目的:检索、评价并整合新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿声音干预的相关证据,为临床实践提供循证依据。方法:根据“6S”证据模型,检索计算机决策支持系统、国内外指南网、相关学会网站及数据库中有关NICU...目的:检索、评价并整合新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿声音干预的相关证据,为临床实践提供循证依据。方法:根据“6S”证据模型,检索计算机决策支持系统、国内外指南网、相关学会网站及数据库中有关NICU新生儿声音干预的文献,包括最佳实践指南、临床决策、指南、证据总结、专家共识、系统评价,检索时限为2019年1月1日—2023年11月30日。由2名研究者独立对纳入文献进行质量评价。结果:纳入18篇文献,其中临床决策1篇、指南1篇、证据总结1篇、系统评价15篇,分别从声音干预获益、声音干预方法、声音干预效果评价、声音干预注意事项4个方面进行证据总结,形成了13条推荐意见。结论:该研究总结了NICU新生儿声音干预的相关证据,医护人员应结合NICU实际情况,有针对性地选择证据,制订并实施科学的声音干预方案,进一步提高重症新生儿护理质量。展开更多
目的:探讨NICU早产儿主要照顾者及护士对家庭参与式预出院病房的真实体验,为制定有效的干预措施提供参考和依据。方法:采用目的抽样法,选取2023年7~9月青岛市某三级甲等医院16例进入NICU预出院病房进行家庭参与式护理的早产儿主要照顾者...目的:探讨NICU早产儿主要照顾者及护士对家庭参与式预出院病房的真实体验,为制定有效的干预措施提供参考和依据。方法:采用目的抽样法,选取2023年7~9月青岛市某三级甲等医院16例进入NICU预出院病房进行家庭参与式护理的早产儿主要照顾者及17例NICU护士作为研究对象,基于信息动机行为技巧模型为理论框架对其进行半结构访谈,运用Colaizzi7步分析法对原始资料进行整理分析,提炼主题。结果:共提炼出5个主题及12个亚主题:1) 家庭参与式预出院病房的信息缺乏;2) 家庭参与式预出院病房带来的益处包括减轻家长焦虑,提高家长的照顾能力,促进早产儿的生长发育;3) 在预出院病房中实施家庭参与式护理遇到的问题包括家庭参与式预出院病房的参与度不够,护士对预出院病房的参与积极性不高,护理人员知识结构系统不够统一规范;4) 期待完善家庭参与式预出院病房的方案包括建立有效沟通,提高家庭参与式预出院病房的参与度,加强心理疏导且增加人文关怀,提供专业的培训体系;5) 建议增加延续性护理的支持系统包括增加随访的频次,开展多元化随访方式,制定规范统一的随访流程。结论:在预出院病房的家庭参与式护理在实践中会遇到多方面的问题,护理人员应提高家长对家庭参与式护理的认知及家长的参与度,从而提高家长的照护能力,为居家照护患儿提供保障。Objective: To explore premature infants primary caregivers’ and NICU nurses’ experience of engagement for taking part in family Integrated Care in Pre-discharge Ward, and to provide bases for formulating targeted interventions. Methods: From July to September in 2023, the purposive sampling was used to select 16 Premature infants primary caregivers and 17 NICU nurses in a tertiary A general hospital in Qingdao. Semi-structured interviews were held based on the Information-Motivation-Behavior Skill Model framework. Colaizzi’s seven-step method was used for data analysis. Results: 5 main themes and 12 sub-themes were identified, including 1) The preparation for family Integrated Care in Pre-discharge Ward is insufficiency, 2) The benefit from family Integrated Care in Pre-discharge Ward (relieve anxiety, improve caregiving ability promote growth and development), 3) The barrier of taking part in family Integrated Care in Pre-discharge Ward (insufficient participation of family Integrated Care in Pre-discharge Ward, low motivation, the knowledge structure is not systematic enough), 4) Looking forward to improving the family Integrated Care’ scheme (establish effective communication, give psychological support to parents, provide professional training system), 5) Suggest to increase continuing care support system (increase follow-up, develop diversified follow-up ways, formulate unified scheme). Conclusion: There are many problems during taking part in family Integrated Care in Pre-discharge Ward. Nurses should improve parents’ cognition, improve parents’ participation in family Integrated Care, so improve caring ability, provide guarantees for home-based care.展开更多
目的系统评价母亲声音刺激干预对新生儿重症监护病房(neonatal intensive care unit,NICU)早产儿生理指标的影响。方法检索PubMed、Web of Science(WOS)、Cochrane Library、CTdatabase、中国知网、万方数据知识服务平台及维普数据库中...目的系统评价母亲声音刺激干预对新生儿重症监护病房(neonatal intensive care unit,NICU)早产儿生理指标的影响。方法检索PubMed、Web of Science(WOS)、Cochrane Library、CTdatabase、中国知网、万方数据知识服务平台及维普数据库中关于母亲声音刺激干预对NICU早产儿生理指标影响的文献,检索时限为建库至2024年7月,对检索到的文献进行筛选,并对文献质量进行评估,采用RevMan 5.3统计学软件进行Meta分析。结果共纳入10篇文献,总样本量为548例。Meta分析结果显示,干预后生理指标中的心率改变存在明显的异质性(I 2=95%,P<0.05),安德森行为状态量表评分无明显异质性(I 2=0%,P>0.05)。与对照组相比,观察组干预后的心率减慢(WMD=-8.32,95%CI:-14.81~-1.84),安德森行为状态量表评分明显降低(WMD=-1.83;95%CI:-2.08~-1.58)。结论对NICU早产儿实施母亲声音刺激干预,可有效改善其心率及行为状态等生理指标。展开更多
目的分析基于超声心输出量监测仪(USCOM)监测下血流动力学与NICU新生儿颅内出血(ICH)的相关性。方法选择我院2024年1月至2024年12月收治的120例NICU新生儿,分为A组(n=60,孕周>37周足月儿)与B组(n=60,孕周≤37周早产儿),收集两组临床...目的分析基于超声心输出量监测仪(USCOM)监测下血流动力学与NICU新生儿颅内出血(ICH)的相关性。方法选择我院2024年1月至2024年12月收治的120例NICU新生儿,分为A组(n=60,孕周>37周足月儿)与B组(n=60,孕周≤37周早产儿),收集两组临床资料,再结合头颅影像学检查结果,将A组分为A1组(发生ICH,n=10)、A2组(未发生ICH,n=50),将B组分为B1组(发生ICH,n=23)、B2组(未发生ICH,n=37),所有新生儿均采用USCOM行血流动力学检查。经单因素及多因素Logistic回归分析足月儿与早产儿发生ICH的危险因素,分析血流动力学与NICU新生儿ICH的相关性。结果USCOM监测下,A1、B1组的外周血管阻力指数、每搏输出量、每搏输出量变异度与A2、B2组对比有统计学差异(P<0.05);B1组的外周血管阻力指数和每搏输出量低于A1、A2、B2组,每搏输出量变异度高于A1、A2、B2组(P<0.05)。多因素Logistic回归分析结果显示自然分娩、产后行机械通气、孕晚期感染、出生5 min Apgar评分≤7分及血小板减少是新生儿发生ICH的危险因素(P<0.05);外周血管阻力指数和每搏输出量、每搏输出量变异度与ICH呈正相关(r=0.601、0.667、0.561,P<0.05)。结论NICU新生儿ICH的发生与分娩方式、机械通气、孕晚期感染、宫内窘迫、血小板减少有关,USCOM监测下的血流动力学指标与ICH的发生具有相关性,需临床关注。展开更多
目的分析新生儿重症监护病房(neonatal intensive care unit,NICU)护士对机械通气早产儿实施体位管理的促进和阻碍因素,为改善机械通气早产儿体位管理质量提供参考。方法应用描述现象学研究,采用目的抽样法,于2024年3月—5月选取太原市...目的分析新生儿重症监护病房(neonatal intensive care unit,NICU)护士对机械通气早产儿实施体位管理的促进和阻碍因素,为改善机械通气早产儿体位管理质量提供参考。方法应用描述现象学研究,采用目的抽样法,于2024年3月—5月选取太原市4所三级甲等综合医院NICU 12名护士为访谈对象,进行面对面半结构式访谈,运用Colaizzi 7步分析法对访谈资料进行整理,分析提炼主题。结果机械通气早产儿体位管理的促进因素包括经验性管理、责任心、共情力、职业认同感和反思与总结;阻碍因素包括护士体位管理认知缺乏、体位管理知识缺乏、存在风险和隐患、人力资源配置不当、科研成果难以转化和体位管理方案缺乏。结论NICU护士在机械通气早产儿体位管理中存在促进和阻碍因素,可通过干预提高机械通气早产儿体位管理质量。展开更多
A new NiCu alloy was developed and utilized as binder phase for WC composites.The composites with spherical cast WC particle contents of 55-65 wt.%were prepared by rapid hot-pressing technique.The microstructures were...A new NiCu alloy was developed and utilized as binder phase for WC composites.The composites with spherical cast WC particle contents of 55-65 wt.%were prepared by rapid hot-pressing technique.The microstructures were characterized by scanning electron microscopy(SEM),energy-dispersive X-ray spectroscopy(EDS),and transmission electron microscopy(TEM).The results reveal that the cast WC particles are uniformly dispersed within the NiCu matrix.The interface between WC and NiCu alloy is clear with no additional phase observed.Mechanical properties testing indicates that the hardness of the composite shows minimal variation as the cast WC particle content increases.Both the transverse rupture strength(TRS)and fracture toughness show a comparable decline,while the impact toughness first increases and then decreases.The NiCu alloy matrix plays a critical role in enhancing the fracture toughness of the composite.However,at high strain rates,the impact toughness deteriorates due to strain rate hardening of the NiCu matrix and a reduced density resulting from the higher WC content.展开更多
评价延续性父母参与式护理对NICU早产儿应激激素水平与出院后随访依从性的影响。方法 前瞻性随机对照,将本院早产儿100例按1∶1分为对照组与观察组;观察组在常规护理基础上实施父母合规培训、每日袋鼠式护理、线索反应安抚、口喂过渡及...评价延续性父母参与式护理对NICU早产儿应激激素水平与出院后随访依从性的影响。方法 前瞻性随机对照,将本院早产儿100例按1∶1分为对照组与观察组;观察组在常规护理基础上实施父母合规培训、每日袋鼠式护理、线索反应安抚、口喂过渡及出院后电话/视频随访。比较唾液皮质醇(入院后第3天、干预7天、出院前)、NIPS评分、父母在室时长与袋鼠式护理累计时长、喂养耐受、随访到诊率与30 d再入院率,并记录不良事件。结果 与对照组相比,观察组7天及出院前皮质醇更低(221±55、201±50 vs 259±58、241±52,均P<0.001),NIPS下降更显著(2.4±0.8vs 3.2±0.9,P<0.001);父母在室时间与袋鼠式护理时长增加(55±15 min/d、10.8±3.2h vs 20±10、3.5±2.0,均P<0.001),达全肠内喂养和由管饲转口喂时间缩短(10.2±2.8d、16.0±4.2d vs 12.5±3.1、19.4±4.6,均P<0.001)。7天与28天按时随访率及两次完成率提高(90%、86%、84% vs 70%、64%、60%,均P=0.01),30天再入院率降低(8% vs 18%,P=0.04);安全事件与对照组相当。结论 延续性父母参与式护理可降低应激、改善喂养并提升出院后随访依从性,安全可行,具推广价值。展开更多
Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in ...Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.展开更多
文摘目的:检索、评价并整合新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿声音干预的相关证据,为临床实践提供循证依据。方法:根据“6S”证据模型,检索计算机决策支持系统、国内外指南网、相关学会网站及数据库中有关NICU新生儿声音干预的文献,包括最佳实践指南、临床决策、指南、证据总结、专家共识、系统评价,检索时限为2019年1月1日—2023年11月30日。由2名研究者独立对纳入文献进行质量评价。结果:纳入18篇文献,其中临床决策1篇、指南1篇、证据总结1篇、系统评价15篇,分别从声音干预获益、声音干预方法、声音干预效果评价、声音干预注意事项4个方面进行证据总结,形成了13条推荐意见。结论:该研究总结了NICU新生儿声音干预的相关证据,医护人员应结合NICU实际情况,有针对性地选择证据,制订并实施科学的声音干预方案,进一步提高重症新生儿护理质量。
文摘目的:探讨NICU早产儿主要照顾者及护士对家庭参与式预出院病房的真实体验,为制定有效的干预措施提供参考和依据。方法:采用目的抽样法,选取2023年7~9月青岛市某三级甲等医院16例进入NICU预出院病房进行家庭参与式护理的早产儿主要照顾者及17例NICU护士作为研究对象,基于信息动机行为技巧模型为理论框架对其进行半结构访谈,运用Colaizzi7步分析法对原始资料进行整理分析,提炼主题。结果:共提炼出5个主题及12个亚主题:1) 家庭参与式预出院病房的信息缺乏;2) 家庭参与式预出院病房带来的益处包括减轻家长焦虑,提高家长的照顾能力,促进早产儿的生长发育;3) 在预出院病房中实施家庭参与式护理遇到的问题包括家庭参与式预出院病房的参与度不够,护士对预出院病房的参与积极性不高,护理人员知识结构系统不够统一规范;4) 期待完善家庭参与式预出院病房的方案包括建立有效沟通,提高家庭参与式预出院病房的参与度,加强心理疏导且增加人文关怀,提供专业的培训体系;5) 建议增加延续性护理的支持系统包括增加随访的频次,开展多元化随访方式,制定规范统一的随访流程。结论:在预出院病房的家庭参与式护理在实践中会遇到多方面的问题,护理人员应提高家长对家庭参与式护理的认知及家长的参与度,从而提高家长的照护能力,为居家照护患儿提供保障。Objective: To explore premature infants primary caregivers’ and NICU nurses’ experience of engagement for taking part in family Integrated Care in Pre-discharge Ward, and to provide bases for formulating targeted interventions. Methods: From July to September in 2023, the purposive sampling was used to select 16 Premature infants primary caregivers and 17 NICU nurses in a tertiary A general hospital in Qingdao. Semi-structured interviews were held based on the Information-Motivation-Behavior Skill Model framework. Colaizzi’s seven-step method was used for data analysis. Results: 5 main themes and 12 sub-themes were identified, including 1) The preparation for family Integrated Care in Pre-discharge Ward is insufficiency, 2) The benefit from family Integrated Care in Pre-discharge Ward (relieve anxiety, improve caregiving ability promote growth and development), 3) The barrier of taking part in family Integrated Care in Pre-discharge Ward (insufficient participation of family Integrated Care in Pre-discharge Ward, low motivation, the knowledge structure is not systematic enough), 4) Looking forward to improving the family Integrated Care’ scheme (establish effective communication, give psychological support to parents, provide professional training system), 5) Suggest to increase continuing care support system (increase follow-up, develop diversified follow-up ways, formulate unified scheme). Conclusion: There are many problems during taking part in family Integrated Care in Pre-discharge Ward. Nurses should improve parents’ cognition, improve parents’ participation in family Integrated Care, so improve caring ability, provide guarantees for home-based care.
文摘目的系统评价母亲声音刺激干预对新生儿重症监护病房(neonatal intensive care unit,NICU)早产儿生理指标的影响。方法检索PubMed、Web of Science(WOS)、Cochrane Library、CTdatabase、中国知网、万方数据知识服务平台及维普数据库中关于母亲声音刺激干预对NICU早产儿生理指标影响的文献,检索时限为建库至2024年7月,对检索到的文献进行筛选,并对文献质量进行评估,采用RevMan 5.3统计学软件进行Meta分析。结果共纳入10篇文献,总样本量为548例。Meta分析结果显示,干预后生理指标中的心率改变存在明显的异质性(I 2=95%,P<0.05),安德森行为状态量表评分无明显异质性(I 2=0%,P>0.05)。与对照组相比,观察组干预后的心率减慢(WMD=-8.32,95%CI:-14.81~-1.84),安德森行为状态量表评分明显降低(WMD=-1.83;95%CI:-2.08~-1.58)。结论对NICU早产儿实施母亲声音刺激干预,可有效改善其心率及行为状态等生理指标。
文摘目的分析基于超声心输出量监测仪(USCOM)监测下血流动力学与NICU新生儿颅内出血(ICH)的相关性。方法选择我院2024年1月至2024年12月收治的120例NICU新生儿,分为A组(n=60,孕周>37周足月儿)与B组(n=60,孕周≤37周早产儿),收集两组临床资料,再结合头颅影像学检查结果,将A组分为A1组(发生ICH,n=10)、A2组(未发生ICH,n=50),将B组分为B1组(发生ICH,n=23)、B2组(未发生ICH,n=37),所有新生儿均采用USCOM行血流动力学检查。经单因素及多因素Logistic回归分析足月儿与早产儿发生ICH的危险因素,分析血流动力学与NICU新生儿ICH的相关性。结果USCOM监测下,A1、B1组的外周血管阻力指数、每搏输出量、每搏输出量变异度与A2、B2组对比有统计学差异(P<0.05);B1组的外周血管阻力指数和每搏输出量低于A1、A2、B2组,每搏输出量变异度高于A1、A2、B2组(P<0.05)。多因素Logistic回归分析结果显示自然分娩、产后行机械通气、孕晚期感染、出生5 min Apgar评分≤7分及血小板减少是新生儿发生ICH的危险因素(P<0.05);外周血管阻力指数和每搏输出量、每搏输出量变异度与ICH呈正相关(r=0.601、0.667、0.561,P<0.05)。结论NICU新生儿ICH的发生与分娩方式、机械通气、孕晚期感染、宫内窘迫、血小板减少有关,USCOM监测下的血流动力学指标与ICH的发生具有相关性,需临床关注。
基金supported by the National Key Research and Development Program of China(No.2021YFB3701801)the Regional Innovation and Development Joint Fund of National Natural Science of China(No.U20A20236)。
文摘A new NiCu alloy was developed and utilized as binder phase for WC composites.The composites with spherical cast WC particle contents of 55-65 wt.%were prepared by rapid hot-pressing technique.The microstructures were characterized by scanning electron microscopy(SEM),energy-dispersive X-ray spectroscopy(EDS),and transmission electron microscopy(TEM).The results reveal that the cast WC particles are uniformly dispersed within the NiCu matrix.The interface between WC and NiCu alloy is clear with no additional phase observed.Mechanical properties testing indicates that the hardness of the composite shows minimal variation as the cast WC particle content increases.Both the transverse rupture strength(TRS)and fracture toughness show a comparable decline,while the impact toughness first increases and then decreases.The NiCu alloy matrix plays a critical role in enhancing the fracture toughness of the composite.However,at high strain rates,the impact toughness deteriorates due to strain rate hardening of the NiCu matrix and a reduced density resulting from the higher WC content.
文摘评价延续性父母参与式护理对NICU早产儿应激激素水平与出院后随访依从性的影响。方法 前瞻性随机对照,将本院早产儿100例按1∶1分为对照组与观察组;观察组在常规护理基础上实施父母合规培训、每日袋鼠式护理、线索反应安抚、口喂过渡及出院后电话/视频随访。比较唾液皮质醇(入院后第3天、干预7天、出院前)、NIPS评分、父母在室时长与袋鼠式护理累计时长、喂养耐受、随访到诊率与30 d再入院率,并记录不良事件。结果 与对照组相比,观察组7天及出院前皮质醇更低(221±55、201±50 vs 259±58、241±52,均P<0.001),NIPS下降更显著(2.4±0.8vs 3.2±0.9,P<0.001);父母在室时间与袋鼠式护理时长增加(55±15 min/d、10.8±3.2h vs 20±10、3.5±2.0,均P<0.001),达全肠内喂养和由管饲转口喂时间缩短(10.2±2.8d、16.0±4.2d vs 12.5±3.1、19.4±4.6,均P<0.001)。7天与28天按时随访率及两次完成率提高(90%、86%、84% vs 70%、64%、60%,均P=0.01),30天再入院率降低(8% vs 18%,P=0.04);安全事件与对照组相当。结论 延续性父母参与式护理可降低应激、改善喂养并提升出院后随访依从性,安全可行,具推广价值。
基金funded by Shanghai Municipal Health and Wellness Commission Health Industry Clinical Research Special Project(202140299).
文摘Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.
