新生儿医源性皮肤损伤高危人群及高危环节的皮肤损伤预警监控管理与效果观察

Early warning and monitoring management of skin lesions and its effects on high risk group and high risk link of neonatal iatrogenic skin lesions

目的探讨预警监控管理在具有医源性皮肤损伤高危人群和高危环节特征的新生儿中的皮肤损伤预防效果。方法选择2014年6月至2015年6月,四川大学华西第二医院新生儿科住院患儿中,1 157例具有医源性皮肤损伤高危人群及高危环节特征的新生儿为研究对象。将2014年6~12月入院的557例患儿纳入对照组,对患儿采取医源性皮肤损伤普遍预防;将2015年1~6月入院的600例患儿纳入观察组,除进行医源性皮肤损伤普遍预防外,还采用本研究自行设计的《新生儿医源性皮肤损伤高危人群监控表》及＂医源性皮肤损伤记录单＂,对容易发生或已经发生医源性皮肤损伤的患儿进行重点预警监控和防治。分析两组不同出生体重患儿医源性皮肤损伤发生情况,比较两组患儿医源性皮肤损伤及主要类型发生率差异。两组患儿性别构成比、胎龄构成比及出生体重构成比比较,差异均无统计学意义（P〉0.05）。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得患儿家属知情同意,并与患儿家属签署临床研究知情同意书。结果 1对照组超低出生体重儿医源性皮肤损伤发生率（93.3%）分别较正常出生体重儿（25.9%）、低出生体重儿（29.6%）及极低出生体重儿（55.9%）高,且差异均有统计学意义（χ^2=27.68、25.02、7.69,P=0.000、0.000、0.006）。2观察组超低出生体重儿医源性皮肤损伤发生率（71.4%）分别较正常出生体重儿（19.6%）、低出生体重儿（15.2%）及极低出生体重儿（29.7%）高,且差异均有统计学意义（χ^2=17.90、23.57、7.82,P=0.000、0.000、0.005）。3两组患儿医源性皮肤损伤主要类型发生率由高到低依次为：药物外渗伤、尿布皮炎、鼻塞式氧疗所致压伤及黏贴伤;观察组患儿医源性皮肤损伤发生率（21.2%）、药物外渗伤发生率（6.5%）及黏贴伤发生率（3.3%）均较对照组低（34.5%、10.8%、6.1%）,且差异有统计学意义（χ^2=25.60、6.74、4.98,P=0.000、0.009、0.026）。结论实施高危人群及高危环节医源性皮肤损伤预警监控,能及时有效采取各种预防措施,从而降低新生儿医源性皮肤损伤发生率。

Objective To investigate the skin lesions prophylactic effects of the early warning and monitoring management for newborns with characteristics of iatrogenic skin lesions in high-risk group and high risk link. Methods From June 2014 to June 2015,a total of 1 157 newborns with characteristics of iatrogenic skin lesions in high-risk group and high risk link,who were hospitalized in department of Neonatology, West China Second University Hospital, Siehuan University,were chosen as study objects. Five hundred and fifty-seven newborns who were admitted from June to December, 2014 were included into control group, and underwent general prevention for iatrogenic skin lesions. Another 600 newborns who were admitted from January to June,2015 were included into observation group. In addition to general prevention for iatrogenic skin lesions, we used a self-design table Monitoring Table for Newborns in High-Risk Group of Iatrogenic Skin Lesions and ＂Iatrogenic Skin Lesions Record Form＂ to focus on early warning and monitoring, prevention and cure for newborns who was prone to iatrogenic skin lesions. The occurrence condition of iatrogenic skin lesions among different birth weight infants in both two groups were analyzed, meanwhile the differences of incidence rates of iatrogenic skin lesions and its main types between two groups were compared. There were no significant differences between two groups in constituent ratio of gender, gestational age and birth weight（P〉0.05）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from the parents of each participant. Results （D Incidence rate of iatrogenic skin lesions of extremely low birth weight infants（93. 3%） in control group was higher than that of normal birth weight infants（25.9 % ）, low birth weight infants（29.6%） and very low birth weight infants（55.9% ）, respectively, and all the differences were statistically significant （3（2 = 27.68,25.02,7.69 ; P = 0. 000, 0. 000,0. 006）. （2）Incidence rate of iatrogenic skin lesions of extremely low birth weight infants （71.4%） in observation group was higher than that of normal birth weight infants（19.6%）,low birth weight infants（ 15.2 %） and very low birth weight infants（29.7 % ）, respectively, and all the differences were statistically significant（x2 =17.90,23.57,7.82;P=0. 000,0. 000,0. 005）. The top four main types of iatrogenic skin lesions were lesion by medicine exosmose, diaper dermatitis, compression injury by nasal oxygen therapy and lesion by paste. The incidence rates of iatrogenic skin lesions（21.2 %）, lesion by medicine exosmose（6.5%） and by paste（3.3 % ） in observation group were lower than those of control group（34.5 %, 10.8 %, 6.10% ）, respectively, and the differences were statistically significant （Xz=25. 60,6.74,4.98;P=0.000,0. 009,0. 026）. Conclusions Conduct the early warning and monitoring to newborns in high-risk group and high risk link of iatrogenic skin lesions can take various preventive measures in a timely and effective manner, thus can reduce the incidence rate of neonatal iatrogenic skin lesions.