中医综合护理干预新生儿病理性黄疸随机平行对照研究

Neonatal Pathologic Jaundice of Random Parallel Control of Integrated Traditional Chinese Medicine Nursingintervention

[目的]观察中医综合护理干预新生儿病理性黄疸疗效。[方法]使用随机平行对照方法,将100例住院患者按按病志号抽签方法随机分为两组。对照组50例常规护理：1严密观察生命体征（呼吸频率、节律,呼吸障碍,心功能不全等）、皮肤黄疸（黄疸加重及黄疸发生时间、程度、进展）、小便（次数、量、颜色）;对重症高胆红素血症密切观察有无胆红素脑病的早期症状,如肌张力低下、嗜睡、精神萎靡、吸吮反射减弱;2防止感染,保持皮肤清洁,严格遵守无菌操作。治疗组50例中医经络穴位按摩综合护理干预：1调节房间室温和湿度,维持在26-28℃和50%-60%,保持柔和光线;2护理人员洗净双手,将适量强生婴儿润肤油涂在患儿身上,此过程给予患儿充分的关怀;3患儿沐浴游泳后安静时进行按摩,按摩过程中保持轻柔手法、准确定位及合适力度,顺时针方向旋推患儿拇指末节罗纹面,补脾经;伸直食指由指端向指根方向直推食指末节罗纹面,清肝经;由虎口向食指端直推食指桡侧缘,清大肠;由食指端向虎口直推食指桡侧缘,补大肠;同时绕脐周对患儿腹部进行顺时针按揉,各200次;若患儿大便干,则减少补脾经,增加清肝经和清大肠;若患儿大便烂,增加补脾经和补大肠,减少清肝经,同时对腹部逆时针按揉;2次/d,10-15min/次;常规护理同对照组。连续治疗护理15d为1疗程。观测临床症状、总胆红素（TBIL）水平、黄疸指数正常时间、胆红素下降幅度、住院时间、家属满意度、不良反应。治疗护理1个疗程,判定疗效。[结果]治疗组治愈26例,显效14例,有效10例,无效0例,总有效率100.00%。对照组治愈20例,显效10例,有效6例,无效14例,总有效率72.00%。治疗组疗效优于对照组（P〈0.05）。总胆红素（TBIL）水平、黄疸指数正常时间、胆红素下降幅度、住院时间、家属满意度治疗组优于对照组（P〈0.05）。[结论]中医综合护理干预新生儿病理性黄疸效果显著,值得推广。

[ Objective ] To observe the curative effect of integrated traditional Chinese medicine nursing intervention of neonatal pathological jaundice. [ Method ] Using random parallel control method, 100 cases hospitalized patientsaceording to disease will number the draw method were randomly divided into two groups. The control of routine nursing group 50 cases ： close observation of vital signs （ respiratory frequency, rhythm, respiratory disorders, heart function not congruent ）, skin （ jaundice occurrence time, degree of progress and jaundice, jaundice exacerbation ）, urine （number, quantity, color ） ; in severe hyperbilirubinemia close observation of early signs of free bilirubinencephalopathy, such as hypotonia, lethargy, spirit is dispirited, sucking reflex weakened; prevent infection, to keep the skin clean, strictly obey the aseptic operation. The treatment group of 50 cases of main and collateral channelsacupoint massage of TCM Comprehensive nursing intervention ： adjust the room temperature and humidity, maintained at 26 to 28 DEG C and 50% - 60%, keep the soft light ; nursing staff to wash hands, the amount of Johnson infant children moisturizing oil on your body, this process is to give children a sufficient concern; thechildren bath after swimming keep quiet when massage, gentle way, in the process of massage accurate positioningand appropriate efforts, ＇clockwise pushing children with distal thumb whorled surface, reinforcing spleen meridian ; stretched index finger from the fingertip to the finger root direction direct push the distal phalanx of index finger ribsurface, by hand to the index finger of Qinggan ; by the end of straight push the index finger radialis border, QingEscherichia; by the finger end axial direct push the index finger radialis border, fill the large intestine ; at the same time around the navel on the child＇s abdomen clockwise Anrou, each 200 times ; if the children dry stool, reduce thespleen through increased by Qing, Qinggan and Escherichia; if the children defecate rotten, invigorating the spleenand tonifying the increase e., reduce Qinggan after, also counter clockwise Anrou abdominal ; 2/d, 10 - 15min/;routine nursing with control group. Continuous treatment with 15d for 1 courses of nursing. Observation of clinical symptoms, total bilirubin （ TBIL ） level, jaundice index in normal time, bilirnbin decline rate, hospitalization time, family satisfaction, adverse reaction. The treatment and nursing of 1 period of treatment, curative effect. [ Results ] The treatment group cured 26 cases, markedly effective in 14 cases, effective 10 cases, invalid 0 cases, the total efficiency of 100%. The control group cured 20 cases, markedly effective in 10 cases, effective 6 cases, invalid 14 cases, the total efficiency of 72%. The efficacy of the treatment group was better than that of the control group （ P〈 0.05 ） . The levels of total bilirubin （ TBIL ）, jaundice index in normal time, bilirubin decline in treatment group than in control group, time of hospitalization, family satisfaction （ P 〈 0.05 ） . [ Conclusion ] The newborn pathological jaundice inTCM Comprehensive nursing intervention effect is significant, worthy of promotion.