超低出生体重儿12例临床护理

目的:探讨超低出生体重儿的护理方法。方法:对2011年8～10月间收治的12例超低出生体重儿的临床资料进行回顾性分析。结果:本组12例超低出生体重儿平均住院117 d,均痊愈出院。结论:密切观察病情和精心护理可提高超低出生体重儿存活率。     

基层医院早产超低出生体重儿的护理

早产超低出生体重儿是指出生体重小于1000g者。由于超低出生体重儿极不成熟,病死率很高。而提高超低出生体重儿的转运率和存活率是基层医院的一个难点。我科于2009年5月收治1例早产超低体重儿,经精心护理,21d后转上级医院治疗,现将护理体会报告如下。     

1例孕29周550克超低出生体重儿的护理

报告了1例550克超低出生体重儿的护理。首先对患儿进行全面细致的评估,强调提前干预,成立超低出生体重儿医护救治小组,加强患儿体温、营养、呼吸系统异常及视网膜病的预防管理,预防院内感染,提供发育照顾性护理。认为通过严谨的、科学的、充满爱心的护理工作能够减少并发症,使超低出生体重儿平稳、安全地度过危险期,提高早产儿生活质量。     

3例超低出生体重早产儿行床旁动脉导管结扎术的护理体会

回顾性总结3例超低出生体重早产儿行床旁动脉导管结扎术的围手术期护理,主要包括术前成立医护一体化多学科协作团队、物品和环境准备、患儿准备与导管建立、体位管理,术中配合,术后严格消毒隔离和预防感染、血流动力学监测、胸腔引流管的护理、气道护理、疼痛管理、延续性远程护理干预。3例患儿均成功完成床旁动脉导管结扎术,在精心护理下实现全肠道喂养,顺利出院,3个月随访时生长发育情况均良好。     

母乳系统化管理提高超低出生体重儿住院期间母乳喂养率的实践研究

[目的]提高住院期间超低出生体重儿母乳喂养率.[方法]将2011年1月-2012年12月符合入选条件的63例超低出生体重儿作为对照组,实施超低出生体重儿母乳喂养的常规宣教及护理,将2013年1月-2014年12月符合入选条件的70例超低出生体重儿作为观察组,对母乳喂养给予系统化管理,包括设立母乳专管护士,开放家长课堂,培训超低出生体重儿家长熟知母乳喂养对超低出生体重儿的重要性以及如何进行母乳的收集、保存、运送、解冻和加温等,建立母乳支持方案,比较两组超低出生体重儿的母乳喂养情况、并发症发生率及住院时间.[结果]观察组首次母乳喂养日龄低于对照组,14 d内及住院期间纯母乳喂养率高于对照组,坏死性小肠结肠炎发生率低于对照组,经比较差异均有统计学意义(P＜0.05).[结论]科学有效的母乳管理是提高住院超低出生体重儿母乳喂养率的有效方法.     

1例超低出生体重儿的护理

超低出生体重儿(extremely low birth weight infamt,ELBWI)是指出生体重＜1 000 g的新生儿,由于其各器官功能发育不完善、抵抗力极低,易发生各种并发症、抢救难度大、病死率高,国外报道其出生死亡率高达57.8%[1].因此,加强超低出生体重儿的护理管理,是提高新生儿重症监护室(NICU)护理质量的关键之一.2008年7月我科成功救治1例800 g超低出生体重儿.现将护理体会介绍如下.     

早期护理干预对超低出生体重儿的影响

目的:探讨早期护理干预对超低出生体重儿的影响。方法:将32例超低出生体重儿随机分为观察组和对照组各16例。对照组给予常规护理,观察组在此基础上给予早期护理干预。比较两组患儿护理前后体质量变化情况及呕吐、哭闹、胃潴留、腹胀、呼吸暂停发生率。结果:观察组护理后1周、2周、3周、1个月的体质量均高于对照组(P<0.05),呼吸暂停、呕吐、哭闹、胃潴留、腹胀发生率低于对照组(P<0.05)。结论:早期护理干预可提高超低出生体重儿存活率,降低并发症发生率,促进生长发育,值得临床推广应用。     

超低出生体重儿生后第一周的护理

报告28例超低出生体重儿生后第一周的护理体会。认为护理要点是加强体温管理、呼吸系统护理、液体疗法护理，重视营养支持、皮肤护理和导管维护，以降低超低出生体重儿的病死率，提高生存质量。     

超低出生体重儿的临床救治

目的：探讨超低出生体重儿的临床救治方法。方法：对3例超低出生体重儿（ELBWI）的临床诊治进行综合分析。结果：3例超低出生体重儿经过10～14周的治疗，1例于生后103d，体重达1400g时死于感染。2例救治成功，出院后的随访追踪1例生后1．6岁（纠正胎龄15月）跟踪体格检查及智力检查发育同正常同龄儿。另一于生后5月（纠正胎龄2月）时出现神经运动发育落后，经过及时的康复治疗，生后9月（纠正胎龄6月）跟踪体格检查及智力检查发育同正常同龄儿。结论：成功救治超低出生体重儿关键是：从入院后的保暖、监护、防治各种并发症、维持内环境稳定和保证营养需求等，制定系统化整体救治方案并实施。而出院后的随访可减少后遗症的发生，提高生命质量。     

超低出生体重儿脐静脉插管术的护理

目的 探讨脐静脉插管术在超低出生体重儿的护理方法.方法 回顾性总结40例超低出生体重儿行脐静脉插管术的护理经验.结果 40例行脐静脉插管术全部穿刺成功.留置导管时间为2～7d.其中5例放弃治疗,35例按原计划拔管,均未见有明显的局部感染灶或败血症,无明显的液体外渗,无空气栓塞、血栓形成或明显出血倾向.结论 脐静脉插管术创伤小,操作简单,有利于超低出生体重儿住院早期的静脉营养治疗和抢救,减轻了患儿痛苦.严格的无菌操作、规范化使用、标准化护理和密切观察病情是插管留置术成功的保证.     

儿童动脉导管未闭介入治疗的护理

目的:总结儿童动脉导管未闭介入手术的护理要点,提高手术成功率。方法:回顾性分析126例行动脉导管未闭介入封堵术患儿的护理要点,包括术前访视、了解病情,术中严密监护、密切配合,术后优质的护理。结果:术前准备充分,术中严密监护、配合默契,术后优质的护理,可提高手术成功率,也能及时发现并减少术后并发症的发生。结论:有效的护理是儿童动脉导管未闭介入封堵术成功的重要保障之一。     

Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus.

OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of closing the ductus arteriosus. Blood samples were drawn at time zero and at 0.5, 1, 2, 4, 12, and 24 hours after the first and third doses. Ibuprofen plasma concentrations were assayed by HPLC. RESULTS: A total of 27 premature infants were included (gestational age, 28.6 +/- 1.9 weeks; birth weight, 1250 +/- 460 g; values are mean +/- standard deviation). Ibuprofen pharmacokinetics followed a 2-compartment open model. Between the first and third doses (day 3 and day 5) there was a significant decrease of the volume of distribution of the central compartment (Vd(c)) (0.244 versus 0.171 L/kg; P =.03) and area under the plasma concentration-time curve (524 versus 447 mg. h/L; P =.01). The decrease in Vd(c) was most pronounced in patients with a closing ductus. Total body clearance and plasma half-life did not change significantly. No significant differences were observed in ibuprofen peak plasma concentrations after the first and third doses in relation to ductal status after treatment. CONCLUSION: Ibuprofen pharmacokinetics showed a large interindividual variation in premature infants during treatment for patent ductus arteriosus, and significant changes may occur between day 3 and day 5 after birth in those infants with a closing ductus. These findings may have implications for the treatment schedule with ibuprofen in patients with patent ductus arteriosus.     

发展性照顾对极低出生体重患儿体重的影响

目的探讨发展性照顾对极低出生体重患儿体重的影响。方法将200例极低出生体重患儿,按入院次序分为对照组和实验组,每组各100例,对照组采用常规护理方法,实验组在常规护理的基础上,实施发展性照顾。比较两组患儿在入院时、入院后7d和15d体重的差异。结果观察组患儿在入院后7d和15d,其体重增长优于对照组患儿,两组比较,均P<0.05,差异具有统计学意义。结论实施发展性照顾可提高极低出生体重患儿体重增长,从而增强患儿的生存能力。     

单侧肺动脉起源异常合并动脉导管未闭患儿的术后护理

总结1例单侧肺动脉起源于升主动脉合并动脉导管未闭患儿肺动脉高压的护理。护理要点包括:术后持续监测肺动脉压,一氧化氮(NO)的使用,气道管理,呼吸管理等。经过精心治疗与护理,患儿痊愈出院。     

布洛芬治疗早产儿动脉导管未闭53例的临床研究

目的探讨口服布洛芬治疗早产儿动脉导管未闭（PDA）的疗效以及安全性,同时研究相关因素对疗效影响。方法符合入选标准的PDA患儿53例给予口服布洛芬治疗,观察患儿动脉导管关闭情况以及不良反应。结果本组首次治疗有效率为84．91％,治疗失败者8例,经第2疗程治疗后有2例PDA关闭,因此,PDA关闭总有效率为88．68％。研究表明布洛芬的用药时间和患儿出生体重对PDA关闭率均有积极显著的影响,且无严重不良反应发生。结论布洛芬治疗早产儿动脉导管未闭疗效确切,用药安全。早期应用布洛芬,可显著提高早产儿的PDA关闭率。     

The use of renal Doppler ultrasonography to diagnose patent ductus arteriosus in preterm infants.

OBJECTIVE: To prospectively study the diagnostic usefulness of altered renal waveforms in patent ductus arteriosus. METHODS: We studied preterm infants undergoing echocardiography for a suspected patent ductus arteriosus. A spectral Doppler display was acquired for both renal arteries, and a resistive index was obtained. Sensitivity, specificity, and likelihood ratios were calculated using a clinically significant patent ductus arteriosus (>1.5-mm diameter on color Doppler ultrasonography) as the standard of reference. RESULTS: Fifty infants had 78 scans. A significant patent ductus arteriosus was present on 39 scans. When the renal resistive index was greater than 1.0, the likelihood ratio for a significant patent ductus arteriosus was 24.8 (specificity, 97.2%; SD, 3.8%). When the renal resistive index was 1.0 or less, the likelihood ratio for a significant patent ductus arteriosus was 0.2 (sensitivity, 77.2%; SD, 9.4%). CONCLUSIONS: Renal resistive index measurement is a simple investigation that can predict a significant patent ductus arteriosus in patients without congenital heart disease or other causes of diastolic runoff when echocardiography is unavailable.     

Management of the neonate with patent ductus arteriosus

Care of the preterm infant with a suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is a frequent challenge for the neonatal nurse. Management of term infants with cardiac lesions dependent upon a PDA can be even more challenging. It is vital for neonatal nurses to understand the normal cardiovascular and pulmonary changes that occur at birth so they can anticipate pathological processes influencing the clinical course of an infant with a PDA. In addition, knowledge of current and effective treatment approaches is essential to providing optimal care for these vulnerable infants, as well as in guiding their parents. The purpose of this article is to review current information about PDA, including physiology, pathophysiology, pharmacological approaches, surgical considerations, complications and outcomes, parental support, and areas for future research.     

极低出生体重儿23例早期护理干预效果研究

目的:探讨早期护理干预对极低出生体重儿存活率及并发症的影响。方法:将46例极低出生体重儿随机分为观察组和对照组各23例。观察组给予早期护理干预(微量喂养、抚触、体位管理等),对照组给予常规护理。观察两组极低出生体重儿护理后体重增长情况、不良反应发生率。结果:与对照组比较,观察组极低出生体重儿体重增长速度快(P<0.01),呕吐、哭闹、胃潴留、腹胀发生率明显降低(P<0.01)。结论:早期护理干预能够提高极低出生体重儿的存活率,减少并发症,值得临床推广。     

Prediction of ductus arteriosus closure by neonatal screening echocardiography

AIMS: We reported the incidence, clinical manifestations and outcome of patent ductus arteriosus (PDA) in full-term infants by screening echocardiography. METHODS AND RESULTS: Total 1230 infants received echocardiographic screening and periodic follow-up. On the third day of life, there were 109 infants with isolated ductus arteriosus aneurysm (DAA), those with persistent patency of the ductus arteriosus (DA) in 26. The DA closed within 48 h in 828 infants, and persisted beyond 48 h in 180. The incidence of PDA in full-term infants was 0.91, 0.83 and 0.66% at 1, 4 and 6 months follow-up, and 0.82, 0.73 and 0.64% if infants with DAA were excluded. Infants with PDA had lower birth body weight (BBW) than those with closed DA (p = 0.02). The DA width on the third day of life ranged from 0.23 to 0.43 cm (0.32 +/- 0.08 cm) and 0.08 to 0.44 cm (0.16 +/- 0.06 cm) in infants with or without PDA, respectively, which was significantly different (p < 0.05). The sensitivity, specificity, predictive positive and negative values were 87.5, 92.5, 36.8 and 99% respectively for the cuff-off point at 0.25 cm of DA width. CONCLUSIONS: Risk factors in infants with PDA included lower BBW and larger measured DA width at the third day of life. We predicted the arterial duct would close if DA width <0.25 cm, and suggested follow up earlier if >0.25 cm on the third day of life.