晚期早产剖宫产术中袋鼠式护理对新生儿出生"黄金小时"健康指标的影响

Effects of kangaroo mother care during cesarean section on neonatal health parameters of late preterm newborns within "golden hour"

目的评估袋鼠式护理对晚期早产剖宫产新生儿出生"黄金小时"健康指标的影响。方法前瞻性纳入温州医科大学附属嘉兴市妇女儿童医院2018年1月1日至12月31日晚期早产(孕34~36周+6)剖宫产产妇120例,采用随机数字表法分为观察组60例和对照组60例。观察组剖宫产术中实施即刻彻底擦干+袋鼠式护理+延迟脐带结扎;对照组实施即刻彻底擦干+常规母婴护理+延迟脐带结扎。比较2组早产儿出生"黄金小时"内的体温变化以及哭声异常、呼吸异常、低氧饱和度、低体温、转新生儿科的发生率及早开奶成功率,比较2组产科及儿科医生满意度、产妇及家属满意度。采用两独立样本t检验及χ2检验进行统计学分析。结果共113例(观察组58例和对照组55例)早产儿纳入分析。观察组早产儿生后5和10 min体温高于对照组(分别为36.5与36.0 ℃,36.4与35.8 ℃,t值分别为11.756和7.512,P值均<0.05),生后15 min^1 h体温也高于对照组,但差异无统计学意义(P值均>0.05)。观察组早产儿低体温发生率低于对照组[0%(0/58)与15%(8/55),χ2=9.079,P<0.001]、早开奶成功率高于对照组[86%(50/58)与58%(32/55),χ2=11.137,P<0.001]。观察组产科医生满意度评分[(19.3±1.1)与(13.4±1.9)分,t=20.517]、儿科医生满意度评分[(18.2±1.8)与(12.6±2.1)分,t=15.382]、产妇满意度评分[(19.6±0.4)与(13.6±1.6)分,t=27.723]和家属满意度评分[(18.2±0.9)与(15.3±1.1)分,t=11.535]均高于对照组,差异均有统计学意义(P值均<0.001)。结论晚期早产剖宫产术中实施袋鼠式护理可改善新生儿出生"黄金小时"的体温,减少低体温发生,促进早开奶,提升医患对母婴管理方式的满意度。

Objective To evaluate the effects of kangaroo mother care (KMC) during cesarean section on neonatal health parameters in the "golden hour" of late preterm infants. Methods A total of 120 singleton pregnant women undergoing preterm cesarean section (34-36+6 gestational weeks) from January 1 to December 31, 2018 in Jiaxing Women and Children's Hospital Affiliated to Wenzhou Medical University were prospectively enrolled and divided into two groups (observation and control groups) with 60 cases in each by random number table method. During cesarean section, the both groups received the thorough drying immediately and delayed cord clamping, in addition, the observation group adopted KMC, while the control group received routine maternal and infant care. Several parameters including changes in body temperature, crying, respiration, oxygen saturation and other vital signs, as well as the incidence of hypothermia, transfer to the Department of Neonatology and the success rate of early breastfeeding initiation during the "golden hour" were compared between the two groups. Satisfaction of obstetricians, pediatricians, the pregnant women and their families to KMC and routine maternal and infant care were compared. Two-independent sample t test and Chi-square test were used as statistical methods. Results In total, 113 cases (58 in the observation group and 55 in the control group) were finally analyzed. The body temperature of the late preterm infants at 5 and 10 min after birth in the observation group was higher than that in the control group (36.5 vs 36.0 ℃, 36.4 vs 35.8 ℃, t=11.756 and 7.512, both P<0.05), and the body temperature during 15 min-1 h after birth was also higher in the observation group but without statistical significance (all P>0.05). The observation group had a lower incidence of hypothermia [0%(0/58) vs 15%(8/55),χ2=9.079, P<0.001] and a higher success rate of early breastfeeding initiation [86%(50/58) vs 58%(32/55),χ2=11.137, P<0.001] than the control group. The satisfaction scores of obstetricians (19.3±1.1 vs 13.4±1.9, t=20.517), pediatricians (18.2±1.8 vs 12.6±2.1, t=15.382), gravidas (19.6±0.4 vs 13.6±1.6, t=27.723) and their family members (18.2±0.9 vs 15.3±1.1, t=11.535) were all higher in the observation group than those in the control group (all P<0.001). Conclusions KMC during cesarean section can improve the body temperature of late premature infants in the "golden hour", reduce the occurrence of hypothermia, facilitate early initiation of breastfeeding and improve the satisfaction of doctors and patients on health care.