was significantly lower than the control group, and the weight gain velocity after regaining BW in FICare group was significantly higher than the control group （P〈0.05）. （3） The implementation of FICare and completion of antenatal steroid were th

关 键 词：重症监护病房 新生儿 婴儿 早产 母乳喂养 家庭参与式管理 结局 

分 类 号：R473.72[医药卫生—护理学]