新生儿重症监护室医源性皮肤损伤多中心横断面调查  

A national multicenter cross-sectional survey of iatrogenic skin injury in neonates in NICU

作　　者：陆春梅[1] 季福婷 吕天婵[1] 袁皓[1] 杨童玲[1] 胡晓静[2] 中国医药教育协会新生儿护理分会新生儿医源性皮肤损伤调查组 LU Chunmei;JI Futing;LV Tianchan;YUAN Hao;YANG Tongling;HU Xiaojing;Investigation Group of Neonatal Iatrogenic Skin Injury of Society of Neonatal Nursing of China Medicine Education Association(Neonatology Department,Children's Hospital of Fudan University,shanghai 201102,China;Nursing Department,Children's Hospital of Fudan University,shanghai 201102,China;不详)

机构地区：[1]复旦大学附属儿科医院新新生儿科,上海201102 [2]复旦大学附属儿科医院新护理部,上海201102 [3]不详

出　　处：《中国循证儿科杂志》2022年第2期122-127,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市申康医院发展中心临床第十二批临优管理项目:SHDC12020642;全国医学教育发展中心医学模拟教育研究项目:2021MNZC05;国家儿童医学中心、复旦大学附属儿科医院临床研究中心专病队列研究:2020ZBDL23。

摘　　要：背景医源性皮肤损伤是入住NICU的新生儿面临的常见问题。目的了解我国NICU内新生儿医源性皮肤损伤的发生率。设计横断面调查。方法建立NICU新生儿的医源性皮肤损伤临床资料数据库(简称数据库),由复旦大学附属儿科医院NICU牵头,包括中国15个省、自治区、直辖市的22家三级甲等医院(简称协作医院)NICU。将医源性皮肤损伤的原因归纳为7类:尿布相关、粘胶相关、压力相关(包括医疗器械相关)、外科手术相关、血管通路相关、各种理化因素相关、其他。数据库上报的对象为协作医院NICU的连续病例,上报数据均来源于所在医院电子病历系统或纸质医疗文书记录。数据上报项目:一般资料,各种医疗器械使用情况,医源性皮肤损伤事件,每次医源性皮肤损伤发生时的日龄、体重、住院时长,皮肤损伤的部位、大小、类型、颜色、处理措施和预后。由牵头医院针对数据库上报指标对协作医院进行培训并考核合格后开始数据的收集并审核。主要结局指标医源性皮肤损伤发生率。结果2019年12月1日至2020年1月31日22家协作医院收集的NICU连续病例(n=8126)数据全部合格,纳入本文分析。其中医源性皮肤损伤521例(6.4%),儿童专科医院、综合性医院和妇幼保健院的NICU医源性皮肤损伤的发生率分别为7.4%(280/3783)、6.4%(153/2387)和4.5%(88/1956)。521例共发生566例次医源性皮肤损伤,发生2次医源性皮肤损伤45例(8.6%)。医源性皮肤损伤发生日龄中位数为6(3,17)d,生后1周内发生者占57.4%(299例);发生医源性皮肤损伤的新生儿入院纠正胎龄中位数为37.2(32.7,40.0)周,纠正胎龄≥37周占56.4%(294例);发生医源性皮肤损伤时的体重中位数为2800(1912~3450)g,体重≥2500 g占59.1%(308例)。尿布相关250例(48.0%),压力相关(包括医疗器械相关)81例(15.5%),粘胶相关69例(13.2%),各种理化因素相关70例(13.4%),血管通路相关22例(4.2%)Background Iatrogenic skin injury is a common problem in neonates admitted to NICU.Objective To investigate the incidence of neonatal iatrogenic skin injury in NICUs in China.Design Cross-sectional survey.Methods Children's Hospital of Fudan University took the lead in establishing the NICU clinical data database of neonatal iatrogenic skin injury,which included 22 tertiary hospitals in 15 provinces,autonomous regions and municipalities directly under the central government.The causes of iatrogenic skin injury were related to diapers,viscose,pressure(including medical devices),surgery,vascular access,and physical or chemical factors.The continuous cases reported by NICUs of the cooperative hospitals were sent to the database,and the data were from the electronic medical record system or paper medical document records.The reported data included demographic data,medical devices used,iatrogenic skin injury events,the age,weight and length of hospital stay of the infant at the time of each iatrogenic skin injury,the location,size,type,color,treatment measures and prognosis of skin injury.The leading hospital trained the cooperating hospitals according to the indicators in the database and started data collection after passing the examination.The leading hospital was responsible for reviewing the data.Main outcome measures Incidence of iatrogenic skin injury in NICU hospitalized neonates.Results From December 1,2019 to January 31,2020,the data of NICU consecutive cases(n=8,126)collected by 22 cooperative hospitals were all qualified and included in this analysis.There were 521 cases of iatrogenic skin injury(6.4%),and the incidence of iatrogenic skin injury in NICU in children's specialized hospitals,general hospitals and maternal and child health hospitals were 7.4%(280/3,783),6.4%(153/2,387)and 4.5%(88/1,956),respectively.There were 566 times of iatrogenic skin injury in 521 neonates,and 45 cases(8.6%)had two times of iatrogenic skin injury.The median age of neonates with iatrogenic skin injury was 6(3,17)days,those

关 键 词：新生儿 医源性皮肤损伤 重症监护病房 多中心 发生率 

分 类 号：R473.72[医药卫生—护理学]