基于常规和三元整合教育方案对超低出生体重儿住院期间父母焦虑抑郁影响的历史对照研究

Historical comparative study on the effect of the routine nursing education and three-dimensional integrated education for hospitalized extremely low birth weight infants in a children’s hospital

目的:评价专业人员-父母-住院早产儿三元整合教育方案(三元整合教育方案)在超低出生体重早产儿(ELBW)中的临床应用效果。方法:选取复旦大学附属儿科医院2个年度ELBW的连续样本,对照组常规护理教育方案,实验组三元整合教育方案,采用贝克焦虑量表(BAI)和贝克抑郁量表第2版(BDI-Ⅱ)作为评价焦虑和抑郁的工具,比较不同教育方案父母的焦虑、抑郁程度的差别和父母入院时和出院前焦虑、抑郁水平。结果:实验组79对父母、对照组64对父母进入本文分析。实验组ELBW平均孕周小于对照组,试管婴儿比例高于对照组,机械通气时间长于对照组,但住院时间并不长于对照组,母乳喂养率也较对照组明显增高,差异均有统计学意义。入院时实验组和对照组BAI粗分[(18.9±9.8)vs(17.1±10.2)]和BDI-Ⅱ评分[(17.2±8.8)vs(16.0±9.0)],中重度焦虑[(37/128)vs(36/158)]和中重度抑郁的例数[(38/128)vs(51/158)],差异均无统计学意义;实验组和对照组出院时较入院时BAI粗分下降了(11.0±6.5)分和(8.5±2.3)分,BDI-Ⅱ评分下降了(11.3±8.1)分和(9.1±7.9)分,中重度焦虑和中重度抑郁的例数均有明显下降,差异均有统计学意义;实验组焦虑和抑郁评分改善值好于对照组,差异有统计学意义。入院时父亲焦虑和抑郁评分均较高于母亲,差异均有统计学意义。结论:三元整合教育方案明显降低了ELBW父母焦虑、抑郁的水平,在单中心的历史对照研究中得到较好的验证。

Objective To evaluate the clinical effect of professional-parent- hospitalized premature integrated education on extremely low birth weight infants. Methods The study design was historical comparative study. Two consecutive ELBW samples were selected from Children's Hospital of Fudan University. The routine nursing education program was conducted in control group (April 1, 2016 to February 28, 2017). A three-dimensional integrated education program was conducted in the experimental group (April 1, 2017 to March 31, 2018). The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory Version 2 (BDI-II) were used as evaluation tools. The anxiety and depression levels of parents in different education programs were compared. The anxiety and depression levels of parents before discharge and at admission were also compared. Results There were 78 cases and 95 cases of ELBW in the control group and experimental group respectively. Sixty-four cases in the control group and 79 cases in the experimental group were chosen according to the inclusion criteria. The average gestational week of ELBW in the experimental group was less than that in the control group. The proportion of test-tube infants was higher and the duration of mechanical ventilation was longer than that of control group. The difference was statistically significant. However, the length of hospitalization was not longer than that of the control group, and the breast-feeding rate was significantly higher than that of the control group. There was no significant difference in BAI gross score[(18.9±9.8) vs (17.1±10.2)], BDI score[(17.2±8.8) vs (16.0±9.0)], the number of cases of moderate and severe anxiety[(37/128) vs (36/158)] and depression[(38/128) vs (51/158)] between the experimental group and the control group at admission. The BAI gross scores of the experimental group and the control group at discharge were 11.0±6.5 and 8.5±2.3 lower than those at admission respectively, while BDI scores were 11.3±8.1 and 9.1±7.9 lower. The number of moderate to severe anxiety and depression decreased significantly, and the difference was statistically significant. The improvement values of anxiety and depression in the experimental group were better than those in the control group, and the difference was statistically significant. The scores of anxiety and depression of fathers at admission were higher than those of mothers, and the differences were statistically significant. Conclusion Three-dimensional integrated education program significantly reduced the level of anxiety and depression of ELBW parents. It has been well validated by the historical comparative study in the single-center.