襁褓浴和浴缸浴对中晚期早产儿沐浴时生理参数及压力影响的比较

Comparison of the effects of swaddle bathing and tub bathing on physiological parameters and stress of mid-late preterm infants during bathing

目的比较襁褓浴和浴缸浴对新生儿重症监护室(NICU)住院中晚期早产儿沐浴时生理情况和行为压力的影响,以期为早产儿的照护提供依据。方法前瞻性纳入2019年4-9月东南大学医学院附属江阴医院NICU住院中晚期早产儿80例,随机分为对照组(n=40)和实验组(n=40),对照组早产儿进行常规浴缸浴,实验组早产儿在单层襁褓巾包裹下行襁褓浴。两组早产儿沐浴持续时间、部位、顺序和沐浴后护理均相同。记录并比较两组早产儿沐浴前后体温、脉搏、呼吸、血氧饱和度的生理参数变化情况和哭泣时长,使用新生儿婴儿疼痛量表(NIPS)比较两组早产儿的沐浴前后的压力水平。结果沐浴后实验组早产儿的体温和血氧饱和度高于对照组,差异有统计学意义(t=8.538、3.180,P<0.05)。沐浴后对照组的早产儿心率和呼吸频率均高于实验组(t=6.335、3.328,P<0.05)。沐浴期间实验组婴儿的哭泣持续时间[(17.45±4.91)s]较对照组[(59.03±24.93)s]明显缩短(t=10.349,P<0.05)。沐浴后实验组早产儿的NIPS评分显著低于对照组(0.98±0.92 vs.1.83±1.08,t=3.783,P<0.05)。结论襁褓浴在维持中晚期早产儿正常生理状态和减轻压力方面有积极作用,值得在NICU推广。

Objective To compare the effects of swaddle bathing and tub bathing on the physiological measurements and behavioral stress of mid-late preterm infants in neonatal intensive care unit(NICU),in order to provide reference for providing better care for preterm infants.Methods Totally 80 mid-late premature infants hospitalized in NICU in Jiangyin People′s Hospital from April to September 2019 were enrolled in this prospective study.The participants were randomly assigned into control group(n=40)and experiment group(n=40).The control received conventional tub bathing,while the experiment group was given swaddled bathing with single layer of towel.The bath duration time,procedure and care were the same in the two groups.The physiological parameters of body temperature,heart rate(HR),respiration,SPO2 and crying time before and after bath between the two groups were recorded and compared.Pre-bath and post-bath stress levels in both groups were compared by using the Newborn Infant Pain Scale(NIPS).Results Body temperature and SPO2 value of the premature infants in experiment group just after the bath were significantly higher than those in control group(t=8.538,3.180,P<0.05).Either HR or respiratory frequency in the control group was significantly higher than those in experiment group(t=6.335,3.328,P<0.05).Crying time was significantly shorter in the experiment group than that in the control group[(17.45±4.91)s vs.(59.03±24.93)s,t=10.349,P<0.05).And NIPS scores of the premature infants in experiment group after bath decreased at a statistically significant level compared with the control group(0.98±0.92 vs.1.83±1.08,t=3.783,P<0.05).Conclusion Given the positive effect of swaddled bathing in maintaining physiological condition and reducing stress,it can be used as an appropriate bathing method in NICU.