不同新生儿重症监护病房环境对极低出生体重早产儿的影响

Effects of different neonatal intensive care unit environments on very low birth weight premature infants

目的:探讨新生儿重症监护病房(neonatal intensive care unit,NICU)的环境差异对极低出生体重早产儿生长发育的影响。方法:对比分析NICU和特别监护病房(special care unit,SCN)的不同环境因素,选取67例极低出生体重早产儿,在初步治疗达到稳定状态后随机分成两组,其中NICU组35例,SCN组32例。比较两组患儿的血压(收缩压/舒张压,systolic blood pressure/diastolic blood pressure,SBP/DBP),心率(heart rate,HR)以及经皮血氧饱和度(percutaneous oxygen saturation,SpO2)的变化,恢复出生体重时间,平均每周体重增长数值以及住院时间。结果:SCN的光照基本符合12 h的光照-黑暗循环(light-dark cycle,L-D);NICU基本处于持续光线刺激下。在诊疗和护理操作上,SCN的管理也明显比NICU更为严格。在噪音方面,SCN白天噪音(59.66±5.53 dB)和夜间噪音(52.21±2.68 dB)均明显比NICU的白天[(71.74±3.57)dB]及夜间[(61.52±4.32)dB]低(P<0.05)。SCN组与NICU组DBP分别为(26.8±10.1)mmHg,(31.5±12.6)mmHg,HR分别为121±12.4,136±14.2,SpO2分别为(98.4±3.6)%,(96.6±2.9)%,早产儿恢复出生体重时间分别为(7.5±3.4)d,(9.4±4.5)d,平均每天体重增长分别为(13.4±4.3)g,(11.0±6.6)g,每周体重增长分别为(91.6±19.4),(82.2±20.7)g,住院天数分别为(47.4±13.8)d,(55.9±16.7)d,两组比较,差异均有统计学意义(P<0.05);SCN组患儿SBP较NICU组低,但差异无统计学意义[(50.3±14.2)mmHg vs(54.7±13.9)mmHg,P>0.05];在并发症发生方面,SCN组的单个并发症病种较NICU组减少,但差异均无统计学意义(P>0.05);而总体并发症发生次数少于NICU组,差异有统计学意义(P<0.05)。结论:不良环境刺激会影响早产儿的生长发育,增加疾病的康复难度和延长住院时间。

Objective:To investigate the effect of environments in neonatal intensive care unit(NICU)on the growth and development of very low birth weight premature infants.Methods:Comparison of different environmental factors between NICU and special care unit(SCN).Sixty-seven cases of very low birth weight premature infants were randomly divided into two groups after initial treatment,including 35 cases in NICU group and 32 cases in SCN group.Changes in blood pressure(systolic blood pressure/diastolic blood pressure,SBP/DBP),heart rate(HR)and percutaneous oxygen saturation(SpO2)were compared between the two groups.The recovery time of birth weight,average weekly weight gain and hospitalization time of the two groups were compared.Results:The lighting conditions of SCN was in accordance with the 12-hour light-dark cycle(L-D),NICU was continuously lighted.The management of SCN was stricter than NICU in treatment and nursing operation.The noise in SCN during day and night is lower than that of NICU(59.66±5.53 dB vs 71.74±3.57 dB)and(52.21±2.68 dB vs 61.52±4.32 dB),P<0.05.The DBP(26.8±10.1 mmHg vs 31.5±12.6 mmHg)and HR(121±12.4 vs 136±14.2)of SCN group were lower than those of NICU group.SpO2 was higher in SCN group than in NICU group(98.4%±3.6%vs 96.6%±2.9%);the days of recovering birth weight in preterm infants of SCN group were shorter than those in NICU group(7.5±3.4 d vs 9.4±4.5 d),the average daily weight gain(13.4±4.3 g vs 11.0±6.6 g),the weekly weight gain(91.6±19.4 g vs 82.2±20.7 g)of SCN group were higher than those in NICU group,and the days of hospitalization of SCN group were shorter than those in NICU group(47.4±13.8 vs 55.9±16.7);the difference between the two groups was statistically significant.The SBP in SCN group was lower than that in NICU group,but there was no significant difference(50.3±14.2 mmHg vs 54.7±13.9 mmHg).In terms of complications,the number of single complications in SCN group was lower than that in NICU group,but there was no statistical significance(P>0.05),while the total number of complications was less than that in NICU group,the difference was statistically significant(P<0.05).Conclusion:Poor environment has adverse effects on the growth and development of premature infants,and increases the difficulty of disease recovery and prolongs hospitalization time.