无创辅助通气超未成熟儿应用袋鼠护理改善呼吸功能的效果

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英文篇名：Kangaroo Mother Care for Improving Respiratory Function in Extremely Immature Infants Requiring Non-Invasive Assisted Ventilation 作者：熊小云 ; 谢小华 ; 杨传忠 ; 孙盼盼 ; 陈丽莲 ; 张剑 ; 汪云云 ; 邓丽萍 英文作者：XIONG Xiao-yun;XIE Xiao-hua;YANG Chuan-zhong;SUN Pan-pan;CHEN Li-lian;ZHANG Jian;WANG Yun-yun;DENG Li-ping;Nursing Cellege,Guangzhou Medical University;Neonatal Intensive Care Unit,Shenzhen Maternal and Child Health Care Hospital Affiliated to Southern Medical University;Nursing Department,Shenzhen Second People's Hospital(the First Affiliated Hospital of Shenzhen University);Nursing College,Anhui Medical University; 关键词：袋鼠式护理 ; 超未成熟儿 ; 无创辅助通气 英文关键词：kangaroo mother care;;extremely preterm infants;;non-invasive assisted ventilation 中文刊名：JXYB 英文刊名：Journal of Nanchang University(Medical Sciences) 机构：广州医科大学护理学院;南方医科大学附属深圳妇幼保健院新生儿重症监护室;深圳市第二人民医院(深圳大学第一附属医院)护理部;安徽医科大学护理学院; 出版日期：2019-06-28 出版单位：南昌大学学报(医学版) 年：2019 期：v.59;No.286 基金：深圳市医疗卫生三名工程项目(SZSM201612045) 语种：中文; 页：JXYB201903015 页数：6 CN：03 ISSN：36-1323/R 分类号：67-71+79

摘要

目的探讨袋鼠式护理(kangaroo mother care,KMC)对需无创辅助通气的超未成熟儿实施的可行性及对其呼吸功能的影响。方法选取在NICU住院的114例超未成熟儿,按随机数字表法分为试验组和对照组,每组57例。对照组实施常规护理,试验组在常规护理基础上,实施KMC,每天1次,每次3 h,干预期限持续2周。结果试验组脱落1例,实际纳入56例;对照组脱落6例,实际纳入51例,共纳入107例。单因素分析结果显示KMC对经鼻间歇正压通气(nasal intermittent positive pressure ventilation,nIPPV)经鼻持续正压通气(nasal continuous positive airway pressure,nCPAP)时间和呼吸暂停次数有影响(P=0.04,P<0.001);按照孕周和出生体质量将研究对象分层,结果显示试验组与对照组相比,超未成熟儿nIPPV/nCPAP时间减少,呼吸暂停次数减少(P<0.05或P<0.01);Logistic回归分析显示,经性别、孕周和出生体质量调整后,KMC与nIPPV/nCPAP时间(β=-7.42,95%CI=-12.19～-2.65;P=0.003)、呼吸暂停次数(β=-8.72,95%CI=-10.85～-6.58);P<0.001)及吸氧总时间(β=-8.03,95%CI=-13.99～-2.06;P=0.01)呈负相关;再次调整性别、孕周和出生体质量、日龄、分娩方式(顺产,剖宫产)、产前激素(不足,足)、试管婴儿(否,是)、宫内窘迫(否,是)因素后,KMC仍然与nIPPV/nCPAP时间(β=-7.26,95%CI=-11.95～-2.58;P=0.003)、呼吸暂停次数(β=-8.36,95%CI=-10.44～-6.27;P<0.001)及吸氧总时间(β=-7.78,95%CI=-13.47～-2.08;P=0.01)呈负相关。结论需无创辅助通气超未成熟儿应用袋鼠式护理安全可行,能减少其呼吸暂停次数,缩短用氧时间,提高生存质量。
        Objective To explore the feasibility of kangaroo mother care(KMC) in extremely preterm infants requiring non-invasive assisted ventilation,and to investigate its effect on respiratory function.Methods A total of 114 extremely immature infants hospitalized in NICU were randomly given conventional care alone(control group,n=57) or in combination with KMC(experimental group,n=57) once daily(3 hours) for 2 weeks.Results Totally 107 cases were included in this study(detachment occurred in 1 in experimental group and in 6 in control group).Univariate analysis showed that KMC affected nIPPV/nCPAP time and apnea frequency(P=0.04,P<0.001).Subjects were stratified according to gestational age and birth weight.The results showed that,compared with control group,both nIPPV/nCPAP time and apnea frequency decreased in experimental group(P<0.05 or P<0.01).After adjusting for gender,gestational age and birth weight,logistic regression analysis showed that KMC was negatively correlated with nIPPV/nCPAP time(β=-7.42,95%CI=-12.19--2.65,P=0.003),apnea frequency(β=-8.72,95%CI=-10.85--6.58,P<0.001) and total oxygen inhalation time(β=-8.03,95%CI=-13.99--2.06,P=0.01).After adjusting for gender,gestational age,birth weight,delivery mode(natural delivery,cesarean delivery),prenatal hormones(insufficient,sufficient),in vitro fertilization(no,yes) and intrauterine distress(no,yes),KMC was still negatively correlated with nIPPV/nCPAP time(β=-7.26,95%CI=-11.95--2.58,P=0.003),apnea frequency(β=-8.36,95%CI=-10.44--6.27,P<0.001) and total oxygen inhalation time(β=-7.78,95%CI=-13.47--2.08,P=0.01).Conclusion Kangaroo mother care is safe and effective for extremely preterm infants requiring non-invasive ventilation.It can reduce apnea frequency,shorten oxygen inhalation time and improve the quality of life.

引文

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