摘要
生理性黄疸是新生儿期常见的生理特点之一,是由于新生儿胆红素代谢的特点使胆红素一过性的增高而使皮肤粘膜及巩膜出现黄染的症候,一般于出生后7-10天自然消退,当新生儿血清胆红素高于一定值时,胆红素增高会引发核黄疸,若不及时治疗可遗留智力低下、手足徐动、听觉障碍、抽搐等后遗症。在WHO的倡导下,全世界提倡纯母乳喂养,母乳喂养率有上升的趋势,故母乳引起的黄疸也较前增多,据报道在部分地区已成为高胆红素血症的主要原因。母乳对黄疸的影响机制至今尚未明确,目前认为由于初乳中β-GD活性高、新生儿早期母乳喂养量不充足,新生儿早期热量、液量摄入不足而导致胆红素代谢的肠-肝循环增加有关;饥饿时胆红素产生增加、胆红素肠-肝循环亦增加;液量不足导致血液浓缩,红细胞破坏增加,胆红素水平升高,造成了新生儿胆红素在生理性黄疸的基础上的异常增加。因此,探索提高母乳喂养有效率的护理干预措施对减轻黄疸症状、预防核黄疸的发生有重要的临床意义。
本研究为探讨品管圈干预下纯母乳喂养对新生儿生理性黄疸的影响,将本院产科住院120例自然分娩的产妇及新生儿分为干预组和对照组,每组60例,干预组实施品管圈活动干预母乳喂养,对照组实施常规母乳喂养指导,两组新生儿分别于生后测得体重、尿布湿的块数、经皮胆红素值及排便次数、首次排便时间、胎便转黄时间进行比较分析,结果显示实施品管圈活动后,新生儿生理性体重下降程度降低,尿布湿的块数增加,排便次数增加,说明母乳喂养有效,可以促进新生儿的肠蠕动,使胎便提早排出,从而使新生儿胆红素峰值降低,降低了高胆红素血症的发生,值得在爱婴医院推广应用。
Objective: Neonatal serum bilirubin higher than a certain value, will lead to kernicterus. With the increase in breastfeeding rates, due to improper breast-feeding the newborn caused by increased serum bilirubin also increased over the previous, it was reported in some areas has become a neonatal hyperbilirubinemia of the main reasons. Thus, intervention measures which improve the success rate of breast-feeding in order to alleviate symptoms of jaundice, prevent the occurrence of kernicterus have important clinical significance. In this study, the use of Quality Control Circle intervention exclusive breastfeeding in order to improve the success rate of breast-feeding, thereby reducing neonatal hyperbilirubinemia occurred. Through the effect of exclusive breastfeeding of neonatal jaundice and physiological assessment of the situation, compare , observe before and after intervention whether such an intervention is effective and feasible, designed to promote quality in the Baby Friendly Hospital Initiative to promote exclusive breastfeeding loop intervention to reduce neonatal hyperbilirubinemia occurred.
Methods: Selected through the questionnaires which are pregnant women of natural delivery and implementation of exclusive breastfeeding of in-patient obstetric of the second hospital of Jilin University. The studied case is total 120 cases, of which 60 cases come from The first treatment area, as the intervention group, 60 cases come from the second treatment zone, as a control group. when Control group of pregnant women are admitted to hospital, after the birth, before discharge, they accept the routine hospital's breastfeeding guidance; Maternal intervention group participated in the activities of Quality Control Circle. Quality Control Circle is formed of nine nurses whom come from The first treatment area.They set the theme to enhance the success rate of exclusive breastfeeding through the survey, the reasons for analysis, development and implementation of countermeasures, after all the members are trained breast-feeding ,they provide breast-feeding guidance to the pregnant women during admission, childbirth ,before discharge . They also follow up after discharge home, continue to provide breast-feeding knowledge and technical guidance and help them to resolve issues related to breast-feeding, the group of statisticians and clerks objective Records of birth weight, the number of wet diaper blocks, bowel frequency, neonatal transcutaneous bilirubin value, the first defecation time, meconium yellow time, and analyzed statistically.
Results: (1) general information on two groups of comparison subjects, newborn gender, weight, mother age, gestational age, comparison of Production number were not significantly different (P> 0.05), comparable; (2) Two groups of newborns in the fifth day after birth, the eighth day, the comparison of their weight have significantly difference (P <0.01), with statistical significance; (3)The comparison of the two groups of neonates the seventh day after birth the average daily stool frequency, the blocks of wet diapers , have significantly difference (P <0.001), with statistical significance; (4) Two groups of newborns in the fifth day after birth, the eighth day compared percutaneous bilirubin, the results have significantly difference (P <0.05) with statistical significance; (5) the first time the two groups of neonatal meconium defecation time and time to Huang, there are significant differences (P <0.05), with statistical significance.
Conclusion: (1) the establishment of quality control circle makes nurses master more solid breastfeeding knowledge, thus theory with practical application and clinical; (2) quality control circle activities to enable maternal a better understanding of benefits of breastfeeding, as early as sucking, open as early as milk, early exposure to and the importance of on-demand breast-feeding; (3) quality control circle activities can help pregnant women to solve the psychological problems, eating issues and related difficulty problems in breast-feeding, increase the effectiveness of breast-feeding, thereby reduce the neonatal bilirubin peak, which has shortened the duration of jaundice, reduction of neonatal hyperbilirubinemia occurred.
引文
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