摘要
目的探讨新生儿早期基本保健技术(early essential newborn care, EENC)对足月剖宫产母婴早期健康指标的影响,以及产妇及手术医护人员对实施该技术的满意度和接受度。方法前瞻性纳入温州医科大学附属嘉兴市妇女儿童医院2018年1月至4月足月剖宫产产妇200例,按住院号单双号随机分为EENC组和对照组各100例。EENC组新生儿实施EENC技术,即新生儿生后即刻彻底擦干、母婴皮肤接触至少90 min完成第一次母乳喂养、延迟脐带结扎(生后l^3 min);对照组新生儿实施常规护理操作,即常规擦干、短暂母婴皮肤接触、生后1 min内结扎脐带。比较2组新生儿脉搏异常、低氧饱和度、低体温、轻度窒息发生率,产妇产后出血发生率及早开奶比例,比较产妇对产时EENC/常规护理的满意度和接受度,以及产科手术团队的接受度。采用t检验、χ2检验对数据进行统计学分析。结果EENC组和对照组各100例均纳入分析。EENC组新生儿低体温发生率[2%(2/100)与13%(13/100),χ2=8.721,P=0.003]和产妇产后出血发生率[1%(1/100)与6%(6/100),χ2=5.701,P=0.035]均低于对照组,早开奶比例高于对照组[56%(56/100)与5%(5/100),χ2=61.352,P<0.001]。2组间新生儿脉搏异常、低氧饱和度和轻度窒息发生率差异无统计学意义(P值均>0.05)。EENC组产妇的满意度评分[(24.6±0.4)与(23.4±1.9)分,t=6.443]和接受度评分[(24.3±0.5)与(23.5±1.4)分,t=5.436]均高于对照组,差异有统计学意义(P值均=0.001)。EENC组手术团队中产科医生接受度评分[(22.6±0.8)与(21.6±1.3)分,t=2.379,P=0.019]、器械护士接受度评分[(23.2±0.9)与(21.3±1.1)分,t=13.592,P<0.001]和麻醉医生接受度评分[(22.6±0.9)与(21.5±1.7)分,t=5.625,P=0.001]均高于对照组,但巡回护士接受度评分在2组之间差异无统计学意义(P=0.086)。结论足月剖宫产术中实施EENC能稳定新生儿体温,减少产后出血,促进早开奶,提升产妇满意度以及产科手术团队和产妇的接受度。剖宫产术中开展EENC具有临床推广价值。
Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2%(2/100) vs 13%(13/100),χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1%(1/100) vs 6%(6/100),χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56%(56/100) vs 5%(5/100),χ2=61.352, P<0.001]. There was no significant difference in the incidence of neonatal abnormal pulse, low oxygen saturation or mild asphyxia between the two groups (all P>0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS.
作者
徐建平
顾水琴
朱群娥
崔小妹
章敏
万丽
陆凯妮
Xu Jianping;Gu Shuiqin;Cui Xiaomei;Zhang Min;Wan Li;Lu Kaini(Operating Room, Jiaxing Women and Children's Hospital Affiliated to Wenzhou Medical University, Jiaxing 314000, China;Department of Nursing, Jiaxing Women and Children's Hospital Affliated to Wenzhou Medical University, Jiaxing 314000, China;Experiment Center of Medical Faculty, Jiaxing University, Jiaxing 314001, China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2019年第8期570-574,共5页
Chinese Journal of Perinatal Medicine
基金
浙江省医药卫生面上项目(2018KY167)
嘉兴市科技计划项目(2018AD32110、2017AY33077).
关键词
剖宫产术
母婴护理
新生儿护理
可行性研究
Cesarean section
Maternal-child nursing
Neonatal nursing
Feasibility studies
