目的 设计与应用新生儿喂养闭环管理系统,并验证其价值.方法 通过移动护理设备采集和核对数据,将传统的配奶、喂养执行向床旁护理延伸,构建一个以喂养类医嘱为中心的新生儿喂养闭环管理系统.采用t检验比较新生儿喂养闭环管理信息化前后的每天合计时间差异.结果 新生儿喂养闭环管理信息化后每天合计时间48 min,明显少于信息前900 min,差异具有统计学意义(t=301.31,P<0.001).结论 新生儿喂养闭环管理不仅能够提高护士的工作效率、实现新生儿喂养医嘱执行可追溯和闭环,而且提高了新生儿喂养的安全性.

目的 探讨超声成像技术评估危重早产儿气管内插管定位的临床应用效果.方法 选择2019年1月-2021年1月于南京医科大学第一附属医院新生儿监护病房住院并接受气管内插管术的103例早产儿为研究对象,以定位气管内插管方式的不同,分为超声定位组(50例)和以听诊肺部及胃泡判断气管导管在位的对照组(53例),导管固定后均采用胸部X线评估导管的位置.观察并分析超声组声像图特征,比较组间定位气管导管适宜率、误入食管率、误入主支气管(置管过深)率、脱管(置管过浅)率,评价2种方式定位导管的准确性.结果 超声组定位导管适宜率(86.0％vs.54.7％,P=0.001)高于对照组,误入主支气管率(6.0％vs.20.8％,P=0.029)、脱管率(4.0％vs.17.0％,P=0.033)低于对照组;以X线定位气管导管位置适宜为金标准,2组定位方式为筛查标准,发现超声组定位灵敏度(91.1％vs.88.9％)、特异度(80.0％vs.11.8％)、约登指数(71.1％vs.6.5％)及Kappa一致性系数(0.561 vs.0.008)均明显高于对照组.结论 超声成像技术评估气管导管定位实时、有效,可准确判断导管位置及深度,减少放射性暴露累积,值得在危重早产儿中推广应用.

Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.

Objective To investigate the effect of colostrum oral immunological nursing on the growth and development of very low birth weight infants (VLBW). Methods Sixty-nine cases of VLBW were selected as the research objects, and randomly divided into treatment group (n=34) and control group (n=35). The control group was given routine nursing, and the treatment group was given colostrum oral immunotherapy related nursing within one week after birth. Results The duration of total intestinal feeding in the treatment group was significantly shorter, the body weight gain per week was significantly higher, and the body weight day of birth was significantly earlier than that in the control group (P Conclusion Colostrum oral immunity nursing can effectively shorten the time for VLBW to reach total enteral nutrition, reduce the incidence of NEC, sepsis and extrauterine growth restriction, and accelerate the growth rate of VLBW.

目的 了解新生儿病房医院感染现况及变化趋势,探讨科学的感染管理对策,减少院内感染的发生.方法 对我院新生儿病房住院患儿的医院感染病例进行回顾性分析,总结出科学有效的感染管理方法及预防措施;对3年的医院感染率、不同体质量新生儿的感染情况以及感染分布状况进行分析.结果 研究期间住院总人数为3450人,医院感染发生率为4.2％,平均病情严重程度为3.30％;调整医院感染发生率为1.27％,体质量不同的患儿其感染率随着体重的增加而呈下降趋势(P<0.05);近3年CRBSI感染率和VAP感染率分别为0.97％,5.63％;体质量越小,其中心静脉置管及呼吸机使用率越高,其医院感染发生率越高;医院感染部位分布中,第一位是下呼吸道,占29.87％,下呼吸道感染构成比逐年下降,败血症呈上升趋势11.86％升至38.18％;病原菌检出多重耐药菌呈逐年上升趋势,占总检出病原菌的46.08％,其中革兰氏阴性菌最多见.讨论新生儿病房是医院感染的高危科室,应充分了解新生儿医院感染的流行趋势及危险因素,建立科学的感染管理制度,实施全面质量管理,对三管监测及多重耐药菌的预防实施集束化管理,以规范医疗、护理行为,从而达到有效控制院感的目的.

Objective To explore effect of family-centered discharge guidance on family care of premature infants in NICU.Methods A total of 174 premature infants with extremely low birth weight in NICU were studied and were randomly divided into study group and control group,with 87 cases per group.Control group received conventional discharge guidance while the study group received family-centered discharge planning.Height and weight changes of neonates at discharge,and at correct gestational age of 2,4,6 months were observed.Nursing knowledge and nursing skills,Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores of puerperae were observed in two groups on admission and at discharge.Breastfeeding rate,re-hospitalization rate,morbidity and mortality within 6 months were compared.Results The body weight,body length and head circumference were not statistically significant of two groups at birth and at corrected gestational age of 40 weeks (P ＞ 0.05),and they were heavier,and larger than those of the control group at corrected gestational age of 2,4 and 6 months (P ＜ 0.05).Breastfeeding rate in the study group was higher,morbidity rate and readmission rate were lower than that of the control group (P ＜ 0.05),but there was no significant difference in mortality of two groups (P ＞ 0.05).At discharge of NICU,mothers of premature infants had no statistically significant difference in nursing knowledge and skills (P ＞ 0.05),but they commanded more after 2 monthsof discharge (P ＜ 0.05),and study group improved more significantly (P ＜ 0.05).At discharge of NICU,SAS and SDS scores of infants'mothers were not statistically significant (P ＞ 0.0 5),but it was significantly decreased at 2 months of discharge (P ＜ 0.0 5),and study group decreased more (P ＜ 0.0 5).Conclusion Family-centered discharge guidance can increase the physical development of children,reduce the morbidity rate,and improve the family's bad mood,so it is worthy of clinical promotion.

Objective To evaluate the appropriate strategies of parenteral nutrition for premature infants.Methods One hundred and seven preterm babies with birth weights ranging from 1 000-2 500 g received parenteral nutrition within 2 h after birth during June 2015 to January 2016.Lipids,glucose and electrolytes were applied with standard protocol of parenteral nutrition;while the amino acids contents were1.0-1.5 g · kg-1 · d-1 in 81 cases (control group) and 2-2.5 g · kg-1 · d-1 in 26 cases (study group).The data of demographics,development,laboratory findings and complications were documented.Results There were no significant differences in the baseline data of gestational age,birth weight between two groups (P ＞ 0.05).There were also no significant differences in total protein intake and target non-protein calorie intake within the first week after birth and the total calorie intake during the first two weeks between study group and control group (P ＞ 0.05).The start of enteral feeding [(3.54 ± 3.18) d vs.(5.64±5.81) d,P=0.02)],the start of total enteral nutrition [(16.50±9.54) d vs.(21.21 ±15.63) d,P=0.07)],the recovery of birth weight [(7.35±4.55) vs.(9.19±9.50) d,P=0.19)] in study group were earlier than those in control group.The duration of parenteral nutrition [(16.88 ± 8.99) d vs.(22.33 ± 18.10) d,P =0.04],the duration of hospital stay [(20.62 ± 10.41] d vs.(24.22 ± 15.62) d,P =0.18] were shorter and the hospitalization expenses [(21 929.00 ± 11 945.42] Yuan vs.(37 499.58 ±71 146.80) Yuan,P =0.14] were lower in study group than those in control group.The incidence of metabolic acidosis was significantly lower in study group than that in control group (19.23％ vs.45.68％,P =0.02).There were no significant differences in complications of necrotizing enterocolitis,sepsis,extrauterine growth retardation,parenteral nutrition-associated cholestasis,patent ductus arteriosus,respiratory distress syndrome,nosocomial and the duration of artificial ventilation and oxygen therapy between two groups (P ＞ 0.05).The incidence of metabolic disorders (hyperglycemia,hypoglycemia,hypocalcemia,hyponatremia,hypokalemia and hypomagnesemia) was similar in two groups (P ＞ 0.05).Conclusion Amino acids should be apply to the premature infants within 2 h after birth,and the contents in parenteral nutrition should be ＞ 2.0 g · kg-1 · d-1.

目的 观察品管圈活动在降低新生儿静脉留置针引起的静脉炎中的护理效果.方法 选取449例静脉留置针输液新生儿,按时间分为2016年1月~5月收治未实行QCC的为对照组,236例为2016年6月~10月收治的实行QCC的为研究组.观察两组静脉炎、针头滑脱、针头堵塞、液体外渗发生率,患儿舒适度和护理人员静脉炎预防理论知识得分.结果 研究组静脉炎、针头滑脱、针头堵塞、液体外渗的发生率均低于对照组(P<0.05);患儿舒适度、家属护理满意度和护理人员静脉炎预防理论知识得分均高于对照组(P<0.05).结论?QCC活动可降低静脉留置针新生儿静脉炎发生率,提高护理满意度,值得临床推广应用.

Objective To study the effects of family participation nursing model on the parents′master degree about nursing knowledge of premature infants, and promote the recovery of premature infants. Methods From June 2014 to May 2016, 46 premature infants admitted in the neonatal intensive care unit ( NICU) of our hospital were selected as research objects. According to the order of admission date, all premature infants were divided into the control group and the intervention group, with 23 cases in each group. Patients in the control group received routine nursing, while patients in the intervention group were given family participation nursing mode. After discharge, the nursing knowledge, nursing satisfaction and practice situation of parents of premature infants were surveyed, and the readmission rate of patients within 1 months after discharge were compared between two groups. Results The basic nursing knowledge and nursing skills of parents in the intervention group were higher than those of the control group (P<0.05); as for the satisfaction, the rate of intervention group was 98.83%, while the rate of control group was 93.67%, so the rate of intervention group was higher than that of the control group (χ2 =6. 732, P<0. 05 ); within six months after discharge, two premature infants in the control group were readmitted, and the readmission rate was 8.7%, while no premature infant was readmitted in the intervention group, and the readmission rate was 0 (χ2 =16. 463, P<0. 01 ) . Conclusions The family participation nursing mode has the advantages of high efficiency, simple operation, labor saving and time-saving, To a certain extent, it also solves the drawbacks of parent nursing for NICU premature infants, and plays an important role in promoting the rehabilitation of premature infants.

目的 探讨3M贴膜及其标识贴固定新生儿经口胃管的应用价值.方法 选取江苏省人民医院新生儿科2014年4月至2015年10月收治的住院期间需经口留置胃管的新生儿54例为研究组,采用3M贴膜及其标识贴固定新生儿经口胃管.另选取同期50例患儿为对照组,采用常规胃管固定方法.记录胃管留置时间,UEX发生率,观察有无面部皮肤异常(红肿、水疱等过敏现象).结果 使用3M贴膜及其标识贴固定新生儿经口胃管法后,54例患儿中49例根据预期进行拔管,最长留置6d,最短2d,平均(3.5±0.4)d,5例行UEX (9.26％),且未见患儿面部皮肤异常,均优于对照组,且两组比较差异有统计学意义(P＜0.05).结论 3M贴膜及其标识贴固定新生儿经口胃管具有较高的使用价值和较好的安全性.

目的 探讨牛肺表面活性物质(PS)治疗新生儿肺透明膜病(HMD)的有效性和安全性.方法 根据首诊医生给药剂量的不同,89例HMD患儿分为两组:A组,34例,给予PS(94.86±14.94) mg/kg;B组,55例,给予PS(55.26±10.70) mg/kg.比较两组患儿的临床疗效.结果 两组用药后的相关观察指标均较用药前改善(P＜0.05或P＜0.01).与B组相比,A组用药后吸氧浓度(FiO2)降低(P＜0.05),动脉血氧分压(PaO2)上升(P＜0.05),氧疗时间、动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)和动脉/肺泡氧分压比值(a/APO2)均有所改善(P＞0.05).两组治愈好转率、病死率以及并发症发生率无统计学差异(P＞0.05).结论 早期大剂量牛PS治疗能有效改善HMD患儿的氧合和通气效率,不增加并发症及死亡风险.

<正>循证护理是以有价值、可信的科学研究结果为证据,提出问题,寻找实证,用评判性的思维寻找最佳的护理行为,实施全面护理质量改进程序,以最低的成本提供最优质的护理。循证护理模式包括4个连续的过程:循证问题、循证支持、循证观察、循证应用[1]。

目的探讨新生儿呼吸窘迫综合征的护理方法,提高抢救成功率。方法回顾性分析12例新生儿呼吸窘迫综合征患儿的治疗与护理。结果 12例患儿,9例治愈、2例死亡、1例家长放弃治疗。结论早期诊治、气道管理、合理氧疗、保证营养和预防感染是抢救成功的关键。

本科在原有经验的基础上通过不断补充、完善,采取适时宣教、按需宣教、反复宣教的儿科病房健康教育方法,取得良好效果,现报告如下.