围产期多学科关键策略对极早产儿体温及临床结局的效果评价

Evaluation of the effectiveness of the evidence base multi-discipline critical strategies on the temperature and clinical outcomes in very preterm infants

分析以证据为基础的围产期多学科关键策略(EBPCS)制定的干预方案对<32周极早产儿(VPIs)的体温及临床结局的效果评价。收集2021年5月1日至2022年5月31日在成都市妇女儿童中心医院产房/手术室出生,需要立即实施体温管理,并转入该院新生儿重症监护病房的VPIs的临床资料。按照随机数字表法将研究对象随机分为对照组和干预组,每组各108例。对照组实施国内指南推荐的常规体温管理,干预组在对照组的基础上增加EBPCS干预措施。比较两组VPIs在不同体温管理策略实施后的体温及临床结局的差异。共纳入216例VPIs,干预组VPIs的低体温发生率更低(30.55%比87.03%,P<0.001)、入住新生儿重症监护病房的平均体温更高[(36.56±0.31)℃比(35.77±0.53)℃,P<0.001]、肺泡表面活性物质使用剂量更低[(115.94±36.96)mg/kg比(151.41±54.68)mg/kg,P=0.014]、机械通气支持时间更短[(5.77±1.26)d比(14.19±4.63)d,P=0.006]、脑室内出血发生率更低(12.04%比23.15%,P=0.032)。对VPIs出生后实施EBPCS理念制定的体温干预策略,可预防和降低其低体温的发生,并改善临床结局。

To evaluate the effectiveness of intervention plans developed by the evidence base multi-discipline critical strategies(EBPCS)on temperature and clinical outcomes in very preterm infants(VPIs)born at<32 weeks.Clinical data were collected from VPIs born in the delivery room/operating room of Chengdu Women's and Children's Central Hospital from May 1,2021,to May 31,2022,who required immediate temperature management and were transferred to the neonatal intensive care unit(NICU)of the hospital.The study population was randomly divided into a control group and an intervention group based on the random number table method,with 108 cases in each group.The control group implemented the conventional temperature management recommended by domestic guidelines,while the intervention group adopted EBPCS interventions compared to the control group.The differences in body temperature and clinical outcomes between the two groups were compared after the implementation of different temperature management strategies.A total of 216 VPIs were included.The intervention group had a lower incidence of hypothermia(30.55%vs.87.03%,P<0.001),higher mean body temperature admitted to the NICU[(36.56±0.31)℃vs.(35.77±0.53)℃,P<0.001],a lower dose of pulmonary surfactant[(115.94±36.96)mg/kg vs.(151.41±54.68)mg/kg,P=0.014],shorter duration of mechanical ventilation[(5.77±1.26)days vs.(14.19±4.63)days,P=0.006],and lower incidence of intraventricular haemorrhage(12.04%vs.23.15%,P=0.032).The implementation of temperature intervention strategies developed by the EBPCS for VPIs after birth could prevent and reduce the incidence of hypothermia and improve clinical outcomes.