Observation on the application of MDT nursing mode in neonates with persistent pulmonary hypertension undergoing tracheal intubation

doi:10.3760/cma.j.issn.1007-1245.2023.03.020

Abstract

Abstract:

Objective　To explore the application effect of multidisciplinary teamwork (MDT) nursing mode in tracheal intubation for persistent pulmonary hypertension of the newborn (PPHN). Methods　It was a prospective randomized controlled trial. A total of 92 cases of PPHN who came to Children's Hospital Affiliated to Zhengzhou University from March 2020 to May 2022 were selected as the research objects, and were simply randomly divided into a conventional group (46 cases) and an observation group (46 cases). In the conventional group, there were 22 males and 24 females, with a gestational age of (39.35±0.74) weeks; in the observation group, there were 20 males and 26 females, with a gestational age of (39.08±0.82) weeks. The conventional group was given traditional nursing intervention, and the observation group was given MDT nursing mode on the basis of the conventional group. The incidence of complications, rehabilitation, systemic blood pressure, systolic pulmonary artery pressure (SPAP), neurobehavior [Neonatal Behaviral Neurological Assessment (NBNA) score], and family members' nursing satisfaction were compared between the two groups. Statistical methods were χ² test and independent sample t test. Results　The incidence of complications in the observation group was lower than that in the conventional group [6.52% (3/46) vs. 21.74% (10/46)], with a statistically significant difference (χ²=4.390, P=0.036). The neonatal intensive care unit (NICU) stay, tracheal intubation time, and oxygen therapy time in the observation group were shorter than those in the conventional group [(8.26±1.38) d vs. (10.14±1.27) d, (5.32±1.05) d vs. (6.74±1.13) d, (7.25±0.97) d vs. (9.47±1.16) d], with statistically significant differences between the two groups (t=6.800, 6.244, and 9.957; all P<0.001). After nursing, the systemic blood pressure of the observation group was (63.89±6.25) mmHg (1 mmHg=0.133 kPa) and (63.64±6.58) mmHg of the conventional group, and there was no statistically significant difference between the two groups (t=0.187, P=0.852); the SPAP in the observation group was significantly lower than that in the conventional group [(37.46±3.85) mmHg vs. (45.84±4.03) mmHg], with a statistically significant difference (t=10.198, P<0.001). The scores of primitive reflex, active muscle tone, passive muscle tone, behavioral ability, and general response of the NBNA in the observation group were (5.32±0.28) points, (5.73±0.34) points, (7.49±0.36) points, (9.35±1.03) points, and (4.38±0.56) points, respectively, which were higher than those in the conventional group [(3.77±0.16) points, (4.32±0.25) points, (5.48±0.27) points, (7.41±0.12) points, and (3.62±0.48) points], with statistically significant differences (t=32.598, 22.660, 30.294, 12.689, and 6.989; all P<0.001). The family members' nursing satisfaction in the observation group was higher than that in the conventional group [91.30% (42/46) vs. 76.09% (35/46)], with a statistically significant difference (χ²=3.903, P=0.048). Conclusion　MDT nursing mode can reduce the risk of complications in children with PPHN, improve their pulmonary artery pressure, promote their neurobehavioral development, accelerate their rehabilitation, and improve their family members' nursing satisfaction.

Key words:

Multidisciplinary teamwork, Persistent pulmonary hypertension of the newborn, Complications, Nursing satisfaction

摘要：

目的　探讨多学科协作（MDT）式护理模式在新生儿持续肺动脉高压（PPHN）气管插管中的应用效果。方法　本研究为前瞻性随机对照试验。选取2020年3月至2022年5月来郑州大学附属儿童医院就诊的92例PPHN作为研究对象，简单随机分为常规组（46例）、观察组（46例）。常规组男22例，女24例，胎龄（39.35±0.74）周，予以传统护理干预；观察组男20例，女26例，胎龄（39.08±0.82）周，在常规组基础上予以MDT式护理模式。比较两组并发症发生率、康复情况、体循环血压、收缩期肺动脉压、神经行为［新生儿神经行为量表（NBNA）评分］及家属护理满意度。统计学方法采用χ²检验、独立样本t检验。结果　观察组新生儿的并发症总发生率低于常规组［6.52%（3/46）比21.74%（10/46）］，差异有统计学意义（χ²=4.390，P=0.036）；观察组的新生儿重症监护室（NICU）住院时间、气管插管时间、氧疗时间均短于常规组［（8.26±1.38）d比（10.14±1.27）d、（5.32±1.05）d比（6.74±1.13）d、（7.25±0.97）d比（9.47±1.16）d］，两组比较差异均有统计学意义（t=6.800、6.244、9.957，均P<0.001）。护理后，观察组体循环血压为（63.89±6.25）mmHg（1 mmHg=0.133 kPa），常规组为（63.64±6.58）mmHg，两组比较差异无统计学意义（t=0.187，P=0.852）；观察组收缩期肺动脉压低于常规组［（37.46±3.85）mmHg比（45.84±4.03）mmHg］，差异有统计学意义（t=10.198，P<0.001）。观察组NBNA的原始反射、主动肌张力、被动肌张力、行为能力、一般反应评分分别为（5.32±0.28）分、（5.73±0.34）分、（7.49±0.36）分、（9.35±1.03）分、（4.38±0.56）分，均高于常规组的（3.77±0.16）分、（4.32±0.25）分、（5.48±0.27）分、（7.41±0.12）分、（3.62±0.48）分，差异均有统计学意义（t=32.598、22.660、30.294、12.689、6.989，均P<0.001）。观察组新生儿家属护理总满意度高于常规组［91.30%（42/46）比76.09%（35/46）］，差异有统计学意义（χ²=3.903，P=0.048）。结论　MDT式护理模式能降低PPHN患儿并发症发生风险，改善肺动脉压，促进患儿神经行为发育，有利于加快患儿康复，从而提高家属护理满意度。

关键词:

多学科协作, 新生儿持续肺动脉高压, 并发症, 护理满意度

Shi Lanlan, Duanmu Yanyan, Liu Yanyan.

Observation on the application of MDT nursing mode in neonates with persistent pulmonary hypertension undergoing tracheal intubation [J]. International Medicine and Health Guidance News, 2023, 29(3): 385-389.

石兰兰端木艳艳刘彦彦.

多学科协作式护理模式在新生儿持续肺动脉高压气管插管中的应用观察 [J]. 国际医药卫生导报, 2023, 29(3): 385-389.

References

[1] 杨蕾,王兆,段淼,等.雾化吸入伊洛前列素联合一氧化氮吸入治疗新生儿持续性肺动脉高压的临床研究[J].中国临床药理学杂志,2020,36(4):387-389. DOI:10.13699/j.cnki.1001-6821.2020.04.001.
[2] 吴杰,林建军,樊慧苏.肺表面活性物质西地那非联合常频机械通气治疗新生儿胎粪吸入综合征并发持续肺动脉高压的疗效观察[J].中国妇幼保健,2021,36(1):104-107. DOI:10.19829/j.zgfybj.issn.1001-4411.2021.01.036.
[3] Mandell E, Kinsella JP, Abman SH. Persistent pulmonary hypertension of the newborn[J]. Pediatr Pulmonol, 2021, 56(3): 661-669. DOI: 10.1002/ppul.25073.
[4] 王振威,艾笛,张腾,等. 多学科协作诊疗模式在老年髋部骨折治疗中的应用[J]. 中华创伤骨科杂志,2020,22(3):200-205. DOI:10.3760/cma.j.cn115530-20191006- 00343.
[5] 时梦娟,刘莉,郑萌,等. 多学科协作护理干预联合胸腔镜治疗胸腺瘤的疗效观察[J]. 海军医学杂志,2020,41(1):85-88. DOI:10.3969/j.issn.1009-0754.2020.01.024.
[6] Rui A, Xu Q, Yang X. Effect of multidisciplinary cooperative continuous nursing on the depression, anxiety and quality of life in gastric cancer patients[J]. Am J Transl Res, 2021, 13(4): 3316-3322.
[7] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组,等. 中国肺动脉高压诊断与治疗指南(2021版)[J]. 中华医学杂志,2021,101(1):11-51. DOI:10.3760/cma.j.cn112137-20201008-02778.
[8] 周伟,毕叶,魏燕燕,等. 亚低温联合神经节苷脂治疗新生儿缺氧缺血性脑病的疗效分析[J]. 解放军医学院学报,2020,41(1):56-59. DOI:10.3969/j.issn.2095-5227.2020.01.015.
[9] Singh Y, Lakshminrusimha S. Pathophysiology and management of persistent pulmonary hypertension of the newborn[J]. Clin Perinatol, 2021, 48(3): 595-618. DOI: 10.1016/j.clp.2021.05.009.
[10] 刘学丹,周浩泉,李晓春. 新生儿持续肺动脉高压发病的相关危险因素分析[J]. 临床肺科杂志,2020,25(10):1511-1514. DOI:10.3969/j.issn.1009-6663.2020.10.012.
[11] Siefkes HM, Lakshminrusimha S. Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(4): 446-455. DOI: 10.1136/archdischild-2020-319705.
[12] 杨勇,阮敏仪,苏锦珍,等. 新生儿持续性肺动脉高压的危险因素分析[J]. 广东医学,2020,41(4):344-348. DOI:10.13820/j.cnki.gdyx.20192387.
[13] Mahmood B. Persistent pulmonary hypertension of newborn[J]. Semin Pediatr Surg, 2022, 31(4): 151202. DOI: 10.1016/j.sempedsurg.2022.151202.
[14] Lai MY, Chu SM, Lakshminrusimha S, et al. Beyond the inhaled nitric oxide in persistent pulmonary hypertension of the newborn[J]. Pediatr Neonatol, 2018, 59(1): 15-23. DOI:10.1016/j.pedneo.2016.09.011.
[15] 万娟,唐荔,任秋萍,等. 多学科协作下的快速康复管理措施对肝移植术后住院时间及并发症的影响[J]. 中国普外基础与临床杂志,2022,29(3):315-321. DOI:10.7507/1007-9424.202105076.
[16] 邢娟,米巍,唐华. 多学科会诊模式下综合呼吸训练在脊髓损伤患者气道护理中的应用[J]. 实用临床医药杂志,2021,25(23):45-48. DOI:10.7619/jcmp.20213933.
[17] 王巧红,张新春,白亚飞. 新生儿肺动脉高压的临床症状与护理观察[J]. 贵州医药,2020,44(12):2006-2007. DOI:10.3969/j.issn.1000-744X.2020.12.088.
[18] 张小利. 程序化护理管理模式在新生儿持续性肺动脉高压护理中的应用[J]. 河南医学研究,2020,29(3):560-561. DOI:10.3969/j.issn.1004-437X.2020.03.091.
[19] Phattraprayoon N, Tangamornsuksan W, Ungtrakul T. Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(1): 31-38. DOI:10.1136/archdischild-2020-318941.
[20] O'Leary GM. Pulmonary arterial hypertension: an overview[J]. Nursing, 2021, 51(11): 37-43. DOI: 10.1097/01.NURSE.0000795272.64847.1b.
[21] 薛霏. 针对性护理干预对新生儿持续肺动脉高压机械血氧饱和度的影响[J]. 黑龙江医药科学,2020,43(1):70-71. DOI:10.3969/j.issn.1008-0104.2020.01.033.
[22] Poitras EL, Gust SL, Kerr PM, et al. Repurposing of the PDE5 inhibitor sildenafil for the treatment of persistent pulmonary hypertension in neonates[J]. Curr Med Chem, 2021, 28(12): 2418-2437. DOI: 10.2174/0929867327666200923151924.
[23] Vandormael C, Schoenhals L, Hüppi PS, et al. Language in preterm born children: atypical development and effects of early interventions on neuroplasticity[J]. Neural Plast, 2019, 18(5): 6873270. DOI: 10.1155/2019/6873270.
[24] 杜扬,周建国,陈超. 早产儿支气管肺发育不良相关肺动脉高压诊治研究进展[J]. 中华儿科杂志,2020,58(2):162-165. DOI:10.3760/cma.j.issn.0578-1310.2020.02.021.
[25] 丁洁珺,丁燕曙,金文杰,等. 脑电图、事件相关电位及全身运动质量评估对高危儿神经发育的预测作用[J]. 国际医药卫生导报,2022,28(1):61-65. DOI:10.3760/cma.j.issn. 1007-1245.2022.01.015.
[26] de Boode WP, Singh Y, Molnar Z, et al. Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn[J]. Pediatr Res, 2018, 84(1): 68-77. DOI: 10.1038/s41390-018-0082-0.
[27] 方晓英,廖卫华,黄宏,等. 亲子袋鼠式皮肤接触联合全身抚触在缺氧性肺动脉高压新生儿中的应用研究[J]. 华夏医学,2021,34(5):157-159. DOI:10.19296/j.cnki.1008-2409. 2021-05-040.
[28] Welch CL, Chung WK. Channelopathy genes in pulmonary arterial hypertension[J]. Biomolecules, 2022, 12(2): 265. DOI: 10.3390/biom12020265.
[29] 金惠芳. 袋鼠式护理对缺氧性肺动脉高压患儿神经行为及生长发育的影响[J]. 内蒙古医学杂志,2020,52(4):469-471. DOI:10.16096/J.cnki.nmgyxzz.2020.52.04.041.
[30] 李晓娟. 多学科协作快速康复在髋膝关节置换围手术期护理中的应用[J]. 甘肃医药,2022,41(5):469-470,477. DOI:10.15975/j.cnki.gsyy.2022.05.028.
[31] 邓小春,冉亚萍,吴海燕,等.多学科团队协作模式的营养干预对慢性阻塞性肺病急性加重期患者营养状态的影响[J].现代临床护理, 2021, 20(8): 50-55. DOI: 10.3969/j.issn.1671-8283.2021.08.008.
[32] McNicholas A, McCall A, Werner A, et al. Improving patient experience through nursing satisfaction[J]. J Trauma Nurs, 2017, 24(6): 371-375. DOI: 10.1097/JTN.0000000000000328.