【作者】 王琦；

【导师】 任燕；

【作者基本信息】 石河子大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的:通过文献回顾、专家会议以及预试验拟定出院准备计划,针对性地加强理论知识以及床边生活护理能力,评价出院准备计划对照护者居家照护技能的效果,为新生儿重症监护室(Neonatal Inte nsive Care Unit,NICU)新生儿出院准备计划的全面实施与推广提供理论依据。方法:选取2021年11月-2022年6月新疆乌鲁木齐市某三级甲等医院NICU新生儿及主要照护者为研究对象,对照组和干预组各60对。采用便利抽样法,2021年11月-2022年2月入院的新生儿及照护者设为对照组,给予NICU常规护理,2022年3月-2022年6月入院新生儿及照护者设为干预组,在对照组的基础上实施出院准备计划干预措施。比较两组照护者干预前后照护能力及紧张焦虑程度的变化情况,新生儿发育情况,包括体格发育(身长、体重),喂养方式,溢奶呛咳及尿布性皮炎发生率。采用SPSS26.0医学统计软件进行数据分析,P<0.05为差异有统计学意义。结果:(1)研究对象的基本信息:新生儿:男婴57例,女婴63例,平均胎龄为(35.62±3.25)周,早产儿56例,占比(46.70%)。对照组平均胎龄(35.77±3.07)周,体重3340.00(2707.50,3615.00)g,干预组平均胎龄(34.03±3.64)周,体重3230.00(2312.50,3578.80)g。照护者:父亲34例,母亲86例,平均年龄为(30.89±4.61)岁。对照组平均年龄为(31.52±4.70)岁,干预组为(30.27±4.47)岁。两组新生儿的胎龄,胎次出生身长和体重以及照护者的性别,年龄及文化程度等人口学特征的一般资料以及入院照护能力、紧张焦虑得分等基线资料的差异均无统计学意义(P>0.05)。(2)主要照护者照护能力得分:干预组照护者干预后照护能力得分(73.25±7.01)高于对照组(50.18±4.80)分,干预组得分差值d(29.37±8.21)高于对照组(8.57±3.19)分,差异具有显著统计学意义(P<0.001)。(3)新生儿NICU父母紧张焦虑得分:干预后组间比较,干预组照护者紧张焦虑总分(90.08±14.52)低于对照组(102.73±18.79)分,差异具有统计学意义(P<0.05);干预组紧张焦虑得分差值d(40.28±16.20)高于对照组(23.35±14.81)分,差异具有统计学意义(P<0.05)。(4)新生儿体格生长发育:干预组生后42天及3个月体重4620.00(3997.50,4854.25)g,5302.50(4605.00,5638.75)均高于对照组4217.50(3092.50,4696.25)g,5040.00(4531.25,5408.75)g,两组差异具有统计学意义(P=0.009,P=0.028)。(5)喂养情况:在院期间,干预组新生儿人工喂养比例16例(23.34%)低于对照组28例(46.67%),混合喂养比例45例(75.00%)高于对照组31例(51.67%),(P=0.043);干预组在院期间首次母乳喂养及全量母乳喂养的时间(2.86±0.82,5.82±1.14)均早于对照组(3.94±1.03,7.58±2.75)天,(P<0.05);出院1周及生后42天喂养方式进行比较,干预组母乳喂养率(55.00%,51.67%)高于对照组(33.33%,20.00%),混合喂养率(38.33%,43.33%)低于对照组(46.67%,65.00%),人工喂养比例(6.67%,5.00%)低于对照组(12.00%,15.00%),(P<0.05);(6)两组新生儿呛咳、尿布性皮炎发生率:干预组新生儿出院后呛咳率(31.67%)和发生尿布性皮炎率(26.67%)均低于对照组(56.67%,45.00%);干预组新生儿发生溢奶呛咳的次数(2.74±0.56)次低于对照组(5.21±1.77)次,差异均具有统计学意义(P<0.05)。结论:(1)实施出院准备计划干预方案后,照护者的照护能力处于中等偏上水平,且在安全防护、特殊照顾及亲子关系三个方面有明显提高。(2)照护者紧张焦虑情绪由很紧张焦虑缓解至一般程度紧张焦虑;(3)新生儿在院期间首次母乳喂养及达到全量喂养的时间均有较明显缩短,出院1周及生后42天的母乳喂养率达到50%以上;溢奶呛咳及尿布性皮炎发生率降低约20%。(4)有必要在新生儿监护室全面推广出院准备计划。更多还原

【Abstract】 Purpose: Through literature review,expert meetings and pre-testing,we developed a discharge preparation program to strengthen theoretical knowledge and bedside living care skills,and evaluated the effect of the di scharge preparation program on caregivers’ home care skills to provide a theoretical basis for the full imple mentation and promotion of the neonatal discharge preparation program in the Neonatal Intensive Care Unit(NICU).Method: Neonates and main caregivers of NICU of a tertiary hospital in Urumqi,Xinjiang from November2021 to June 2022 were selected as the study objects,with 60 pairs from the control group and the intervent ion group.By convenience sampling method,newborns and caregivers admitted from November 2021 to Fe bruary 2022 were assigned as the control group and given routine care in the NICU,newborns and caregiver s admitted from March 2022 to June 2022 were assigned as the intervention group,and the discharge prepar ation program intervention was implemented on the basis of the control group.Compchanges in care ability and anxiety before and after the intervention,neonatal development,including physical development(lengt h,weight),feeding method,milk choking,bucking and diaper rash.SPSS26.0 medical statistical software was used for data analysis,and P<0.05 was considered statistically significant.Results:(1)Basic information of the study subjects: newborn infants: 57 male infants,63 female infants,the average gestational age was(35.62±3.25)weeks,and 56 premature infants,the proportion(46.70%).Mea n gestational age(35.77±3.07)weeks,body weight 3340.00(2707.50,3615.00)g,intervention group mean gestational age(34.03±3.64)weeks,and body weight 3230.00(2312.50,3578.80)g.Caregivers: 34 fathers and 86 mothers,with a mean age of(30.89±4.61)years.The mean age of the control group was(31.52±4.70)years and(30.27±4.47)years in the intervention group.There were no statistically significant differenc es between the two groups in gestational age,fetal birth length and weight,and general information on demo graphic characteristics such as sex,age and education of the caregivers,as well as baseline information such as admission caregiving ability and stress and anxiety scores(P > 0.05).(2)Primary caregiver caregiving a bility scores: the post-intervention caregiving ability scores of caregivers in the intervention group(73.25±7.01)were higher than those in the control group(50.18±4.80),and the difference in scores in the interventio n group d(29.37±8.21)was higher than that in the control group(8.57±3.19),with statistically significant differences(P<0.001).(3)Nervous anxiety scores of parents of neonates in NICU: comparing between gro ups after the intervention,the total nervous anxiety scores of caregivers in the intervention group(90.08±14.52)were lower than those in the control group(102.73±18.79),and the difference was statistically signifi cant(P<0.05);the difference of nervous anxiety scores d in the intervention group(40.28±16.20)was high er than the control group(23.35±14.81),and the difference was statistically significant(P<0.05).(4)Physic al growth and development of newborns:The body weight of the intervention group at 42 days and 3 months after birth was 4620.00(3997.50,4854.25)g and 5302.50(4605.00,5638.75)higher than that of the contro l group at 4217.50(3092.50,4696.25)g and 5040.00(4531.25).5408.75)g,the difference between the two groups was statistically significant(P=0.009,P=0.028).(5)Feeding: During hospitalization,the proportion of artificial feeding was lower in 16 cases(23.34%)than in 28 cases(46.67%)in the control group,and the proportion of mixed feeding was higher in 45 cases(75.00%)than in 31 cases(51.67%)in the control group(P=0.043);the time of first breastfeeding and full breastfeeding in the intervention group during hospitaliza tion(2.86±0.82,5.82±1.14)were earlier than in the control group(3.94±1.03,7.58±2.75)days,(p<0.05);When feeding patterns were compared at 1 week of discharge and 42 days after birth,the intervention gr oup had a higher breastfeeding rate(55.00%,51.67%)than the control group(33.33%,20.00%),a lower mi xed feeding rate(38.33%,43.33%)than the control group(46.67%,65.00%),and a lower proportion of man ual feeding(6.67%,5.00%)than the control group(12.00%,15.00%),(P < 0.05);(6)The incidence of chok ing and diaper dermatitis in the two groups: the choking rate(31.67%)and the incidence of diaper dermatiti s(26.67%)after discharge were lower in the intervention group than in the control group(56.67%,45.00%);the number of choking and coughing with milk overflow was lower in the intervention group(2.74±0.56)than in the control group(5.21±1.77),and the differences were The differences were statistically significan t(P < 0.05).Conclusion:(1)After the implementation of the discharge preparation program intervention,the caregivers’ caregiving ability was moderately high,and there was a significant improvement in the three areas of safet y and security,special care,and parent-child relationship.(2)The caregivers’ nervousness and anxiety decre ased from very nervous and anxious to average nervous and anxious;(3)The time to first breastfeeding and full feeding of newborns in the hospital was significantly reduced,and the breastfeeding rate reached more t han 50% in the first week of discharge and 42 days after birth;the incidence of choking on overflowing mil k and diaper dermatitis decreased by about 20%.(4)It is necessary to fully promote the discharge preparati on program in the neonatal care unit.更多还原