摘要
目的 通过开展以循证证据应用为基础的质量改进活动降低剖宫产母婴同室新生儿低血糖发生率，降低低血糖对新生儿的影响，增强护士对循证证据的应用能力，提高护理质量，保证新生儿的健康。方法 成立QC小组，通过循证方法找出预防新生儿低血糖的方法证据，并进行质量评价，通过FAME会议得出最终的证据，并将证据用于临床实践，分析证据应用过程中遇到的障碍因素，对障碍因素进行分析，找出原因，制定对策，实施对策，定期进行效果评价、总结。比较证据使用前后剖宫产母婴同室新生儿低血糖的发生率。结果 质量改进后指标一、指标二、指标三、指标四和指标五的发生率均高于基线审查，差异具有统计学意义（P<0.05）。而低血糖在证据应用前后的差异无统计学意义（P>0.05），尚不能认为两者存在差异。结论 质量改进活动对于降低剖宫产母婴同室新生儿低血糖发生率作用并不明显，仍需进行进一步的研究，以有利于提高护理质量和实施优质护理。
关键词： 循证；新生儿低血糖；剖宫产；质量改进
Abstract
Objective: To reduce the incidence of hypoglycemia and the influence of hypoglycemia on newborns by carrying out quality improvement activities based on evidence-based evidence application, enhance the ability of nurses to apply evidence-based evidence, improve nursing quality and ensure the health of newborns. Methods: The QC team was established to find out the evidence for the prevention of neonatal hypoglycemia by evidence-based method and to evaluate the quality. The final evidence was obtained by FAME meeting. The evidence was used in clinical practice, the obstacles encountered in the application of evidence were analyzed, the causes were found, the countermeasures were formulated, and the effects were evaluated and summarized regularly. To compare the incidence of hypoglycemia before and after the evidence implementation Results: After quality improvement, the incidence of indicators 1, 2, 3, 4 and 5 was higher than that of baseline review, and the difference was statistically significant (P < 0.05). However, there was no significant difference in hypoglycemia before and after the application of the evidence (P > 0.05). Conclusion : The effect of quality improvement activities on reducing the incidence of hypoglycemia of newborns in the same room of cesarean section is not obvious. Further research is still needed, but it is conducive to improving the quality of nursing and implementing quality nursing.
Key words： Evidence-Based; Neonatal Hypoglycemia; Cesarean Section; Quality Improvement
参考文献 References
[1] 王蕾,卢典,吴伟玲,郑大同.新生儿低血糖及其治疗管理[J].临床儿科杂志,2016,(1)：55-58.
[2] MCKINLAY CJD, ALSWEILER JM, ANSELL JM, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years[J]. N Engl J Med, 2015, 373(16): 1507-1518. PMID: 26465984. PMCID: PMC4646166. DOI: 10.1056/NEJMoa1504909.
[3] HARRIS DL, WESTON PJ, HARDING JE. Incidence of neonatal hypoglycemia in babies identified as at risk[J]. J Pediatr, 2012, 161(5): 787-791. PMID: 22727868. DOI: 10.1016/j.jpeds.2012.05.022.
[4] 张国军，郑丽华,孙锡红.妊娠期糖尿病研究进展[J].河北医科大学学报,2015,36(7):862-866.
[5] Queensland Clinical Guidelines: Newborn hypoglycaemia August 2018.http://www.health.qld.gov.au/qcg
[6] WESTON PJ, HARRIS DL, BATTIN M, BROWN J, et al .Oral dextrose gel for the treatment of hypoglycaemia in newborn infants.[J].Cochrane Database Syst. Rev, 2016, (5): CD011027.
[7] HEGARTY J E, HARDING J E, CROWTHER C A, et al. Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates.[J]. Cochrane Database Syst. Rev,2017,(7).10.1002/14651858.CD012152.pub2
[8] 冯嘉蕾,包艾荣,吕燕辉，等.剖宫产术前禁食禁饮时间对妊娠期糖尿病产妇及新生儿血糖的影响[J].中华现代护理杂志,2017,23(4):509-512.
[9] 刘晓薇,郑碧,于晓,等.禁食对剖宫产新生儿血糖的影响[J].实用妇产科杂志,2008,24(5):297-298.
[10] 林蓉金,金调芬,孙欣悦.母婴皮肤早接触对妊娠期糖尿病产妇新生儿血糖的影响[J].中国妇幼保健,2019,34(11)：2507-2509.
[11] 顾信佳,俞君,吴静.妊娠期糖尿病产妇分娩新生儿早期血糖变化及影响低血糖发生的危险因素研究[J].中国妇幼保健,2020,35(14)：2635-2637.
[12] 张丰健, 官春燕，刘义兰，等.医院护理人文关怀模式研究现状及对人文关怀模式构建的思考[J].护理研究,2020，34(16)：2892-2895.
[13] 廖薇,林亚娟,赵杰.优质护理对初产妇新生儿护理及自我保健能力的影响[J].护理研究,2020,34(2)：315-317.
[14] PHILIP J W; DEBORAH L H;JANE E H.Dextrose gel treatment does not impair subsequent feeding . [J]. Arch Dis Child Fetal Neonatal Ed 2017,102(6):F539-F541 doi:10.1136/archdischild-2017-312772.