通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析  

Clinical analysis of improving hypothermia of premature infants in NICU by quality improvement program

作　　者：杨春燕[1] 申青华[1] 李丛[1] 刘凤敏 马静[2] 许平[1] 杨巧芝[1] 宋晓岩 YANG Chun-yan;SHEN Qing-hua;LI Cong;LIU Feng-min;MA Jing;XU Ping;YANG Qiao-zhi;SONG Xiao-yan(Neonatal Intensive Care Unit;Scientific Research Department,Liaocheng Peopled Hospital,Liaocheng,Shandong 252000,China;Children's National Medical Center,Washington DC 20010,USA)

机构地区：[1]聊城市人民医院儿科NICU,山东聊城252000 [2]聊城市人民医院科研处,山东聊城252000 [3]美国华盛顿国家儿童医学中心,华盛顿20010

出　　处：《中国儿童保健杂志》2020年第11期1263-1266,共4页Chinese Journal of Child Health Care

基　　金：山东省重点研发计划项目(2018GSF118173);山东省医药卫生科技发展计划项目(2017WS218);聊城市人民医院院级青年科研基金资助项目(LYQN201933)。

摘　　要：目的分析质量提升项目(QI)方法对新生儿重症病房(NICU)极低出生体重早产儿的低体温发生率的影响,为改善早产儿临床结局提供依据。方法选取2017年1月1日-2019年1月31日出生后30 min内入住聊城市人民医院NICU的极低出生体重早产儿(胎龄<32周和/或出生体重<1500 g)为研究对象,低体温的诊断标准为入院时肛温低于36.5℃。其中,2017年1月1日-12月31日收治的早产儿为对照组(128例),采用常规的体温管理措施;2018年2月1日-2019年1月31日为干预组(120例),通过QI采用综合性体温管理措施,对围生期相关情况、低体温、颅内出血和病死率等进行比较。结果干预组早产儿入院体温为(36.6±0.7)℃,明显高于对照组(35.9±0.8)℃(t=4.54,P<0.01),低体温发生率从92.5%降低至40.5%,干预组早产儿入院后低血压(43.4%)、颅内出血发生率(43.3%)、肺表面活性物质的应用(26.1%)、脓毒血症发生率(24.0%)均显著低于对照组(29.5%、32.9%、65.6%、41.0%,χ^2=3.56、5.99、7.56、12.15,P<0.05)。结论以循证医学为依据的QI的实施可以显著降低极低出生体重早产儿入院时的体温过低,改善临床结局。Objective To analyze the effect of quality improvement item(QI)on the incidence of hypothermia of very low birth weight premature infants in Neonatal Intensive Care Unit(NICU),in order to provide evidence for improving the clinical outcome of premature infants.Methods The very low birth weight premature infants(gestational age<32 weeks and/or birth weight<1500 g)admitted to NICU in Liaocheng People′s Hospital were enrolled in this study from 1 st January,2017 to 31 st January,2019.Infants whose annal temperature was lower than 36.5℃were diagnosed with hypothermia.Infants admitted in this hospital from 1 st January,2017 to 31 st December,2017 were enrolled in control group(n=128),and received typical measures controlling temperature.And infants admitted in this hospital from 1 st February,2018 to 31 st January,2019 were selected as intervention group(n=120),whose temperature was administered through quality improvement program.The rates of prenatal conditions,hypothermia,intraventricular hemorrhage and morbidity were compared between the two groups.Results The rate of hypothermia in very low birth weight premature infants decreased from 92.5%to 40.5%during the intervention period,and the temperature of intervention group at admission was significantly higher than that of control group[(36.6±0.7)℃vs.(35.9±0.8)℃,t=4.54,(P<0.01)].The incidence of hypotension(43.4%)and intracranial hemorrhage(43.3%),the application of pulmonary surfactant(26.1%)and the incidence of sepsis(24.0%)in intervention group were significantly lower than those in control group(29.5%,32.9%,65.6%,41.0%,χ^2=3.56,5.99,7.56,12.15,P<0.05).Conclusion The implementation of quality improvement program based on evidence-based medicine can significantly reduce hypothermia of very low birth weight premature infants at admission and improve their clinical outcomes.

关 键 词：质量提升项目 低体温 早产儿 

分 类 号：R722.6[医药卫生—儿科]