多中心质量改进循证实践降低极低出生体重儿的入院低体温发生率  

Evidence-based quality improvement reduces admission hypothermia in very low birth weight infants:a multicentered study

作　　者：山东新生儿协作网多中心低体温质量改进项目临床研究协作组 于永慧 Multicenter Clinical Research Collaboration Group of Hypothermia Quality Improvement Project in Shandong Neonatal Network;Yu Yonghui

机构地区：[1]不详

出　　处：《中华围产医学杂志》2022年第10期781-787,共7页Chinese Journal of Perinatal Medicine

基　　金：山东省重点研发计划(2018GSF118163);山东省科技发展计划(2014GSF118110);济南市科技局临床医学科技创新计划(201602160)。

摘　　要：目的探讨质量改进方法对降低多中心新生儿重症监护病房(neonatal intensive care unit,NICU)中极低出生体重儿(very low birth weight infant,VLBWI)的入院低体温发生率的有效性。方法本研究为前瞻性队列研究,纳入2018年1月1日至2019年12月31日山东省共12家参与单位NICU的VLBWI,根据2018年12月为低体温质量改进预实验阶段,分为改进前组(2018年1月至11月)和改进后组(2019年1月至12月)。主要结局指标是入院低体温发生率;次要结局指标是入院体温;过程指标包括:环境(产房或手术室)温度提高至25℃、戴预热绒帽、塑料薄膜包裹、转运暖箱转运、记录生后10 min体温等措施的实施率。比较质量改进前后入院低体温发生率的变化情况。采用χ^(2)检验或Fisher精确概率法、t检验或秩和检验对数据进行分析。过程指标实施率与入院低体温发生的相关性采用Spearman分析。结果研究共纳入1570例VLBWI,其中改进前组701例(44.6%),改进后组869例(55.4%)。质量改进后,VLBWI入院低体温发生率降低[93.7%(657/701)与75.9%(660/869),χ^(2)=90.68,P<0.001],入院体温升高[(35.7±0.6)℃与(36.0±0.7)℃,t=-3.35,P=0.001]。12家单位的过程指标总体实施率与入院低体温发生率呈负相关(r=-0.81,P<0.01),且12家单位的过程指标实施率各不相同,比如环境温度提高至25℃的实施率>90%和<80%各6家单位,不擦干塑料薄膜包裹的实施率>90%和<80%分别为5家和7家单位等。结论规范实施质量改进方法可以有效降低VLBWI的入院低体温发生率,提高参与单位各过程指标的实施率,有望进一步降低VLBWI入院低体温发生率。Objective To analyze the effectiveness of evidence-based practice for improving quality in reducing the incidence of admission hypothermia in very low birth weight infants(VLBWIs)in neonatal intensive care units(NICUs).Methods VLBWIs in 12 NICUs were enrolled in this prospective cohort study from January 1,2018,to December 31,2019,and were divided into two groups:pre-quality improvement group(January to November 2018)and post-quality improvement group(January to December 2019).The primary outcome was the incidence of hypothermia on admission and the secondary outcome was admission temperature.Process indicators included the implementation rates of maintaining ambient temperature(delivery room or operating room)at 25℃,using pre-warmed hats,polyethylene wrap,and transport incubator,and recording body temperature 10 min after birth.Changes in the incidence of admission hypothermia were analyzed between the two groups.Categorical variables were compared using Chi-squared test or Fisher's exact test,and continuous variables were compared using t-test or Wilcoxon rank-sum test.Spearman analysis was used to analyze the correlation between the implementation rate of process indicators and the incidence of admission hypothermia.Results A total of 1570 VLBWIs were included in this study,with 701(44.6%)in the pre-and 869(55.4%)in the post-quality improvement group.After quality improvement,the incidence of admission hypothermia decreased from 93.7%(657/701)to 75.9%(660/869)(χ^(2)=90.68,P<0.001),and the mean body temperature on admission to NICU increased significantly from(35.7±0.6)℃to(36.0±0.7)℃(t=-3.35,P=0.001).Correlation analysis showed that the overall actual implementation rate in all participating centers was negatively associated with the incidence of admission hypothermia(r=-0.81,P<0.01).Further statistical analysis revealed that the implementation rates of process indicators varied in different centers.For instance,the implementation rate of increasing the ambient temperature to 25℃reached>90%in six cen

关 键 词：婴儿 极低出生体重 低体温 发病率 重症监护病房 新生儿 质量改进 循证医学 多中心研究 

分 类 号：R473.72[医药卫生—护理学]