新生儿重症监护室实施家长参与早产儿护理的平行对照研究

Parallel controlled study of parental involvement in pre-term infant care and routine care in the neonatal intensive care unit

目的探讨在新生儿重症监护室(NICU)早产儿护理中实施家长参与式护理模式的效果及可行性。方法以平行对照设计研究方案,对2018年7月-2019年12月南阳市中心医院NICU中符合纳入标准的261例早产儿,以胎龄、体重和出生时诊断相近为标准进行匹配分组,研究组纳入35例,对照组纳入70例。研究组在专科护士指导下患儿家长与专科护士共同完成患儿生活护理、病情观察、喂养护理、皮肤护理等工作,每天参与4 h至患儿出院;对照组所有患儿护理工作均由专科护士完成,家属每周隔窗探视3次,每次30 min。观察2组患儿体重增长情况,院内感染、二次住院及家属投诉发生率,医疗费用及科室支出费用等。结果入监护室时,研究组与对照组患儿体重差异无统计学意义[(1890.75±317.57)g vs.(1888.91±320.73)g,t=0.028,P=0.978];出监护室时,研究组体重高于对照组[(2473.97±284.72)g vs.(2267.59±316.54)g,t=3.254,P=0.002],差异有统计学意义。研究组体重增长速度较对照组高,平均治疗费用、住院时间、家属投诉率、出院后30 d内二次入院发生率均较对照组低,差异有统计学意义(均P<0.05)。2组患儿院内感染发生率差异无统计学意义(P>0.05)。研究期间科室支出费用较前增加。结论在NICU实施家长参与式护理模式可促进早产儿体重增长,降低医疗费用和二次住院发生率,且不增加院内感染发生率,安全可行,但科室支出费用有所增加。

Objective To explore the effect and feasibility of implementing the parent-participatory nursing model in the nursing of premature infants in the neonatal intensive care unit.Methods Based on a parallel control design study plan,261 premature infants who met the inclusion criteria in the NICU of Nanyang Central Hospital from July 2018 to December 2019 were matched and grouped in accordance with the criteria of similar gestational age,weight and diagnosis at birth.The study group included 35 cases,and the control group included 70 cases.Under the guidance of specialist nurses,the parents of the study group and the specialist nurses jointly completed the life care,condition observation,feeding care and skin care of the child and participated in 4 h every day until the child was discharged.The children in the control group were nursed by specialist nurses.Family members visited 3 times a week,30 min each time.The weight gain of the two groups of children was observed,and the incidence of nosocomial infection,secondary hospitalisation and family complaints,medical expenses and department expenditures was determined.Results When entering the intensive care unit,no significant difference in the average weight of the two groups of children was found[(1890.75±317.57)g vs.(1888.91±320.73)g,t=0.028,P=0.978].When leaving the intensive care unit,the average weight of the study group was significantly higher than that of the control group[(2473.97±284.72)g vs.(2267.59±316.54)g,t=3.254,P=0.002].The weight gain rate of the study group was higher than that of the control group.The average treatment cost,length of stay,family complaint rate and incidence of secondary admission within 30 days after discharge were lower in the study group than in the control group,and the difference was statistically significant(all P<0.05).No significant difference in the incidence of nosocomial infection was found between the two groups(P>0.05).During the study period,department expenditures increased than before.Conclusion The implementation of the parent-participatory care model in NICU can promote the weight gain of premature infants,reduce the medical expenses and the incidence of secondary hospitalisation and does not increase the incidence of nosocomial infections.It is safe and feasible,but the department expenditures have increased.