促进母婴分离产妇母乳采集的循证实践

doi:10.3761/j.issn.0254-1769.2020.01.003

中华护理杂志 ›› 2020, Vol. 55 ›› Issue (1): 22-27.DOI: 10.3761/j.issn.0254-1769.2020.01.003

促进母婴分离产妇母乳采集的循证实践

邓永芳,贺芳,符白玲,郭晓萍,何静妍,梁秋霞,刘灿红,梁琪琪,顾莺,林艳()

510623 广州市妇女儿童医疗中心产科（邓永芳，符白玲，何静妍，梁秋霞，梁琪琪），新生儿科（贺芳，郭晓萍，刘灿红），护理部（林艳）；复旦大学附属儿科医院护理部（顾莺）

收稿日期:2019-03-14 出版日期:2020-01-15 发布日期:2020-01-17
通讯作者: 林艳
作者简介:邓永芳：女,硕士,主管护师,E-mail：dengyfsc@163.com
基金资助:
广州市卫生和计划生育委员会资助项目(2060404);复旦大学循证护理中心证据转化与临床应用项目(Fudanebn201805);广州市妇女儿童医疗中心内部科研项目(YIP-2018-039)

Evidence-based practice to promote breast milk expression among postpartum women with neonatal-maternal separation

DENG Yongfang,HE Fang,FU Bailing,GUO Xiaoping,HE Jingyan,LIANG Qiuxia,LIU Canhong,LIANG Qiqi,GU Ying,LIN Yan()

Delivery and Labor Room, Guangzhou Women and Children’s Medical Center,Guangzhou,510145,China

Received:2019-03-14 Online:2020-01-15 Published:2020-01-17
Contact: Yan LIN

摘要/Abstract

摘要：

目的实施母婴分离产妇母乳采集的循证实践并探索其对泌乳的影响。方法应用循证护理的方法获取最佳证据,以基于证据的持续质量改进模式为理论框架,于2018年5月—12月,按照证据获取、现状审查、证据引入和效果评价4个阶段将循证实践应用于母婴分离产妇,比较循证实践应用前后产妇母乳采集的依从性和泌乳量等指标的变化。结果循证实践应用了12条证据。循证实践后,产妇母乳采集的依从性提高,送母乳至新生儿科的产妇人数比例提高,产妇开始送母乳时间提前,产后1周内产妇泌乳总量增加。结论通过循证护理对母婴分离产妇进行管理,可有效规范产妇母乳采集行为,促进成功泌乳及提高泌乳量,可为母婴分离状态下母乳喂养的管理提供参考。

关键词: 母婴分离, 母乳采集, 循证实践, 持续质量改进, 产科护理

Abstract:

Objective To implement evidence-based practice of breast milk expression behaviors among postpartum women with neonatal-maternal separation and explore its influences on lactation. Methods Evidence-based nursing was used to obtain best evidence. The model of evidence-based continuous quality improvement was adopted as the theoretical framework. From May to December 2018,the best evidence was applied to separated mothers according to four stages：evidence acquisition,current situation review,evidence introduction and effect evaluation. The changes of breast milk expression compliance and lactation volume were observed before and after the application of evidence. Results A total of 12 items of evidence were applied. Breast milk expression compliance was improved after evidence implementation. The number of women who transported breast milk to neonatology department increased. The initial time of breast milk transportation after delivery was brought forward. The total estimated lactation volume per woman in the first seven days after delivery was increased. Conclusion Evidence-based nursing is useful to manage breast milk expression behaviors among postpartum women with neonatal-maternal separation,optimize lactation success and increase the amount of milk,which can provide references for breastfeeding management for women with neonatal-maternal separation.

Key words: Neonatal-Maternal Separation, Milk Expression, Evidence-Based Practice, Continued Quality Improvement, Obstetrical Nursing

邓永芳, 贺芳, 符白玲, 郭晓萍, 何静妍, 梁秋霞, 刘灿红, 梁琪琪, 顾莺, 林艳. 促进母婴分离产妇母乳采集的循证实践[J]. 中华护理杂志, 2020, 55(1): 22-27.

DENG Yongfang, HE Fang, FU Bailing, GUO Xiaoping, HE Jingyan, LIANG Qiuxia, LIU Canhong, LIANG Qiqi, GU Ying, LIN Yan. Evidence-based practice to promote breast milk expression among postpartum women with neonatal-maternal separation[J]. Chinese Journal of Nursing, 2020, 55(1): 22-27.

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参考文献 25

[1]	杨红艳, 张波, 段志英 , 等. 早产母婴分离产妇产后护理新模式的应用[J]. 中国护理管理, 2015,15(S1):106-108.
[2]	Ogias D, Rattes IC, Hosoya LYM , et al. Neonatal-maternal separation primes zymogenic cells in the rat gastric mucosa through glucocorticoid receptor activity[J]. Sci Rep, 2018,8(1):9823.
[3]	León Rodríguez DA, Dueñas Z . Maternal separation during breastfeeding induces gender-dependent changes in anxiety and the GABA-A receptor alpha-subunit in adult wistar rats[J]. PLoS One, 2013,8(6):e68010.
[4]	Aya-Ramos L, Contreras-Vargas C, Rico JL , et al. Early maternal separation induces preference for sucrose and aspartame associated with increased blood glucose and hyperactivity[J]. Food Funct, 2017,8(7):2592-2600.
[5]	杨怀洁, 董琼, 林文华 , 等. 双胞胎母亲母乳喂养体验和需求的质性研究[J]. 中国护理管理, 2015,15(9):1051-1054.
[6]	Victora CG, Bahl R, Barros AJ , et al. Breastfeeding in the 21st century:epidemiology,mechanisms,and lifelong effect[J]. Lancet, 2016,387(10017):475-490.
[7]	Sharma IK, Byrne A . Early initiation of breastfeeding:a systematic literature review of factors and barriers in South Asia[J]. Int Breastfeed J, 2016,11:17.
[8]	冯宗太, 贲晓明 . 采集母乳与母乳库母乳喂养对早产儿生长发育的影响[J]. 国际儿科学杂志, 2010,37(2):119-121,182.
[9]	Dyson L, McCormick F Renfrew MJ . Interventions for promoting the initiation of breastfeeding[J]. Cochrane Database Syst Rev, 2005, 18(2):CD001688.
[10]	杨漂羽, 张玉侠, 胡晓静 , 等. 极低出生体重儿母乳喂养的循证实践[J]. 中华护理杂志, 2018,53(6):656-661.
[11]	Goodchild L, Hussey L, Mcphee AJ , et al. Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit:a best practice implementation project[J]. JBI Database System Rev Implement Rep, 2018,16(10):2027-2037.
[12]	Parker LA, Hoffman J, Darcy-Mahoney A . Facilitating early breast milk expression in mothers of very low birth weight infants[J]. MCN Am J Matern Child Nurs, 2018,43(2):105-110.
[13]	周英凤, 胡雁, 顾莺 , 等. 基于证据的持续质量改进模式图的构建[J]. 中国循证医学杂志, 2017,17(5):603-606.
[14]	杨漂羽, 施姝澎, 张玉侠 , 等. 住院新生儿母乳喂养循证指南的改编及评价[J]. 中华护理杂志, 2018,53(1):57-64.
[15]	Dicenso A, Bayley L, Haynes RB . Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009,12(4):99-101.
[16]	Boies EG, Vaucher YE . ABM clinical protocol 10:breastfeeding the late preterm(34-36 6/7 weeks of gestation) and early term infants(37-38 6/7 weeks of gestation),second revision 2016[J]. Breastfeed Med, 2016,11:494-500.
[17]	Harris RP, Helfand M, Woolf SH , et al. Current methods of the US preventive services task force:a review of the process[J]. Am J Prev Med, 2001,20(3 Suppl):21-35.
[18]	谢利民, 王文岳 . 《临床指南研究与评价系统》简介[J]. 中西医结合学报, 2012,10(2):160-165.
[19]	Jordan Z, Lockwood C, Munn Z , et al. Redeveloping the JBI model of evidence based healthcare[J]. Int J Evie Based Heal-thc, 2018,16(4):227-241.
[20]	孙黎, 余欣, 陈嘉玉 , 等. 基于HIMSS 7级的母乳喂养闭环管理系统的设计与应用[J]. 护理学报, 2018,25(17):45-49.
[21]	Arts M, Taqi I, Bégin F . Improving the early initiation of breastfeeding:the WHO-UNICEF breastfeeding advocacy initiative[J]. Breastfeed Med, 2017,12(6):326-327.
[22]	Wood NK, Woods NF, Blackburn ST , et al. Interventions that enhance breastfeeding initiation,duration,and exclusivity:a systematic review[J]. MCN Am J Matern Child Nurs, 2016,41(5):299-307.
[23]	栾丹丹, 于秀荣, 王云芳 , 等. NICU住院早产儿母亲在母婴分离期的泌乳量及相关因素研究[J]. 中华护理杂志, 2018,53(1):65-70.
[24]	Liu Y, Yao J, Liu X , et al. A randomized interventional study to promote milk secretion during mother-baby separation based on the health belief model:a consort compliant[J]. Medicine(Baltimore), 2018,97(42):e12921.
[25]	Xu Q, Wu Z, Yang N , et al. Impact of epidural analgesia during labor on breastfeeding initiation and continuation:a retrospective study[J]. J Matern Fetal Neonatal Med, 2019: 1-4.

促进母婴分离产妇母乳采集的循证实践

Evidence-based practice to promote breast milk expression among postpartum women with neonatal-maternal separation

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