支气管肺发育不良早产儿出院家庭准备度方案的制定及应用

Formulation and application of family readiness program for premature infants with bronchopulmonary dysplasia

目的探讨支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿出院家庭准备度方案的制定及应用成效。方法选取解放军总医院第七医学中心八一儿童医院新生儿重症监护室2018年6月至2019年12月诊断为BPD的41例超早儿及家庭主要照护者为对照组,按照常规出院准备进行干预,家长不能进入病房,每周2次、每次30 min,隔着玻璃窗户进行探视,出院当天进行常规健康宣教。2019年1月至7月诊断的44例BPD超早产儿及主要照护者设为观察组,通过患儿准备度、家庭主要照护者准备度、环境准备度、卫生支持系统准备度4个方面制定和实施出院家庭准备度方案进行干预。比较两组患儿出院前家长焦虑评分和出院前照护能力自评得分。比较出院后两组超早产儿体质量、头围、身长增长>P10的比例、返院率。统计学方法采用χ^(2)和t检验。结果两组BPD超早产儿及家长的一般资料比较差异无统计学意义(P>0.05);观察组广泛性焦虑量表评分(17.0±1.0)分,明显低于对照组的(20.1±1.3)分,差异有统计学意义(P<0.01);观察组患儿家长在进入病房参与护理及培训后照护知识自评得分(102.1±6.1)分,显著高于对照组(68.2±7.8)分,差异有统计学意义(P<0.01)。出院后观察组早产儿1、2、4周体质量>P10的比例分别为88.6%、86.4%、90.9%,优于对照组的65.9%、65.9%、60.0%。两组出院后第1周身长>P10的比例比较差异无统计学意义,观察组第2、4周身长>P10的比例分别为88.6%、90.9%,优于对照组的70.7%、72.5%,差异有统计学意义(P<0.05)。两组患儿头围增长出院后第1、2周无差异,第4周观察组头围>P10的比例为90.9%,高于对照组的70.0%,差异有统计学意义(P<0.05)。观察组出院后返院率为4.55%,低于对照组的21.95%,差异有统计学意义(P<0.05)。结论制定及应用BPD超早产儿出院家庭准备度方案能降低家长焦虑情绪,提高照护知识水平,促进患儿体质量、头围、身长的增长,降低返院率,提高生存质量。

Objective To study the formulation and application effect of family preparation for discharge of premature infants with BPD.Methods 41 cases of ultra-preterm infants with BPD and their family main caregivers admitted in Nennatal Intensive Care Unit,the Seventh Medical Center of Chinese PLA General Hospital from June 2018 to December 2019 were selected as control group.The intervention was carried out according to the routine discharge preparation,their parents couldn't enter the ward,twice a week for 30 minutes each time to visit the patients through glass windows,regular health education was conducted on the day of discharge.From January to July 2019,44 cases of ultra-preterm infants with BPD and their primary caregivers were included in the observation group.The family readiness program for discharge was formulated and implemented in four aspects:child readiness,primary family caregiver readiness,environment readiness,and health support system readiness.Parents'anxiety scores and self-assessment of care ability before discharge were compared between the two groups.After discharge,the growth rate of weight,head circumference and body length>P10 and the rate of returning to hospital were analyzed.Statistical methods were used byχ^(2) and t test.Results There was no statistical significance in the general data of preterm infants and their parents between the two groups(P>0.05).The score of generalized anxiety scale in the observation group(17.0±1.0)was significantly lower than that in the control group(20.1±1.3),with statistically significant(P<0.01).The self-assessment score of care knowledge of main family caregivers in the observation group was(102.1±6.1),significantly higher than that the control group(68.2±7.8),with statistically significance(P<0.01).After discharge,the growth rate of body weight>P10 in the observation group at 1,2 and 4 weeks was 88.6%,86.4%and 90.9%respectively,which was better than that in the control group(65.9%,65.9%,60.0%).There was no difference in the growth rate of body length in the two groups at the first week after discharge.The increase rate of body length>P10 were 88.6%and 90.9%at 2 and 4 weeks respectively,which was better than that in the control group(70.7%and 72.5%).There was no difference in the increase levels of head circumference in the two groups at 1,2 weeks after discharge,and the increase rates of>P10 for head circumference in the observation group at the fourth week were 90.9%.It was higher than that in the control group(70.0%),with statistically significance(P<0.05).The return to hospital rate of the observation group after discharge was 4.55%,which was lower than that in the control group(21.95%),with statistically significance(P<0.05).Conclusion The formulation and application of family readiness for discharge of ultra-premature infants with BPD can reduce parents'anxiety,improve the level of care knowledge,promote the growth of children's weight,head circumference and body length,reduce the rate of return to hospital,and improve the quality of life.