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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- 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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