目的 分析质量提升项目(QI)方法对新生儿重症病房(NICU)极低出生体重早产儿的低体温发生率的影响,为改善早产儿临床结局提供依据。方法 选取2017年1月1日-2019年1月31日出生后30 min内入住聊城市人民医院NICU的极低出生体重早产儿(胎龄＜32周和/或出生体重＜1 500 g)为研究对象,低体温的诊断标准为入院时肛温低于36.5℃。其中,2017年1月1日-12月31日收治的早产儿为对照组(128例),采用常规的体温管理措施;2018年2月1日-2019年1月31日为干预组(120例),通过QI采用综合性体温管理措施,对围生期相关情况、低体温、颅内出血和病死率等进行比较。结果 干预组早产儿入院体温为(36.6±0.7)℃,明显高于对照组(35.9±0.8)℃(t=4.54,P＜0.01),低体温发生率从92.5%降低至40.5%,干预组早产儿入院后低血压(43.4%)、颅内出血发生率(43.3%)、肺表面活性物质的应用(26.1%)、脓毒血症发生率(24.0%)均显著低于对照组(29.5%、32.9%、65.6%、41.0%,χ2=3.56、5.99、7.56、12.15,P＜0.05)。结论 以循证医学为依据的QI的实施可以显著降低极低出生体重早产儿入院时的体温过低,改善临床结局。
Abstract
Objective To analyze the effect of quality improvement item (QI) on the incidence of hypothermia of very low birth weight premature infants in Neonatal Intensive Care Unit (NICU),in order to provide evidence for improving the clinical outcome of premature infants. Methods The very low birth weight premature infants (gestational age＜32 weeks and/or birth weight＜1 500 g) admitted to NICU in Liaocheng People's Hospital were enrolled in this study from 1st January,2017 to 31st January,2019.Infants whose annal temperature was lower than 36.5℃ were diagnosed with hypothermia.Infants admitted in this hospital from 1st January,2017 to 31st December,2017 were enrolled in control group(n=128),and received typical measures controlling temperature.And infants admitted in this hospital from 1st February,2018 to 31st January,2019 were selected as intervention group(n=120),whose temperature was administered through quality improvement program.The rates of prenatal conditions,hypothermia,intraventricular hemorrhage and morbidity were compared between the two groups. Results The rate of hypothermia in very low birth weight premature infants decreased from 92.5% to 40.5% during the intervention period,and the temperature of intervention group at admission was significantly higher than that of control group[(36.6±0.7) ℃ vs.(35.9±0.8)℃,t=4.54,P＜0.01)].The incidence of hypotension(43.4%) and intracranial hemorrhage(43.3%),the application of pulmonary surfactant (26.1%) and the incidence of sepsis(24.0%)in intervention group were significantly lower than those in control group (29.5%,32.9%,65.6%,41.0%,χ2=3.56,5.99,7.56,12.15,P＜0.05). Conclusion The implementation of quality improvement program based on evidence-based medicine can significantly reduce hypothermia of very low birth weight premature infants at admission and improve their clinical outcomes.
关键词
质量提升项目 /
低体温 /
早产儿
Key words
quality improvement /
hypothermia /
premature infants
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] De Almeida MF,Guinsburg R,Sancho GA,et al.Hypothermia and early neonatal mortality in preterm infants[J].J Pediatr,2014,164(2):271-275.
[2] Fatsman BR,Howell EA,Holzman I,et al.Current perspective on temperature management and hypothermia in low birth weight infants[J].J Newborn Infant Nurs,2014,14(3):50-55.
[3] De Siqueira Caldas JP,Ferri WAG,Marba STM,et al.Admission hypothermia,neonatal morbidity,and mortality:evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center[J].Eur J Pediatr,2019,178(7):1023-1032.
[4] Pinheiro JM,Boynton S,Furdon SA,et al.Use of chemical warming packs during delivery room resuscitation is associated with decreased rates of hypothermia in very lowbirth-weight neonates[J].Adv Neonatal Care,2011,11(5):357-362.
[5] Bhatt DR,White R,Martin G,et al.Transitional hypothermia in preterm newborns[J].Adv Neonatal Care,2010,10(Suppl 5):15-17.
[6] Pinheiro JM,Furdon SA,Boynton S,et al.Decreasing hypothermia during delivery room stabilization of preterm neonates[J].Pediatrics,2014,133(1):e218-e226.
[7] Perlman JM,Wyllie J,Kattwinkel J,et al.Neonatal Resuscitation Chapter Collaborators.Part 7:Neonatal Resuscitation.2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J].Circulation,2015,132(16 Suppl 1):204-241.
[8] Cramer K,Wiebe N,Hartling L,et al.Heat loss prevention:a systematic review of occlusive skin wrap for premature neonates[J].J Perinatol,2005,25(12):763-769.
[9] Brown A.Applying the care group model to tuberculosis control:findings from a community-based project in Mozambique[J].Int J Tuber Lung Dis,2017,21(10):1086-1093.
[10] Yip WY,Quek BH,Fong MCW,et al.A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit[J].Int J Qual Health Care,2017,29(7):922-928.
[11] Reilly MC,Vohra S,Rac VE,et al.Randomized trial of occlusive wrap for heat loss prevention in preterm infants[J].J Pediatr,2015,166(2):262-268.
[12] Singh A,Duckett J,Newton T,et al.Improving neonatal unit admission temperatures in preterm babies:exothermic mattresses,polythene bags or a traditional approach?[J].J Perinatol,2010,30(1):45-49.
[13] Lee HC,Ho QT,Rhine WD.A quality improvement project to improve admission temperatures in very low birth weight infants[J].J Perinatol,2008,28(11):754-758.
[14] Lyu Y,Shah PS,Ye XY,et al.Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation[J].JAMA Pediatr,2015,169(4):e150277.
[15] Drassinower D,Friedman AM,Obi an SG,et al.Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J].Am J Obstet Gynecol,2016,214(6):743.e1-e6.
[16] Miller SS,Lee HC,Gould JB.Hypothermia in very low birth weight infants:distribution,risk factors and outcomes[J].J Perinatol,2011,31 (Suppl 1):49-56.
[17] Billimoria Z,Chawla S,Bajaj M,et al.Improving admission temperature in extremely low birth weight infants:a hospital-based multiintervention quality improvement project[J].J Perinat Med,2013,41(4):455-460.
基金
山东省重点研发计划项目(2018GSF118173);山东省医药卫生科技发展计划项目(2017WS218);聊城市人民医院院级青年科研基金资助项目(LYQN201933)
PDF(577 KB)
