低体重早产儿呼吸窘迫综合征无创通气治疗期间实施母亲参与袋鼠式照护的临床观察

周佩艳; 罗飞翔

doi:10.16766/j.cnki.issn.1674-4152.003250

低体重早产儿呼吸窘迫综合征无创通气治疗期间实施母亲参与袋鼠式照护的临床观察

doi: 10.16766/j.cnki.issn.1674-4152.003250

周佩艳^1, ,,
罗飞翔²

1.
金华市人民医院新生儿重症监护病房，浙江金华 321015
2.
浙江大学医学院附属儿童医院新生儿重症监护病房，浙江杭州 320000

基金项目:

浙江省医药卫生科技计划项目 2020KY611

详细信息

通讯作者:
周佩艳，E-mail：214109233@qq.com

中图分类号: R441.8 R722
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- 文章访问数: 60
- HTML全文浏览量: 21
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- 被引次数: 0
出版历程
- 收稿日期: 2023-08-07
- 网络出版日期: 2024-01-13

Clinical Observe of on maternal participation in kangaroo care during non-invasive ventilation therapy for low birth weight premature infants with RDS

ZHOU Peiyan^{1
, ,},
LUO Feixiang²

1.
Newborn Intensive Care Unit, Jinhua People' s Hospital, Jinhua, Zhejiang 321015, China

摘要

摘要: 目的低体重早产儿具有较高的呼吸窘迫综合征(RDS)发生风险，科学合理的照护方式直接影响患儿预后水平，本研究探讨在患儿无创通气治疗期间实施母亲参与袋鼠式照护(KMC)的临床效果。方法以2020年1月—2022年12月于金华市人民医院新生儿重症监护病房(NICU)收治的156例低体重RDS早产儿(体重<2 000 g)为研究对象，按照随机数字表法分为对照组(78例)和研究组(78例)，2组均予以无创通气治疗，在此期间，对照组给予常规照护，研究组给予母亲参与的KMC。比较干预前和撤机时患儿动脉血气指标；记录无创通气持续时间、肺表面活性物质(PS)重复使用、中途转有创机械通气情况；观察无创通气期间呼吸机通气相关并发症情况。结果 2组患儿撤机时PaCO₂均较干预前显著下降，而PaO₂、SaO₂和pH均较干预前显著上升(均P<0.05)，而2组患儿各动脉血气指标差异均无统计学意义(均P>0.05)。研究组患儿无创通气持续时间显著短于对照组[(7.41±0.62)d vs. (8.35±0.71)d，t=8.807，P<0.001]，且PS重复使用率和中途转有创机械通气率均显著低于对照组(均P<0.05)。研究组患儿无创通气期间并发症总发生率(8.97%，7/78)显著低于对照组(23.08%, 18/78, χ²=5.764，P=0.016)。结论对低体重RDS早产儿行无创通气治疗期间实施母亲参与的KMC，可有效缩短无创通气时间，减少PS用量，降低无创通气失败率及相关并发症发生风险。
- 早产儿 /
- 低体重 /
- 呼吸窘迫综合征 /
- 鼻塞式持续性气道正压通气 /
- 袋鼠式照护 /
- 并发症
Abstract: Objective Low weight premature infants have a higher risk of developing respiratory distress syndrome (RDS), and the scientific and reasonable care methods directly affect the prognosis of the children. Therefore, the clinical effect of implementing mother' s participation in kangaroo care (KMC) during invasive ventilation treatment for the children is explored. Methods A total of 156 cases of low weight RDS preterm infants (weight<2 000 g) admitted to the neonatal intensive care unit (NICU) of Jinhua People' s Hospital from January 2019 to December 2022 were taken as the research objects, and they were divided into control group (n=78) and study group (n=78) according to the random number table. Both groups were given non-invasive ventilation treatment. During this period, the control group was given routine care, and the study group was given KMC participated by mothers. The difference of arterial blood gas between before intervention and after weaning were compared. The duration of noninvasive ventilation, repeated use of pulmonary surfactant (PS), and midway conversion to invasive mechanical ventilation were recorded. The complications related to ventilator ventilation during non-invasive ventilation intervention were observed. Results The PaCO₂ values of the two groups were significantly lower than those before the intervention, while the PaO₂, SaO₂ and pH values were significantly higher than those before the intervention (all P<0.05), while the arterial blood gas values of the two groups were not significantly different (all P>0.05); The duration of noninvasive ventilation of RDS premature infants in the study group was significantly shorter than that in the control group [(7.41±0.62) d vs. (8.35±0.71) d, t=8.807, P<0.001], and the repeated use rate of PS and the rate of midway invasive mechanical ventilation were significantly lower than those in the control group (all P<0.05). The overall incidence of complications during noninvasive ventilation of RDS premature infants in the study group (8.97%, 7/78) was significantly lower than that in the control group (23.08%, 18/78, χ²=5.764, P=0.016). Conclusion Implementing KMC with mother involvement during non-invasive ventilation treatment for low weight RDS premature infants can effectively shorten non-invasive ventilation time, reduce PS dosage, and reduce the risk of non-invasive ventilation failure and related complications.
- Premature infant /
- Low weight /
- Respiratory distress syndrome /
- Nasal continuous positive airway pressure ventilation /
- Kangaroo mother care /
- Complication

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表 1 2组RDS患儿干预前后血气指标比较(x±s)

Table 1. Comparison of blood gas indicators between two groups of RDS children before and after intervention (x±s)

组别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		SaO₂(%)		pH值
组别	例数	干预前	撤机时	干预前	撤机时	干预前	撤机时	干预前	撤机时
研究组	78	55.68±3.75	45.16±2.34^a	54.09±3.68	73.92±4.86^a	80.78±3.74	92.17±1.46^a	7.17±0.11	7.39±0.14^a
对照组	78	55.52±3.69	45.49±2.37^a	54.43±3.76	73.58±4.71^a	81.03±3.82	92.39±1.49^a	7.20±0.13	7.36±0.11^a
t值		0.294	0.875	0.571	0.417	0.413	0.931	1.556	1.488
P值		0.768	0.383	0.569	0.645	0.680	0.353	0.122	0.139
注：与同组干预前比较，^aP<0.05。

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表 2 2组RDS患儿临床治疗指标情况比较

Table 2. Comparison of clinical treatment indicators between two groups of RDS children

组别	例数	无创通气持续时间(x±s，d)	PS重复使用[例(%)]	中途转有创机械通气[例(%)]
研究组	78	7.41±0.62	13(16.67)	3(3.85)
对照组	78	8.35±0.71	27(34.62)	11(14.10)
统计量		8.807^a	6.590^b	5.022^b
P值		<0.001	0.010	0.025
注：^a为t值，^b为χ²值。

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表 3 2组RDS早产儿无创通气相关并发症情况比较[例(%)]

Table 3. Comparison of non-invasive ventilation related complications between two groups of RDS premature infants [cases (%)]

组别	例数	气胸	鼻腔损伤	腹胀	总发生
研究组	78	1(1.28)	4(5.13)	2(2.56)	7(8.97)
对照组	78	3(3.85)	10(12.82)	5(6.41)	18(23.08)
注：2组并发症总发生率比较，χ²=5.764，P=0.016。

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参考文献(18)

[1]	王华, 许志有, 林鲁飞, 等. 加热、湿化经鼻高流量氧疗联合肺表面活性物质对新生儿呼吸窘迫综合征的疗效观察[J]. 临床肺科杂志, 2019, 24(5): 815-818. WANG H, XU Z Y, LIN L F, et al. Observation of curative effect of HHFNC on neonatal respiratory distress syndrome[J]. Journal of Clinical Pulmonary Medicine, 2019, 24(5): 815-818.
[2]	马秀慧, 金宝, 雷红林, 等. 微创肺表面活性物质注入技术联合双水平气道正压通气治疗早产儿呼吸窘迫综合征[J]. 中华新生儿科杂志, 2022, 37(4): 298-304. MA X H, JIN B, LEI H L, et al. Less invasive surfactant administration combined with bi-level positive airway pressure in preterm infants with respiratory distress syndrome: a clinical research[J]. Chinese Journal of Neonatology, 2022, 37(4): 298-304.
[3]	朱柳杰, 任广立, 谢聪, 等. 两种不同无创通气策略治疗新生儿呼吸窘迫综合征疗效分析[J]. 天津医药, 2019, 47(10): 1067-1072. ZHU L J, REN G L, XIE C, et al. Efficacy analysis of two different noninvasive ventilation strategies in neonatal respiratory distress syndrome[J]. Tianjin Medical Journal, 2019, 47(10): 1067-1072.
[4]	胡晓静, 张玉侠, 庄薇, 等. 新生儿重症监护病房袋鼠式照护对早产儿生理、行为和神经发育影响的研究进展[J]. 中国循证儿科杂志, 2019, 14(2): 152-157. HU X J, ZHANG Y X, ZHUANG W, et al. Research progress on the effects of kangaroo care in neonatal intensive care unit on the physiology, behavior, and neurodevelopment of premature infants[J]. Chinese Journal of Evidence Based Pediatrics, 2019, 14(2): 152-157.
[5]	曾欣, 李丽玲, 胡晓静. 国外早产儿父亲实施袋鼠式护理的研究进展及启示[J]. 中华护理杂志, 2022, 57(15): 1898-1903. CENG X, LI L L, HU X J. Research progress and enlightenment on kangaroo father care of premature infants abroad[J]. Chinese Journal of Nursing, 2022, 57(15): 1898-1903.
[6]	孙丽娜, 闫光霞, 李征. 袋鼠式照护在NICU早产儿护理中的应用[J]. 齐鲁护理杂志, 2020, 26(15): 111-113. SUN L N, YAN G X, LI Z. The application of kangaroo care in NICU premature infant care[J]. Journal of Qilu Nursing, 2020, 26(15): 111-113.
[7]	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011: 395-398. SHAO X M, YE H M, QIU X S. Practical neonatology[M]. 4th edition. Beijing: People's Health Publishing House, 2011: 395-398.
[8]	胥焕, 许平. 不同制剂肺表面活性物质对早产儿呼吸窘迫综合征的疗效分析[J]. 中华危重病急救医学, 2021, 33(2): 174-179. XU H, XU P. Efficacy analysis of different pulmonary surfactants in premature infants with respiratory distress syndrome[J]. Chinese Critical Care Medicine, 2021, 33(2): 174-179.
[9]	王柱, 杜岚岚, 陈佳, 等. 经鼻间歇正压通气联合微创肺表面活性物质治疗极早产儿呼吸窘迫综合征疗效分析[J]. 中华新生儿科杂志, 2022, 37(4): 293-297. WANG Z, DU L L, CHEN J, et al. Efficacy analysis of nasal intermittent positive pressure ventilation and minimally invasive surfactant therapy in very preterm infants with respiratory distress syndrome[J]. Chinese Journal of Neonatology, 2022, 37(4): 293-297.
[10]	宋飞飞, 张兰. LISA技术和INSURE技术治疗早产儿呼吸窘迫综合征的疗效分析[J]. 中华全科医学, 2021, 19(8): 1322-1325, 1429. doi: 10.16766/j.cnki.issn.1674-4152.002051 SONG F F, ZHANG L. Comparison of LISA technique and INSURE technique in the treatment of respiratory distress syndrome in premature infants[J]. Chinese Journal of General Practice, 2021, 19(8): 1322-1325, 1429. doi: 10.16766/j.cnki.issn.1674-4152.002051
[11]	冯敏, 罗兵. 不同剂量肺表面活性物质联合INSURE技术治疗新生儿呼吸窘迫综合征的效果观察[J]. 中华全科医学, 2021, 19(10): 1689-1692. doi: 10.16766/j.cnki.issn.1674-4152.002143 FENG M, LUO B. Comparison of LISA technique and INSURE technique in the treatment of respiratory distress syndrome in premature infants[J]. Chinese Journal of General Practice, 2021, 19(10): 1689-1692. doi: 10.16766/j.cnki.issn.1674-4152.002143
[12]	刘娟娟, 黄珊珊, 陈晓庆, 等. 无创呼吸机及肺表面活性物质联合治疗新生儿睡眠呼吸窘迫综合征(NRDS)的疗效及护理方法[J]. 世界睡眠医学杂志, 2020, 7(10): 1772-1773. LIU J J, HUANG S S, CHEN X Q, et al. Efficacy and nursing method of non-invasive ventilator and pulmonary surfactant in the treatment of neonatal sleep respiratory distress syndrome (NRDS)[J]. World Journal of Sleep Medicine, 2020, 7(10): 1772-1773.
[13]	WHO Immediate KMC Study Group. Immediate "Kangaroo Mother Care" and survival of infants with low birth weight[J]. N Engl J Med, 2021, 384(21): 2028-2038. doi: 10.1056/NEJMoa2026486
[14]	SINHA B, SOMMERFELT H, ASHORN P, et al. Effect of community-initiated kangaroo mother care on postpartum depressive symptoms and stress among mothers of low-birth-weight infants: a randomized clinical trial[J]. JAMA Netw Open, 2021, 4(4): e216040. DOI: 10.1001/jamanetworkopen.2021.6040.
[15]	THUKRAL A. Kangaroo mother care practices: sustainability is important[J]. Indian J Pediatr, 2021, 88(6): 534-535. doi: 10.1007/s12098-021-03777-7
[16]	熊小云, 谢小华, 杨传忠, 等. 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[J]. 南昌大学学报(医学版), 2019, 59(3): 59-63, 71. XIONG X Y, XIE X H, YANG C Z, et al. Kangaroo mother care for improving respiratory function in extremely immature infants requiring non-Invasive assisted ventilation[J]. Acta Academiae Medicinae Jiangxi, 2019, 59(3): 59-63, 71.
[17]	熊小云, 谢小华, 杨传忠, 等. 袋鼠式护理改善无创辅助通气超未成熟儿喂养的效果评价[J]. 护理学杂志, 2019, 34(15): 1-4. XIONG X Y, XIE X H, YANG C Z, et al. Effect of kangaroo mother care on feeding results of extremely preterm infants requiring noninvasive assisted ventilation[J]. Journal of Nursing Science, 2019, 34(15): 1-4.
[18]	李玉, 李胜玲, 孙彩霞, 等. 袋鼠式护理对无创机械通气早产儿呼吸功能的影响[J]. 护理学杂志, 2021, 36(6): 11-14. LI Y, LI S L, SUN C X, et al. The effect of kangaroo mother care on respiratory function of premature infants on noninvasive ventilation[J]. Journal of Nursing Science, 2021, 36(6): 11-14.