早產(chǎn)兒發(fā)育性護(hù)理及NICU環(huán)境控制

早產(chǎn)兒發(fā)育性護(hù)理及NICU環(huán)境控制

-DevelopmentalsupportiveCareNICU監(jiān)護(hù)NICU監(jiān)護(hù)NICU監(jiān)護(hù)首都兒科研究所NICU改善NICU環(huán)境

減輕疼痛舒適體位促進(jìn)非營(yíng)養(yǎng)性吸吮撫觸注重人性化護(hù)理關(guān)注環(huán)境對(duì)生長(zhǎng)發(fā)育的影響改善NICU環(huán)境

適宜的溫濕度

-室溫：24~26°C-濕度：55~65%-層流凈化適宜的光線減少噪音避免不必要的打擾-避免強(qiáng)烈的光線

強(qiáng)烈光線影響睡眠影響生長(zhǎng)發(fā)育刺激視網(wǎng)膜血管異常增長(zhǎng)-視網(wǎng)膜病變避免不必要的打擾-避免強(qiáng)烈的光線光線柔和白天使用窗簾夜間不用強(qiáng)光夜間使用暖箱罩制造周期性光照環(huán)境避免不必要的打擾-減少噪音過(guò)強(qiáng)噪音：引起呼吸暫停，心動(dòng)過(guò)緩，心率、呼吸、血壓、血氧飽和度波動(dòng)引起聽(tīng)力缺失(4-13%)噪音與一些不良刺激(強(qiáng)光、疼痛等)有協(xié)同作用說(shuō)話50-60分貝，電話85-92分貝，開(kāi)關(guān)暖箱門(mén)80-120分貝，暖箱上寫(xiě)字64分貝，暖箱上放奶瓶84分貝避免不必要的打擾-減少噪音推薦<50分貝醫(yī)護(hù)：說(shuō)話輕、走路輕、關(guān)門(mén)輕、操作輕呼吸管路無(wú)多余積水報(bào)警迅速應(yīng)答吸痰時(shí)關(guān)掉呼吸機(jī)報(bào)警使用塑料垃圾桶

注意暖箱發(fā)動(dòng)機(jī)聲音避免不必要的打擾-集中護(hù)理查體（聽(tīng)觸叩）－更換尿布－更換體位－口鼻胃管喂食、吸痰－侵入性治療、采血不突然驚醒早產(chǎn)兒，操作前輕喚或撫摸患兒動(dòng)作緩慢、輕柔“鳥(niǎo)巢”護(hù)理-舒適體位

“鳥(niǎo)巢”護(hù)理-舒適體位

“鳥(niǎo)巢”護(hù)理-舒適體位

“鳥(niǎo)巢”護(hù)理-舒適體位

屈曲為主肢體趨向身體中心部位,發(fā)展手-嘴綜合能力手放在口邊，自我安慰促進(jìn)身體的對(duì)稱(chēng)性預(yù)防不正確的姿勢(shì)及變形“袋鼠”護(hù)理-舒適體位

‘Kangaroomothercare’topreventneonataldeathsduetopretermbirthcomplications

JoyELawn,JudithMwansa-Kambafwile,BernardoLHorta,FernandoCBarrosandSimonCousens

InternationalJournalofEpidemiology2010;39:i144–i154doi:10.1093/ije/dyq031“袋鼠”護(hù)理

Background‘Kangaroomothercare’(KMC)includesthermalcarethroughcontinuousskin-to-skincontact,supportforexclusivebreastfeedingorotherappropriatefeeding,andearlyrecognition/responsetoillness.Whilstincreasinglyacceptedinbothhigh-andlow-incomecountries.Objectivesreviewtheevidence,estimatetheeffectofKMConneonatalmortalityduetocomplicationsofpretermbirth.Methodssystematicreviews,Meta-analyses.“袋鼠”護(hù)理

Results15studiesreportingmortalityand/ormorbidityoutcomesincludingninerandomizedcontrolledtrials(RCTs)andsixobservationalstudiesallfromlow-ormiddle-incomesettings.Exceptone,allwerehospital-basedandincludedonlybabiesofbirth-weight<2000g.Meta-analysisofthreeRCTscommencingKMCinthefirstweekoflifeshowedasignificantreductioninneonatalmortality[relativerisk(RR)0.49,95%confidenceinterval(CI)0.29–0.82]comparedwithstandardcare.Ameta-analysisofthreeobservationalstudiesalsosuggestedsignificantmortalitybenefit(RR0.68,95%CI0.58–0.79).FiveRCTssuggestedsignificantreductionsinseriousmorbidityforbabies<2000g(RR0.34,95%CI0.17–0.65).ConclusionThisisthefirstpublishedmeta-analysisshowingthatKMCsubstantiallyreducesneonatalmortalityamongstpretermbabies(birthweight<2000g)inhospital,andishighlyeffectiveinreducingseveremorbidity,particularlyfrominfection.Skintoskin雙親皮膚接觸“袋鼠”護(hù)理舒適體位-俯臥位俯臥位

胸廓和膈肌運(yùn)動(dòng)更為協(xié)調(diào)

呼吸穩(wěn)定

睡眠好

早產(chǎn)兒放置俯臥位，能提高PaO2雙子同床(co-bedding)病情穩(wěn)定，無(wú)感染的情況下雙子可以通過(guò)相互觸摸，肢體纏繞，相互撫慰，促進(jìn)生長(zhǎng)發(fā)育減輕疼痛減少不必要的疼痛刺激使用靜脈留置針，PICC使用輸液泵鎮(zhèn)靜、鎮(zhèn)痛：芬太尼：1-5ug/kg.h,ivd嗎啡10-50ug/kg.h.ivd給予安撫措施減輕疼痛-PICC兩用暖箱與

Developmentals