新生儿护理门诊的建立与实施

目的 为满足新生儿延续性护理服务需要,建立并实施新生儿护理门诊。方法 制订新生儿护理门诊规范,选拔出诊护士,成立新生儿护理门诊,提供新生儿黄疸筛查和育儿指导,由护士、医生、患儿家长对新生儿护理门诊进行评价。结果 共选拔16名护士出诊,2017年3月—8月新生儿护理门诊共接诊2 543例次,其中新生儿黄疸患儿最多,为2 038例（80.14%）。出诊护士均认为新生儿门诊的设立提升了患儿家长对医院和护理工作的满意度,认为自己在出诊过程中提升了处理专科护理问题的能力;66.67%的医生认为护理门诊对患儿的诊治有帮助;80%的家长对护理门诊的总体评价为90~100分。结论 新生儿护理门诊的开设可有效识别病理性黄疸并解决家长的育儿问题,提升了新生儿专科护士的社会地位和作为临床护理专家的信心,得到了医生和家长的认可。     

Effects of different surfactant administrations on cerebral autoregulation in preterm infants with respiratory distress syndrome

To treat respiratory distress syndrome, surfactant is currently delivered via less invasive surfactant administration (LISA) or INtubation SURfactant Extubation (INSURE). The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation. Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation (ScO₂), and the mean arterial blood pressure (MABP) was simultaneously recorded. Of 44 preterm infants included, the surfactant was administrated to 22 via LISA and 22 via INSURE. The clinical characteristics, treatments and outcomes of the infants showed no significant differences between the two groups. The correlation coefficient of ScO₂ and MABP (r _ScO2-MABP) 5 min before administration was similar in the two groups. During surfactant administration, r _ScO2-MABP increased in both groups (0.44±0.10 to 0.54±0.12 in LISA, 0.45±0.11 to 0.69±0.09 in INSURE). In the first and second 5 min after instillation, r _ScO2-MABP was not significantly different from baseline in the LISA group, but increased in the first 5 min after instillation (0.59±0.13, P=0.000 compared with the baseline in the same group) and recovered in the second 5 min after instillation (0.48±0.10, P=0.321) in the INSURE group. There were significant differences in the change rates of r _ScO2-MABP between the two groups during and after surfactant administration. Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration. The effect duration of LISA is shorter than that of INSURE (<5 min in LISA vs. 5–10 min in INSURE).     

论高年资护士在NICU的作用

目的:探讨高年资护士在NICU中的作用。方法:通过分析NICU高年资护士的特点来总结高年资护士的作用。结果:总结出高年资护士的作用,体现在护理技术操作能力方面、护理缺陷方面、带教作用方面。结论:NICU护士要具备高素质和处理复杂问题的能力。