Analysis of influencing factors of decision-making conflicts of decision-making agents for premature infants and their impact on clinical outcomes of premature infants
早产儿决策代理人决策冲突影响因素分析及其对早产儿临床结局的影响

摘要

目的 系统评价NICU早产儿决策代理人决策冲突情况；剖析影响因素及其相互作用关系，探索决策冲突对于早产儿临床结局的影响，为临床制定具有针对性决策辅助干预方案提供依据。方法 在2024年9月至2025年2月之间，应用整群随机抽样法，方便抽取某市三甲等医院NICU符合条件的210名早产儿监护人进行研究，使用一般资料调查表、中文版DCS、决策满意度量表、决策后悔量表以及领悟社会支持量表进行横断面调查，同时利用医院信息系统回顾性获取早产儿相关临床资料。数据分析依次用单因素分析、LASSO回归筛选、广义线性模型多元分析以及Spearman秩相关分析，统计分析软件用SPSS 25.0和R4.3.3。结果 210位决策代理人的决策冲突总分中位数是29.69分，有41.9%属于高度冲突，22.9%属于中度冲突，35.2%属于低度冲突；多因素分析结果显示胎次、家庭人均月收入、决策满意度、决策后悔以及社会支持评分都是决策冲突独立的影响因素(P<0.05)；决策冲突程度不同的组之间，早产儿母乳喂养率（P＜0.001）、住院总费用（P=0.045）与无创辅助通气时间（P=0.031）差异均有统计学意义。结论 早产儿决策代理人存在不同程度的决策冲突，其影响因素具有多重性以及相互作用的关系；决策冲突程度与是否母乳喂养，住院花费，无创机械通气持续时间有密切联系。

Abstract

Objective To systematically evaluate the decision-making conflicts of decision-making agents for premature infants in the NICU; to analyze the influencing factors and their interaction relationships, and to explore the impact of decision-making conflicts on the clinical outcomes of premature infants, providing a basis for the clinical formulation of targeted decision-making assistance intervention plans.
Methods From September 2024 to February 2025, using cluster random sampling method, 210 guardians of eligible premature infants in a tertiary hospital NICU in a certain city were conveniently selected for the study. A cross-sectional survey was conducted using general information questionnaires, Chinese version of DCS, decision satisfaction scale, decision regret scale, and social support scale. Meanwhile, relevant clinical data of premature infants were retrospectively obtained from the hospital information system. Data analysis was performed using univariate analysis, LASSO regression screening, generalized linear model multivariate analysis, and Spearman rank correlation analysis. Statistical analysis software was SPSS 25.0 and R 4.3.3.
Results The median total score of decision-making conflicts of 210 decision-making agents was 29.69 points, with 41.9% belonging to high conflict, 22.9% to moderate conflict, and 35.2% to low conflict; the results of multivariate analysis showed that the number of pregnancies, family per capita monthly income, decision satisfaction, decision regret, and social support scores were independent influencing factors of decision-making conflicts (P < 0.05); there were statistically significant differences in the breastfeeding rate of premature infants (P < 0.001), total hospitalization cost (P = 0.045), and non-invasive mechanical ventilation duration (P = 0.031) among groups with different degrees of decision-making conflicts.
Conclusion   There are different degrees of decision-making conflicts among premature infant decision-making agents, and their influencing factors have multiple and interactive relationships; the degree of decision-making conflict is closely related to whether premature infants are breastfed, hospitalization costs, and duration of non-invasive mechanical ventilation.