目的 探讨舒尔特方格训练联合脑电生物反馈训练对注意缺陷多动障碍(ADHD)儿童的护理效果.方法 选取2020年5月—2022年5月在南京市妇幼保健院就诊的80例ADHD儿童,按照随机数表法分为观察组和对照组,每组40例.对照组采用舒尔特方格训练,观察组采用舒尔特方格训练联合脑电生物反馈训练.比较两组Conners父母症状问卷(PSQ)和Conners教师量表(TRS)评分、脑电波频率、执行功能(注意力).结果 干预前,两组品行问题、冲动多动、心身问题、学习问题及焦虑评分比较,差异无统计学意义(P＞0.05

目的 评价父母介导的干预对孤独症谱系障碍(ASD)儿童症状改善的有效性,为ASD儿童的治疗、干预提供理论依据.方法 检索PubMed、Web of Science、Embase、CINAHL、知网、万方、维普以及Sinomed共8个数据库中关于父母介导的干预对ASD儿童影响的随机对照试验.检索时间为从建库到2022年9月,采用RevMan 5.3软件进行统计分析和其中的Cochrane协作工具进行文献的质量评价.结果 纳入了 19篇随机对照试验(RCTs)研究,共纳入1 299名ASD儿童,Meta分析结果显示,父母介导的干预在患儿的社交(SMD=0.34,95％CI:0.16～0.52,P＜0.05)、适应性行为(MD=5.48,95％CI:2.44～8.52,P＜0.001)、共同关注(SMD=0.31,95％CI:0.05～0.56,P＜0.05)以及 ASD 的严重程度(SMD=-0.93,95％CI:-1.10～-0.77,P＜0.001)等方面都有改善,但是表达性语言、接受性语言方面以及在刻板行为方面的改善差异无统计学意义(P＞0.05);对父母来说,其压力(SMD=-0.30,95％CI:-0.54～-0.07,P=0.01)也有所减轻.结论 父母介导的干预对ASD儿童症状改善及减少父母压力都有有益的影响,但是还需要高质量的研究进一步验证.

目的 了解南京市学龄前儿童听觉记忆发展情况,并分析其影响因素.方法 采用便利抽样法,于2021年1月11日—2021年1月27日抽取南京市2所幼儿园的497例3～6岁儿童为研究对象,家长填写基本信息调查表,采用韦氏智力量表第4版中背数测试对儿童听觉记忆进行评估,记录顺序得分和倒序得分.结果 不同年龄儿童背数顺序得分[3.5～＜4岁为(7.37±2.70)分、4～＜4.5 岁为(8.05±2.67)分、4.5～＜5 岁为(8.45±2.16)分、5～＜5.5 岁为(9.24±2.27)分、5.5～＜6 岁为(10.04±1.98)分、6～＜6.5 岁为(9.60±2.29)分]和倒序得分[3.5～＜4 岁为(0.92±1.73)分、4～＜4.5 岁为(1.55±1.94)分、4.5～＜5 岁为(3.32±2.07)分、5～＜5.5 岁为(4.50±1.91)分、5.5～＜6 岁为(4.91±1.52)分、6-＜6.5岁为(5.55±1.45)分]比较,差异均有统计学意义(F顺序=14.48、F倒序=86.09,均P＜0.05).多元线性回归分析结果显示,儿童月龄、出生体质量、第二语言学习及母亲受教育程度均是顺序得分的影响因素(均P＜0.05);儿童月龄、绘画学习、书法学习、乐器学习、第二语言学习及母亲受教育程度均是倒序得分的影响因素(均P＜0.05).结论 南京市学龄前儿童随着年龄的增长其听觉记忆能力增强,其听觉记忆能力受儿童年龄、出生体质量、是否学习绘画、书法、乐器、第二语言及母亲受教育程度的影响.

Objective To analyze the physical growth and body composition in 3-year-old preterm infants, in order to provide guidance for clinical nutrition support and promoting the growth development of children. Methods Premature infants born from June 2018 to April 2019 and undergoing regular physical examination at the Children′s Health Care Department of the Women′s Hospital of Nanjing Medical University were randomly selected as the study group, while 3-year-old full-term infants who took physical examination at the same period were selected as the control group. The physical growth index and body composition index of children were measured to compare difference in the growth and body composition of preterm and full-term infants during this period. Results 1) Compared with the controls, the weight and height of premature infants were significantly lower（t=-2.36,-3.26, P＜0.05）. 2) The detection rates of emaciation, overweight and obesity were not significantly different between preterm and full-term infants（χ~2=5.01, P＞0.05）. 3) Compared with the controls, the total body water, protein, inorganic salt and fat-free mass of premature infants were significantly lower（t=-2.70,-2.15,-2.33,-2.79, P＜0.05）, but no significant difference was found in the total amount of body fat between the two groups（P＞0.05）. 4) BMI of premature infants were significantly lower than that of controls（t=-2.05,P=0.03）, but fat mass index and body fat percentage had no difference between the two groups（P＞0.05）. Conclusions At 3 years of age, preterm infants still lag behind full-term infants in terms of physical growth and differ from full-term infants in terms of body composition, with weight gain in preterm infants being more prominent in terms of body fat gain. Therefore, physical measurements need to be combined with body composition monitoring when assessing the growth of preterm infants to better promote healthy growth.

目的 探讨3～18个月婴幼儿头颅畸形的头颅形态特征及影响因素,为婴幼儿头颅畸形的预防和干预提供指导和依据.方法 于2022年1月选取2019年1-12月在南京市妇幼保健院健康体检时诊断为头颅畸形的228名婴幼儿为病例组,并选取同期健康体检的性别、年龄匹配的394名头颅形态正常婴幼儿为对照组.分析病例组婴幼儿头颅形态特征,并通过比较两组间基本信息、母亲孕产史、睡眠姿势、骨密度等差异分析头颅畸形的影响因素.结果 1)3～18个月头颅畸形患儿头颅形态特征:头颅畸形组中男性占比高于女性;6月±7 d的占比最高,之后随着年龄的增长,头颅畸形占比呈下降趋势;短头畸形的检出率最高,且不同类型头颅畸形在年龄(x2=34.409)和严重程度(x2=11.404)之间差异有统计学意义(P＜0.05).2)单因素分析结果显示:头颅畸形组和正常组在单/双胎(x2=4.724)、新生儿期头部损伤史(x2=8.430)、睡眠姿势(x2=23.881)和骨密度(t=2.771)之间差异有统计学意义(P＜0.05).3)多因素Logistic回归分析显示,年龄(以 3 月±7 d 组为参照,6 月±7 d 组 OR=3.720,95&CI:1.959～7.066,P＜0.05;8 月±7 d 组 OR=3.181,95％CI:1.449～6.984,P＜0.05;12 月±7 d 组 OR=3.195,95％CI:1.281～7.966,P＜0.05)、双胎(OR=3.950,95％CI:1.227～12.717,P＜0.05)是头颅畸形的危险因素、混合睡姿(OR=0.209,95％CI:0.129～0.338,P＜0.05)和骨密度(OR=0.763,95％CI:0.636～0.917,P＜0.05)是婴幼儿头颅畸形的保护因素.结论 年龄、双胎、睡眠姿势以及骨密度是婴幼儿头颅畸形的重要影响因素,随着婴幼儿年龄的增长,头颅畸形可能有所改善,仍需进一步的纵向研究去验证婴幼儿头颅畸形的影响因素.

目的:探讨早期综合护理对早产儿骨密度的影响.方法:选取我院2019年1月—2022年1月儿童保健科收治的76例早产儿为研究对象,将患儿进行随机分组,各38例,对照组患儿给予常规护理,研究组患儿在对照组的基础上给予早期综合护理,干预3个月后对比两组患儿骨密度水平变化及骨密度不足发生率.结果:干预前两组患者胫骨中段骨密度比较无统计学差异(P>0.05),干预3个月时研究组患者胫骨中段骨密度显著高于对照组(P<0.05);干预3个月时研究组患者骨密度不足发生率(50.00％)较对照组(78.95％)更低,组间差异显著(P<0.05).结论:早期综合护理有助于提高早产儿的骨密度,降低骨密度不足发生率,在早产儿护理中具有较高的应用价值.

目的:探讨医护教延续性家庭护理指导对早产儿生长发育的影响.方法:选择2018年1月至2019年6月550例早产儿作为研究对象,随机分为两组,对照组(n=250)予以常规早期干预随访,研究组(n=300)在对照组基础上进行医护教延续性家庭护理指导.比较两组体格发育与神经发育,情绪管理情况.结果:两组出生时和出生1个月的身长和体质量无明显差异(P>0.05),而研究组出生6个月、12个月、18个月、24个月的身长和体质量明显长/重于对照组(P<0.05),更容易代养.两组出生时、出生6个月及24个月的头围无明显差异(P>0.05),而研究组出生12个月、18个月的头围明显大于对照组(P<0.05).研究组出生6个月、12个月、18个月的大运动发育明显优于对照组(P<0.05),而在出生24个月无明显差异(P>0.05).研究组出生6个月、12个月、18个月、24个月的精细运动发育明显优于对照组(P<0.05).两组出生6个月、12个月、18个月、24个月的语言发育无明显差异(P>0.05).两组出生6个月、24个月的适应行为发育无明显差异(P>0.05),而出生12个月、18个月研究组明显优于对照组(P<0.05).两组出生6个月、12个月、18个月、24个月的个人-社交能力发育均无明显差异(P>0.05).结论:以医护教延续性家庭护理模式对早产儿父母进行健康宣教指导,可有效提高早产儿顺应性喂养的有效性,从而促进早产儿大运动,精细运动,社交和情绪的发展,促进早产儿生长和发育,建议将其作为早产儿早期干预的常规干预手段.

目的 分析儿童保健体检中心理护理干预的应用价值.方法 2019年4月～2020年4月,来南京市妇幼保健院保健体检中心接受体检的儿童中,抽取100例入组研究,摸球实验法,将其分为常规组(n=50)和实验组(n=50),给予常规组儿童基础性护理,基于此,为实验组儿童加用心理护理干预,对比两组配合度、检查时间、检查准确率以及家长满意度.结果 实验组干预效果较好,儿童配合度较好,体检时间较短,家长满意度高(P<0.05).结论 为接受体检的儿童实施心理护理,可提高体检质量和效率,价值大,可借鉴.

Objective:To analyze the current situation of the mothers and infants at their first visit to the breastfeeding counseling clinic, and provide a reference for promoting breastfeeding in infancy.Methods:Clinical data of 581 mother-infant-dyads visiting the breastfeeding counseling clinic of Nanjing Maternal and Child Health Hospital from January 2019 to December 2019 were collected and analyzed retrospectively, including the general information of the dyads, and the subjective and actual reasons for visits. According to the age of infants coming to the clinics, they are divided into the younger group (60 d and below, n=316), middle-aged group (61-120 d, n=178), and older group (121 d and above, n=87). Differences in exclusive breastfeeding rate and reasons for visits between different groups were analyzed by analysis of variance, Kruskal-Wallis rank sum test, Chi-square test, or Fisher's exact test. Results:The age of the 581 infants at the first visit were mainly at 30-34, 41-45 and 90-94 d, which accounted for 9.3%( n=54), 25.3%( n=147), and 9.0%( n=52), respectively. The total exclusive breastfeeding rate was 71.8%( n=417) at visit, and there were significant differences among the younger, middle-aged and older group [67.7%(214/316), 79.8%(142/178), 70.1%(61/87), χ 2=14.294, P=0.006), and between the younger and middle-aged group in the pairwise comparison. The most common subjective reason for visiting was slow weight gain ( n=249, 42.9%), followed by worrying about insufficient milk ( n=142, 24.4%) and feeding difficulties ( n=132, 22.7%). Whereas the top three practical reasons for visiting included infant's inability to latch on or sucking ( n=165, 28.4%), lack of breastfeeding knowledge ( n=149, 25.6%) and inappropriate maternal feeding skills ( n=140, 24.1%). The younger group faced more problems regarding latching on or sucking [39.6%(125/316] and mother's feeding skills[25.9%(82/316)], while the lack of breastfeeding knowledge mainly occurred in the older group[48.3%(42/87)]. The coincidence rates between the subjective and actual reasons for slow weight gain, worrying of insufficient milk, and feeding difficulties were only 1.2%( n=3), 6.3%( n=11), and 21.2%( n=28). Conclusions:Breastfeeding- related problems exist in infants of different ages below one year old. There is a big knowledge gap between the subjective reasons for medical visits and the actual problems that interfere with breastfeeding. Therefore, individualized breastfeeding guidance for infants of different ages is recommended in children's health clinics.

目的 探究儿童保健宣教对儿童生长发育的影响效果.方法 将2020年1月至2020年7月入选的110例实施保健宣教的儿童作为此次研究对象,随机分为对照组和观察组,各55例.对照组采取常规保健方式,观察组采取儿童保健宣教.比较两组儿童营养性疾病发生率和生长发育效果.结果 观察组儿童营养性疾病发生率3.64％,低于对照组16.36％,差异有统计学意义(P<0.05).观察组儿童身高、体重分别为(79.62±1.06)cm、(12.06±0.74)kg,高于对照组(73.16±1.42)cm、(9.42±0.41)kg,观察组患者运动和适应性评分分别为(89.26±1.45)分、(93.15±1.74)分,高于对照组(72.48±1.42)分、(79.17±1.94)分,对比两组数据,P<0.05,有统计学意义.结论 采用儿童保健宣教方式能够有效降低儿童出现营养性疾病,促进儿童生长发育,值得推广.

目的:探讨婴幼儿超声骨密度测定与护理干预.方法:选取本院自2018年2月至2021年2月收治的100例婴幼儿的临床资料并对其进行回顾分析,均给予超声骨密度测定,并比较常规护理干预与综合护理干预的临床效果.结果:干预后,研究组婴幼儿的身高(74.16±8.85)、体重(10.94±1.24)、SOS(2978.94±376.54)均高于对照组(67.15±7.34、8.67±1.11、2886.89±378.45),有显著差异(P<0.05).结论:测定婴幼儿超声骨密度利于早期了解婴幼儿骨骼的发育,通过综合护理干预利于婴幼儿骨密度值的增长,值得临床推广应用.

目的 探讨母乳喂养门诊的延续性指导对婴幼儿生长发育及产妇出院后母乳喂养状况的影响.方法 选取2018年1-12月于南京市妇幼保健院儿童保健门诊就诊的1月龄内婴儿及其母亲240例,随机分为干预组与对照组.对照组婴儿只接受儿童保健门诊常规体检,干预组在对照组基础上继续转入母乳喂养门诊,并由国际认证泌乳顾问(IBCLC)对产妇母乳喂养给予延续性的指导干预.对比两组产妇产后1、3、6和12个月母乳喂养情况及两组婴儿的健康状况.结果 两组产妇产后1个月时纯母乳喂养率对比差异无统计学意义(P＞0.05);干预组产后3、6个月的纯母乳喂养率和12个月的母乳喂养率高于对照组,母乳喂养持续时间长于对照组,差异均有统计学意义(P＜0.05);干预组婴儿3、6月龄时的身高、体重和BMI均高于对照组,差异有统计学意义(P＜0.05);干预组产妇产后3个月时的自我效能在技巧维度和内在思考维度得分均高于对照组,产后6个月时技巧维度得分高于对照组,差异均有统计学意义(P＜0.05).结论 母乳喂养门诊开展延续性指导可明显提高产妇出院后纯母乳喂养率,增强产妇自我效能,并延长母乳喂养持续时间.

Objective:To observe the clinical effect of helmet therapy in cranial remodeling of infants with deformational plagiocephaly.Methods:A total of 114 infants with plagiocephaly received helmet therapy at the age of 4 to 12 months over the period from 2016 to 2018 and the results were analyzed retrospectively. Seventy-four were male and forty female. The average ages were (7.49±1.91) and (7.54±2.10) months, respectively. A Spectra scanner was used to quantify each head′s radial symmetry index (RSI), cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) before and after 100 days of treatment, and those data were related with age (4-6 months, 7-9 months and 10-12 months), gender and severity of deformity (levels III-V).Results:The average RSI, CVA and CVAI improved significantly for all of the infants studied. The average RSI, CVA and CVAI improved the most for those 4-6 months old. Those with level-IV deformity showed significantly better improvement than those with level III or V deformity.Conclusions:Helmet therapy is an effective way to improve deformities due to plagiocephaly among infants. The best age for treatment is 4-6 months. Patients with less malformation are more easily corrected.

目的 探讨三岁以下儿童母亲孕产期保健和儿童保健的知信行.方法 以调查问卷方式进行母亲孕产期保健及儿童保健调查,选取2017年8月至2018年10月在我院分娩的50名儿童母亲作为研究对象,对比分析50名研究对象孕产期保健和儿童保健的知、信、行.结果 所有调查对象的知信行总体合格率为78.2％,其中知识合格率为57.4％、态度合格率为89.3％、行为合格率为43.5％,母亲教育程度及职业等基本情况对孕产期保健和儿童保健的影响比较,差异具有统计学意义(P<0.05).结论 三岁以下儿童母亲孕产期保健和儿童保健与母亲的知信行行为有密切关系,儿童母亲的保健知识水平越高,有助于形成良好的妇幼保健行为.

目的 探讨感觉统合失调与儿童运动协调能力和行为表现的关系.方法 随机抽取南京市6所幼儿园的5～6岁儿童350例为调查对象,采用3～6岁儿童感觉统合能力检核表、儿童发育性运动协调障碍问卷和Conners父母症状问卷调查.结果 (1)350例中,筛查出感觉统合能力失调儿童53例(15.1％).其中,男28例,女25例;5岁儿童阳性检出37例,6岁儿童阳性检出16例.不同性别、年龄间的阳性检出率差异无统计学意义(P＞0.05);(2)感觉统合失调组儿童在动作控制、精细动作等方向的分值低于正常组(P＜0.01);(3)感觉统合失调组儿童在品行、学习、心身、冲动-多动和焦虑评分均高于正常儿童组(P＜0.01).结论 感觉统合失调与儿童运动协调能力及行为问题密切相关,早期干预对促进儿童感觉统合能力发展、减少心理行为问题的发生有重要作用.

肠梗阻指各种原因引起肠内容物不能顺利通过肠道,主要临床表现包括腹痛、呕吐、腹胀、停止排便排气.肠梗阻是外科最常见急腹症之一,但剖宫产术后并发肠梗阻比较少见,发生率在0.5％～2.3％[1].本文对本科2014年8月～ 2017年2月收治的剖宫产术后并发不完全性肠梗阻7例患者的临床资料进行回顾性分析,现报告如下.

Objective:To explore the effect of episiotomy on pelvic floor function in primipara after vaginal delivery.Methods:A total of 136 lying-in women were selected,who received postpartum 6-8 weeks pelvic floor function examination at the rehabilitation center of our hospital from March to June 2017.They were divided into episiotomy group of 65 cases and non-episiotomy group of 71 cases.The stress incontinence,pelvic organ prolapse and perineal pain incidence and pelvic floor muscle strength screening resuhs were compared 42 days postpartum.Results:The differences of the stress incontinence,pelvic organ prolapse,and pelvic floor muscle strength screening results were not statistically significant(P ＞ 0.05).The ache of episiotomy group was obviously more than the non-episiotomy group,and the differences were statistically significant (P ＜0.05).Conclusion:Episiotomy cannot improve the pelvic floor dysfunction of lying-in women,instead,it can cause postpartum pain.Lateral episiotomy indication should be observed closely combined with perineal conditions.

目的 探讨个体化医学营养治疗对妊娠期糖尿病(GDM)高龄孕妇妊娠结局的影响.方法 选取2016年9月~2016年12月102例妊娠期糖尿病高龄孕妇,按照入院时间分为对照组(52例)和干预组(50例).对照组给予常规健康教育和营养指导,干预组在对照组的基础上实施个体化医学营养治疗.比较两组干预前后血糖、体重控制情况和妊娠结局.结果 两组患者空腹及餐后2 h血糖、体重达标情况及妊娠结局比较差异均有统计学意义(P<0.05).结论 对GDM高龄孕妇采取医学营养治疗方案,可以有效控制血糖水平与孕期体重变化,进而改善母儿妊娠结局,提高人口质量.

Objective:To compare the curative effect of traditional breast massage techniques and reverse pressure softening massage manipulation for relieving the parturient breast distension,by comparing the conventional one and the Reverse Pressure Softening.Methods: By convenience sampling,198 cases of maternal were breast swelling were selected and randomly divided into control group and observation group,99 cases in each.The patients in control group used the traditional massage.The patients in observation group received reverse pressure softening,then to observe the post-massage distension,the post-massage pain of the parturient and the breast-feeding of maternal between both groups.Results:The curds and breast pain and the amount of lactation were improved in the two groups before and after treatment,and the treatment effect of patients in observation group was significantly higher than that in control group,the difference was statistically significant(P<0.05).Conclusion:The Reverse Pressure Softening has a good effect for alleviating early postpartum breast swelling,which is worth for promotion.

目的：探讨反交接班模式在产科特需病房晨间交接班中的实施效果。方法2014年5月～10月采用由交班者汇报病情的传统交班模式。2014年11月～2015年4月采用由接班者汇报病情的反交班模式，具体方法：①主动查阅。接班护士提前15 min到岗根据护士长弹性排班，主动查看患者信息一览表，查阅所管床位患者病历与交班卡。②至病房进行晨间护理，与患者沟通，自我介绍，初步评估与收集分管床位患者情况。③分组进行床头交接班，责任组长跟随责任护士与夜班护士进行床边交接，根据一级护理“九知道”及床旁护理查体规范，梳理出患者的首优护理问题，并拟定相关护理措施及关注重点。④集中交班。由接班责任护士汇报各自负责床位的患者的病情，运用护理程序提出患者现存的护理问题、护理措施及健康教育重点。⑤夜班交班护士、责任护理组长予以补充与指导。⑥护士长进行讲评。根据交班内容对病区疑难、危重患者的护理重点、难点进行点评。以交接班质量考核、护士病情掌握能力、护士专科知识掌握度、患者对护士的满意度及交接班时间为评价指标进行比较。结果实行反交班模式后，从以上五方面进行比较，除交接班时间上差异无统计学意义（ P＞0．05）外，在护士对患者病情掌握、专科知识能力的提高、交接班质量、患者对护理的满意度方面效果明显优于传统的的交接班模式，差异均有统计学意义（均P＜0．05）。结论反交班模式在不延长交接班时间的基础上，通过强调责任护士“接班”，加强对分管床位的病情掌握与护理，同时也促进护理人员对护理专科知识的学习，提高专业内涵，从而提高了年轻护士的临床实践能力，提升了护理质量和患者满意度。