产房内呼吸支持质量改进项目对极低/超低出生体重儿近期临床结局的影响  

Effects of quality improvement project of respiratory support in delivery room on the short-term clinical outcomes of very/extremely low birth weight infants

作　　者：段顺艳 杨洋[1] 陈佳[1] 杜岚岚[1] 刘颖[1] 王柱[1] 高薇薇[1] Duan Shunyan;Yang Yang;Chen Jia;Du Lanlan;Liu Ying;Wang Zhu;Gao Weiwei(Department of Neonatology,Guangdong Women and Children's Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州511400

出　　处：《中华新生儿科杂志（中英文）》2022年第1期35-39,共5页Chinese Journal of Neonatology

基　　金：广东省医学科研基金项目(A2011076)。

摘　　要：目的探讨产房内呼吸支持质量改进项目对极低/超低出生体重儿(very/extremely low birth weight infant,VLBWI/ELBWI)近期临床结局的影响。方法回顾性分析广东省妇幼保健院产房内呼吸支持质量改进项目实施前后,即2019年1~10月(改进前组)与2020年1~12月(改进后组)VLBWI/ELBWI病例资料,比较改进前后两组患儿产房内气管插管率、生后72 h内气管插管率、机械通气时间、总用氧时间、支气管肺发育不良等早产儿相关并发症发生率。结果改进前组85例,改进后组85例,两组胎龄分别为(29.2±1.4)周和(29.1±1.5)周,出生体重分别为(1180±195)g和(1186±207)g,差异无统计学意义(P>0.05)。改进后组产房内气管插管率(2.4%比32.9%)、生后72 h内气管插管率(27.1%比58.8%)、肺表面活性物质使用率(38.8%比54.1%)、有血流动力学意义的动脉导管未闭发生率(5.9%比17.6%)均低于改进前组,差异有统计学意义(P<0.05);其他相关并发症发生率比较差异均无统计学意义(P>0.05)。结论产房内呼吸支持质量改进项目可显著降低VLBWI/ELBWI产房内及生后72 h内气管插管率,且不增加短期内不良结局。Objective To study the effects of quality improvement project of respiratory support in delivery room on the short-term clinical outcomes of very/extremely low birth weight infant(VLBWI/ELBWI).Methods The clinical data of VLBWI/ELBWI before and after the implementation of the quality improvement project of respiratory support in delivery room in our hospital were retrospectively analyzed.The incidences of endotracheal intubation in delivery room,total endotracheal intubation within 72 h after birth,mechanical ventilation duration,total oxygen therapy duration,bronchopulmonary dysplasia(BPD)and other complications were compared between pre-improvement group(from January to October 2019)and post-improvement group(from January to December 2020).Results A total of 85 cases were included in pre-improvement group and 85 in post-improvement group.The gestational age of the two groups were(29.2±1.4)weeks and(29.1±1.5)weeks and the birth weight were(1180±195)g and(1186±207)g,without significant differences(P>0.05).After the implementation of the quality improvement project,the incidence of endotracheal intubation in the delivery room decreased from 32.9% to 2.4%,and the total incidence of endotracheal intubation within 72 h after birth decreased from 58.8% to 27.1%.The usage of pulmonary surfactant significantly decreased from 54.1% to 38.8%(P<0.05)and the incidence of hemodynamically significant patent ductus arteriosus(hsPDA)also significantly decreased from 17.6% to 5.9%(P<0.05).No significant differences existed among other complications(P>0.05).Conclusions The quality improvement project of respiratory support in the delivery room can significantly reduce the incidence of endotracheal intubation in VLBWI/ELBWI without increasing short-term adverse outcome.

关 键 词：呼吸支持 质量改进 婴儿 极低出生体重 婴儿 超低出生体重 

分 类 号：R722.6[医药卫生—儿科]