新生儿重症监护室(NICU)环境对新生儿的不良影响及护理干预效果观察

【摘要】目的探讨NICU环境对新生儿的不良影响及护理干预效果。方法选择我院2008年6月――2009年6月60例在NICU接受治疗的新生儿，给予一系列护理干预，比较护理干预前后新生儿的激素水平和生理指标。结果护理前皮质醇、肾上腺素和去甲肾上腺素的分泌水平均较高，且波动范围大，护理后三者水平明显降低，浓度相对稳定，护理后去甲肾上腺素低于护理前，结果具有统计学意义（P

【关键词】NICU；护理干预；不良影响

由于各种各样的原因，部分新生儿出生后需要到新生儿重症监护室（NICU）进行治疗，虽然NICU的抢救能够恢复新生儿的健康，但另一方面，NICU高噪音、强光度、疼痛刺激多、缺乏母子交流的压力环境，也大大影响了新生儿的成长发育，因此，积极改善NICU环境，减少其对新生儿的不良影响对新生儿有着重要的意义[1-2]。本文通过护理干预取得了一定的效果，具体情况如下。

1资料与方法

1.1临床资料选取我院2008年6月――2009年6月60例在NICU接受治疗的新生儿，其中男33例，女27例，胎龄36.1-42.3周，平均胎龄38.6周，出生体重2750-4000g，排除先天畸形及遗传代谢性疾病者。

1.2方法

1.2.1减少噪音和强光刺激将毯子、被子覆盖在暖箱上，拉上新生儿重症监护室的房间窗帘，尽量减少噪音和光照，必要时可以给患儿带上耳塞，保证患儿的睡眠免受打扰，NICU的医务人员要动作轻柔，减少人为的噪音，手机转为振动或静音，对各种设备的报警反应迅速及时关闭。

1.2.2人为创造昼夜交替的环境医务人员可以人为创造昼夜交替环境，在晚7时-早7时降低噪音和光度，使新生儿建立昼醒夜眠的睡眠方式。

1.2.3提倡人性化的护理模式减少侵入性治疗和疼痛刺激，按照Levin提出的人性化的、医疗护理模式进行护理，即：①母亲应24h同有病的婴儿在一起；②每一个工作人员应照顾母亲和婴儿，满足其生理需求；③工作人员应促进每个母亲实行母乳喂养和学习挤奶技术；④整个治疗期间应尽量减少母亲的心理压力；⑤除医疗所需外，不应给予婴儿母乳外的任何东西；⑥如果婴儿不能吸吮，应通过胃管并尽量由母亲给予母乳；⑦将对母亲的检查和化验减少到最低程度；⑧尽可能多进行母-儿、皮肤-皮肤、空气-空气接触，尽量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跎倮蒙璞刚展擞ざ虎崆秩胄灾瘟朴Ρ患跎俚阶钌伲虎庥κ幽盖缀陀ざ叵得芮械纳硇墓亓低常扛霾》坎唤鲆攵杂ざ乙攵阅盖椎男枰弧1在较长的住院期间内，应允许健康的家庭成员（父亲、祖父母、帮助者）探望母亲和婴儿。另外，帮助新生儿采取舒适的。

1.2.4鼓励母婴接触母婴多接触、母子多交流是非常有必要的，护理人员应该将新生儿的最新情况及时告知家长，并创造条件让母婴多接触，指导家长进行母乳喂养。

1.3疗效观察比较护理干预前后新生儿的激素水平和生理指标。

1.4统计学方法采用SPSS13.0统计软件进行统计分析，采用t检验，P

2结果

2.1新生儿护理前后激素水平比较皮质醇由护理前的（90.3±44.8）μg/dl变为护理后的（67.7±23.3）μg/dl，去甲肾上腺素由护理前的（102±59.6）μg/dl变为护理后的（64.4±39.6）μg/dl，护理后去甲肾上腺素低于护理前，结果具有统计学意义（t=1.243，1.722，2.998，P

2.2新生儿护理前后生理指标比较新生儿的脉搏由护理前的（140.0±9.2）次/min变为护理后（120.0±5.2）次/min，SO2由护理前的（94.1±2.2）%变为护理后（85.2±2.2）%、SBP由护理前的（72.3±12.8）mmHg变为护理后（70.2±11.6）mmHg，脉搏、SO2、SBP的差异具有统计学意义（t=2.265，2.813，3.682，3.952，P

3讨论

NICU高噪音、强光度、疼痛刺激多、缺乏母子交流的压力环境大大影响了新生儿的生长，噪音可以使新生儿脉搏减慢、呼吸节奏、血压及氧饱和度改变、甚至引起听力障碍；强光刺激可增加新生儿应激性激素，造成新生儿呼吸暂停、耗氧量增加、改变睡眠习惯、体重增加不理想等，不利于患儿疾病的恢复；侵入性治疗和过多的触摸，使新生儿情绪不稳定，影响新生儿发育；疼痛刺激对新生儿成年后下丘脑-垂体-肾上腺轴的反应性有较强的影响，此外，NICU环境还对亲子关系等有一定，因此，通过一系列护理干预改善NICU的环境是非常有必要的[3-4]在护理干预过程中加入人文关怀，以患儿为中心，可减轻患儿的痛苦，缓解患儿的压力，减少能量的消耗，降低伤残的发生。本文通过研究结果显示：皮质醇、去甲肾上腺素在实施护理干预后均优于护理前，结果具有统计学意义（t=1.243，1.722，2.998，P

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