母婴同室新生儿标准化流程管理对新生儿临床结局的影响  

The effect of standardized management of rooming-in care for newborns on clinical outcomes

作　　者：陈佳[1] 管利荣[1] 余静[1] 魏丽蓉[1] 羊钦裕 薛丹[1] 周余能 刘振球[2] CHEN Jia;GUAN Lirong;YU Jing;WEI Lirong;YANG Qinyu;XUE Dan;ZHOU Yuneng;LIU Zhenqiu(Department of Neonatology,Children′s Medical Center,Mian Yang Central Hospital,Mianyang,Sichuan 621000,China;Department of Neonatology,Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing 400014,China)

机构地区：[1]四川省绵阳市中心医院儿童医学中心新生儿科,621000 [2]重庆医科大学附属儿童医院新生儿中心/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心(重庆)/儿童发育重大疾病国家国际科技合作基地,重庆400014

出　　处：《重庆医学》2020年第22期3729-3732,共4页Chongqing medicine

基　　金：国家重点研发计划项目(2018YFC0114405);四川省卫生和计划生育委员会课题(18PJ048)。

摘　　要：目的探讨母婴同室标准化流程管理对新生儿临床结局的影响。方法以2018年在四川省绵阳市中心医院产科出生的新生儿3466例作为观察组,2017年在该院出生的新生儿3526例作为对照组。对照组新生儿按常规流程管理;观察组新生儿按母婴同室新生儿标准化流程管理,包括对产前产时母婴高危因素评估、围产期窒息的处置、新生儿高胆红素血症管理及新生儿血氧饱和度(SPO2)早期筛查等方面。观察两组新生儿窒息发生情况、高胆红素血症发生情况、新生儿常规SPO2监测阳性病例、新生儿窒息医患矛盾发生情况。结果观察组轻度窒息及重度窒息发生率均明显低于对照组(0.89%vs.1.56%,0.32%vs.0.96%,P<0.05),新生儿因高胆红素血症再入院率及重度高胆红素血症发生率明显低于对照组(2.11%vs.4.91%;0.32%vs.1.39%,P<0.05)。观察组SPO2早期监测发现3例无明显症状的复杂性先天性心脏病、3例肺炎及1例气胸。观察组42例新生儿窒息均未发生医患矛盾,对照组89例新生儿窒息医患矛盾发生率为8.99%,差异有统计学意义(P<0.05)。结论母婴同室标准化流程新生儿管理可减少新生儿窒息、重度高胆红素血症等疾病发生,早期发现复杂性先天性心脏病,并减少医患矛盾。Objective To explore the influence of standardized management of rooming-in care for newborns on clinical outcomes in newborns.Methods A total of 3466 newborns born in the obstetrics department of Mianyang Central Hospital in Sichuan Provice in 2018 were taken as the observation group,and 3526 newborns born in this hospital in 2017 were taken as the control group.The newborns in the control group were treated according to the normal process,while the newborns in the observation group were treated according to the standardized procedures of rooming-in care for newborns,including the assessment of high risk factors for the mothers and newborns during the prenatal period and delivery,perinatal asphyxia management,neonatal hyperbilirubinemia management and neonatal oxygen saturation(SPO2)monitoring.The incidence of neonatal asphyxia and hyperbilirubinemia,the neonatal SPO2 monitoring positive cases and the occurrence of doctor-patient contradiction due to neonatal asphyxia were observed in the two groups.Results Theincidence rates of mild and severe neonatal asphyxia in the observation group were lower than those in the control group(0.89%vs.1.56%,0.32%vs.0.96%,P<0.05).The readmission rate due to hyperbilirubinemia and the incidence rate of severe hyperbilirubinemia in the observation group were significantly lower than those in the control group(2.11%vs.4.91%;0.32%vs.1.39%,P<0.05).The results of early SPO2 monitoring revealed that there were 3 cases of complex congenital heart disease without obvious symptoms,3 cases of pneumonia and 1 case of pneumothorax in the observation group.No doctor-patient contradiction due to neonatal asphyxia occurred among 42 cases in the observation group,while the incidence rate of doctor-patient contradiction due to neonatal asphyxia among 89 cases in the control group was 8.99%,the difference was statistically significant(P<0.05).Conclusion The standardized management of rooming-in care for newborns can effectively reduce the incidence of neonatal asphyxia,severe jaundice and other d

关 键 词：围产期 母婴同室 标准化管理 新生儿窒息 高胆红素血症 血氧饱和度 

分 类 号：R473.71[医药卫生—护理学]