Chinese Journal of Nursing

Prediction of postoperative complications in elderly patients using frailty assessment combined with American Society of Anesthesiologists physical classification

LI Qiuping,HAN Binru

2019, 54(5): 645-648. DOI: 10.3761/j.issn.0254-1769.2019.05.001

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Objective To explore the effects of frailty assessment and American Society of Anesthesiologists （ASA） physical classification on predicting postoperative complications among elderly patients.Methods General information,frailty status,ASA physical classification and incidence of complications were collected in 245 elderly patients in a tertiary hospital. The receiver operating characteristic （ROC） was used to evaluate the predictive ability of frailty assessment,ASA physical classification,and their combination.Results The area under the curve（AUC） in prediction of complications using combination of frailty assessment and ASA physical classification was 0.858 and significantly higher than individually using ASA physical classification（0.751） and frailty assessment（0.762）（P<0.001）. The sensitivity of combination was 90.48% and the specificity was 63.74%.Conclusion Frailty assessment combined with ASA physical classification can effectively predict the occurrence of postoperative complication. Frailty assessment evaluated by nurses can provide basis for perioperative safety management in elderly patients.

Construction of nursing clinical thinking training platform

CHEN Liqun, MU Shaoyu, DING Fu, WANG Huilai, LIU Jizhong

2019, 54(5): 649-653. DOI: 10.3761/j.issn.0254-1769.2019.05.002

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Objective To design and develop a nursing clinical thinking training platform and provide a new way for cultivation of clinical thinking in the context of “Internet +”.Methods Web technology of HTML5,CSS3 and JS,operating system of Windows Server 2008 R2,and B/S Network structure were applied to develop the platform. Twelve teachers and 10 graduate students were investigated with a self-designed questionnaire to evaluate the platform.Results The nursing clinical thinking training platform consisted of three parts,including Theoretical Knowledge,Case Analysis,and Examination & Evaluation. Nursing theoretical knowledge and corresponding test questions for 20 symptoms were included. There were 1856 cases from inpatient medical records,and 20 were completed for critique. More than 85% of teachers and students were satisfied with the platform.Conclusion The platform is close to clinical practice with the merits of simplicity and practicality,and plays an important role in cultivation of clinical thinking for students.

Construction of early warning and evaluation index system for postpartum hemorrhage

ZHAO Jing, XU Yang, CONG Xue, FAN Guohui, WANG Na, LU Hong

2019, 54(5): 654-658. DOI: 10.3761/j.issn.0254-1769.2019.05.003

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Objective To construct a preliminary early warning and evaluation index system for postpartum hemorrhage,and to provide a content framework for further establishing and improving the postpartum hemorrhage early warning evaluation system.Methods The literature search and Delphi technique were used to identify and classify the risk factors of postpartum hemorrhage and to construct an early warning and evaluation index system for postpartum hemorrhage.Results The recovery rates of two rounds of inquiry were both 90%,expert authority coefficients of two rounds of inquiry were both 0.75,the opinion coordination coefficient was 0.351 and 0.590. The resulting early warning and evalvation index system for postpartum hemorrhage included 12 prenatal risk factors,7 intrapartumand postpartum risk factors.Conclusion The constructed postpartum hemorrhage early warning and evaluation index system carries out continuous evaluation on maternal antenatal,intrapartum and postpartum, the evaluation content is comprehensive,which can improve the predictive ability of clinical medical staff on maternal postpartum hemorrhage.

Current situation of symptom management under the HIV/AIDS designated hospital system：a qualitative research

ZHU Zheng,HU Yan,ZHAO Rui,HAN Shuyu,FU Yanfen,ZHAO Xia,BAO Meijuan,ZHANG Lin,WEI Caiyun,LUAN Yuquan,LIU Qingfen,YANG Lian,ZHAO Dongning

2019, 54(5): 658-663. DOI: 10.3761/j.issn.0254-1769.2019.05.004

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Objective To understand the current situation and problems of HIV/AIDS symptoms management under the HIV/AIDS designated hospital system in China.Methods From April to July,2017,36 healthcare staff were recruited from four HIV/AIDS designated hospitals in Shanghai,Hengyang （Hunan Province）,Nanning （Guangxi Province）,and Kunming（Yunnan Province）. Semi-structured interviews were conducted to collect data.Results Thirteen themes were grouped into four major themes including the content of symptom management under the HIV/AIDS designated hospital system,advantages and difficulties,current problems of current HIV/AIDS symptom management,and recommendations for optimizing current symptom management under HIV/AIDS designated hospital system.Conclusion This study found that the current clinical practice for HIV/AIDS symptom management was diversified but with a low degree of specialization. Although symptom management under HIV/AIDS designated hospital system could satisfy the social need of patients,it also increased the difficulties of professional care. We suggested one-stop service between other disciplines and HIV/AIDS designated hospitals should be promoted under the HIV/AIDS designated hospital system. Nurse-led symptom assessment and information platform for follow-ups should also be strengthened.

Application and effect of virtual cognitive rehabilitation training in breast cancer patients with cognitive impairment after chemotherapy

CHEN Xiaomin,JIN Aixiang,ZHU Hui,ZHANG Danni

2019, 54(5): 664-667. DOI: 10.3761/j.issn.0254-1769.2019.05.005

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Objective To explore the effect of virtual cognitive rehabilitation training on cognitive function and activities of daily living among breast cancer patients with cognitive impairment.Methods Eighty breast cancer patients with cognitive impairment after chemotherapy received cognitive intervention training. Before and after intervention,clinical effects of virtual cognitive rehabilitation training were evaluated by Montreal Cognitive Assessment scale,Activity of Daily Living Scale,Mini-Mental State scale,and semi-structured interviews.Results After 8-week-intervention,the scores of the Montreal Cognitive Assessment Scale increased significantly,and the difference was statistically significant （P<0.05）. After intervention,the scores of ADL were lower than those before intervention,and the difference was statistically significant （P<0.05）. All patients gave recognition of effects of virtual cognitive rehabilitation training on improving cognitive function,while they were willing to continue this training.Conclusion Virtual cognitive rehabilitation training can improve cognitive function and daily life ability of breast cancer patients with cognitive impairment after chemotherapy.

Investigation on the current status of breastfeeding in puerpera with hepatitis B

YUE Caihong,WANG Xiaoai,HU Yini,BAI Xinhang,JIAO Jing,YANG Xinxia,QI Yaqian

2019, 54(5): 668-671. DOI: D0I:10.3761/j.issn.0254-1769.2019.05.006

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Objective To investigate the current status of breastfeeding among puerpera with Hepatitis B virus（HBV）infection and analyze the influencing factors.Methods The 602 puerpera with Hepatitis B virus in a tertiary hospital in Beijing from January 2016 to February 2018 were selected as study subjects. The self-designed questionnaire for access to breastfeeding and its influencing factors was used to survey the puerpera at the 42 days after delivery,and data were analyzed.Results The breastfeeding rate of HBV infected puerpera was 45.85%,of which the exclusive breastfeeding rate was 26.91%. The factors affecting breastfeeding：using antiviral drugs in 215 cases（65.95%）,worries about mother-to-child transmission in 226 cases（69.33%）,and family opposition in 116 cases（35.58%）.Conclusion The breastfeeding rate among puerpera with HBV is low,and is influenced by many factors. Health care professionals should strengthen knowledge education related to breastfeeding,eliminate concerns,and promote breastfeeding rate.

The level of care dependency in elderly stroke patients

HAN Binru,ZHANG Congya

2019, 54(5): 672-677. DOI: 10.3761/j.issn.0254-1769.2019.05.007

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Objective To describe the level of care dependency among elderly stroke patients and to explore the influencing factors.Methods From April 2017 to November 2017,totally 262 elderly stroke patients in the neurology ward and general medicine ward of a tertiary hospital in Beijing were selected. A self-designed general information questionnaire was used to collect patients’ demographic data and disease related data. Care Dependency Scale,Mini-Mental State Examination,Mini Nutritional Assessment-short form and Geriatric Depression Scale were used to measure care dependency and influencing factors. Binary logistic regression analysis was used to investigate the influencing factors.Results Among 262 elderly stroke patients,the score of care dependency was （56.04± 10.531）,the incidence of care dependency was 80.5%. Multivariate regression analysis showed that：age,history of fall within one year,limb dysfunction,number of chronic diseases,depression,nutritional status and cognitive function state were the influencing factors（P<0.05）.Conclusion The incidence of care dependency in elderly stroke patients was high,which was related to age,history of fall,limb dysfunction,comorbidity,depression status,abnormal nutritional status and cognitive function. It suggests that nurses should take active and effective measures to reduce quality of life decreasing due to care dependency.

Application of fluid management strategy in patients received lung transplantation

ZHONG Jin,YU Cuixiang,TAO Hongmei,LAI Kailan,PENG Liping,GUO Yuan,ZHOU Yuping

2019, 54(5): 678-681. DOI: 10.3761/j.issn.0254-1769.2019.05.008

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This study summarized experience of application of fluid management strategy in prevention of primary graft dysfunction for 19 cases of lung transplantation. According to patient’s blood pressure,central venous pressure,transplanted pulmonary edema fluid,urine volume,amount of bleeding,blood lactic acid and previous blood pressure levels,etc.,individualized fluid management strategy was provided after comprehensive analysis. The condition of 18 patients was improved significantly and patients were transferred to the thoracic surgery ward for further treatment,and one patient died.

Nursing cooperation for hybrid recanalization surgery of internal carotid artery occlusion

TANG Hongyan,WANG Zheng,ZHANG Hong,LI Wei,SUN Mengmeng,JIAO Liqun

2019, 54(5): 682-685. DOI: 10.3761/j.issn.0254-1769.2019.05.009

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From nursing cooperation experiences for the hybrid recanalization surgery of internal carotid artery occlusion,key points of nursing cooperation were summarized for the traditional carotid endarterectomy and hybrid interventional surgery：①According to the results of preoperative cerebral angiography,surgery supplies were prepared in advance. ②Equipment in the operating room should be organized rationally to avoid repeated movement of the instrument. ③Patient positioning and care of aseptic area. ④Catheter fixation and care. ⑤Usage of catheters and vascular sheaths for thrombosis prevention and intraoperative cooperation for using anticoagulant.⑥Dose observation for usage of heparin sodium during surgery and additional administration of medicine. ⑦Observation of intraoperative complications and nursing measures. 69 cases were recanalized successful,one case showed recanalization immediately subtraction angiography, one case showed internal carotid cavernous sinus fistula,and the surgery was stopped immediately without causing adverse consequences. All wounds were healed in the first degree.

Perioperative nursing experience of 32 cases of children who had hemoptysis treated with bronchial artery embolization

LIU Ting,HAN Xiaorong,LIU Wenjing,GUO Lei,ZHAO Xiaoqun,LIU Baoyan,ZHANG Zhaofang

2019, 54(5): 686-689. DOI: 10.3761/j.issn.0254-1769.2019.05.010

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This article summarized perioperative nursing experience of 32 cases of hemoptysis in children treated with bronchial artery embolization. Key points of nursing included: correct preoperative evaluation of patients’ condition,wariness on asphyxia,timely standardized rescue,implementation of individualized psychological care;reasonablepostoperative sedation, immobility and prevention of hemorrhage at insertion site,prevention of thrombosis,reasonable hydration and prevention of contrast-associated nephropathy,as well as nursing for complications and medication. Through systematic and regulated nursing,31 cases gained good recovery without any severe perioperative complications, except that one case gave up treatment.

The effects of Sizi Powder with salt hot-ironing on meridians for spastic hemiplegia in stroke patients

LI Zhuangmiao,CHEN Lanrong,LI Rongqing,LIU Fang,LI Xia,LIN Li,LIN Wenying

2019, 54(5): 690-695. DOI: 10.3761/j.issn.0254-1769.2019.05.011

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Objective To evaluate the effects of Sizi Powder with salt hot-ironing on meridians for spastic hemiplegia in convalescent stroke patients.Methods Totally 86 patients were randomly divided into two groups,namely,the experimental group and the control group with 43 cases in each group. Patients in the experimental group received routine treatment,nursing,and rehabilitation,plus Sizi Powder with salt hot-ironing treatment,whereas the control group only received routine treatment. Hot-ironing treatment was applied for 30 minutes per day,5 days per week for 4 weeks. The spasticity and motor function were measured at pretest,2 weeks and 4 weeks after intervention by the Modified Ashworth Scale（MAS）,Compopsite Spasticity Scale（CSS）,and simplify Fugl-Meyer Assessment Scale（FMA）.Results Compared with pretest and 4 weeks after intervention,the scores of MAS,CSS and FMA in the experimental group were significantly improved（P<0.01）. The effective rate of spasticity improvement in upper limb and lower limb in the experimental group were significantly higher than that in the control group （P<0.05）. Repeated measurements analysis of variance showed that the main effect of time was statistically significant （P<0.01） in the score of CSS and scores for each dimension,the interaction effect of intervention and time were statistically significant（P<0.01） in the CSS score and tendon reflex. The main effect of time and the interaction effect of groups and time were statistically significant （P<0.01） in the score of FMA.Conclusion Sizi Powder with salt hot-ironing on meridians for spastic hemiplegia in stroke patients may have effects on spasticity to some extent,and improve patients’ motor function.

The effect of acupoint stimulation on preoperative anxiety in patients undergoing elective surgery in Department of Orthopedics

ZHAO Zhifang,CHEN Feier,GUO Qiaoying,HE Hongxia,CHI Genying,LIU Lanying

2019, 54(5): 696-699. DOI: 10.3761/j.issn.0254-1769.2019.05.012

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Objective To evaluate the effect of acupoint stimulation among patients with anxiety before elective surgery in Department of Orthopedics.Methods We used the Hamilton anxiety scale（HAMA） to evaluate the anxiety level of patients undergoing elective surgery in Department of Orthopedics and screen patients with preoperative anxiety,and 82 patients were identified. We randomly divided the patients into the experimental group and the control group,with 41 patients in each group. The experimental group received acupoint stimulation as well as the routine nursing. The intervention time was from admission day to 1 day before surgery. The number of intervention times per day was less than 1,and the total intervention frequency was more than 3.The control group received routine nursing. The evaluation indicators included patients’ anxiety level,sleep status,blood pressure and pulse rate. The HAMA was used to evaluate the level of anxiety and the St.Mary Hospital Sleep Questionnaire（SMH） was used to evaluate the sleep status. Indicators were evaluated at the time of admission and in the morning of the day for surgery.Results There were no significant differences in the HAMA,SMH score,blood pressure and pulse rate between two groups before intervention（P>0.05）. After intervention,there were significant differences in the HAMA,SMH scores and pulse rate between two groups（P<0.05）. But there was no significant difference in blood pressure（P>0.05）.Conclusion Acupoint stimulation can reduce preoperative anxiety level,improve the sleep status of patients and slow down pulse rate caused by anxiety. But further research is needed to confirm the effect of acupoint stimulation on blood pressure.

Construction and application of quantified performance appraisal system of nursing in children’s hospital operating room

WANG Zhen,YANG Xia,LIU Yingmin,HU Chanjia

2019, 54(5): 700-703. DOI: 10.3761/j.issn.0254-1769.2019.05.013

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Objective To establish a quantified performance appraisal system for nursing in children’s hospital operating room and analyze its clinical effects of application.Methods Through quantitative appraisal calculation method,a quantified performance appraisal system based on conventional nursing skills,together with specialized surgical skills,was established and applied to clinical practice.Results Surgical nursing quality was improved（P<0.001）; nurses’ satisfaction with the performance appraisal system increased（P<0.05）; the average number of daily operation for each nurse was increased,and the number of rest application for each week was decreased.Conclusion The quantified performance appraisal system for nursing establishes an objective and unified standard for operating room nurses,improves the quality of surgical nursing,mobilizes nurses’ work enthusiasm,increases nurses’ satisfaction and working efficiency,which has a positive impact on nursing management in operating room.

Establishment of pre-discharge ward for premature infants based on family integrated care model

LIU Xin,LU Shuya

2019, 54(5): 704-708. DOI: 10.3761/j.issn.0254-1769.2019.05.014

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Objective To establish the pre-discharge ward for premature infants based on family integrated care（FIC） model and evaluate its effects of application.Methods Families with premature infants admitted to a PICU in a tertiary hospital from January,2016 to January,2018 were recruited. Based on FIC model,48 families were transferred to pre-discharge ward and provided with comprehensive interventions （establishing multi-disciplinary team,providing supports of equipment and environment,professional training of caregivers,and providing discharge plan and support）. As the control group,48 families with premature infants matched with the experimental group were enrolled and provided with routine care. Care ability,anxiety,and infection rate were compared between two groups.Results Care ability of caregivers in pre-discharge ward was better than that in the control group,and anxiety was lower as well with significant differences（P<0.05）. No infant developed infection during hospitalization in the experimental group.Conclusion Pre-discharge ward based on FIC model can improve care ability and decrease anxiety of the caregivers,which can be promoted considering the present situation in China and health care system.

Intervention research of undergraduate intern nursing students’ professional identity

XU Min,CHEN Qin,LIU Xiaohong,WANG Ruiqi

2019, 54(5): 709-715. DOI: 10.3761/j.issn.0254-1769.2019.05.015

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Objective To explore the influence of cognitive intervention program on undergraduate intern nursing students’ professional identity and professional self-efficacy.Methods Two comprehensive tertiary class-A hospitals which were comparable in scale,salary,hospital environment and quality of teaching staff,were selected using convenience sampling method,and were randomly assigned as the experimental group and the control group. Convenience sampling method was used to recruit 75 nursing students in the experimental group and 69 nursing students in the control group. The intervention program was based on ABC Theory and Broaden-and-Build Theory. The experimental group was given a 5-times cognitive intervention training biweekly based on the routine training. The intervention program mainly consisted of the online and offline lectures and the interactive discussion in class. The control group was given a 5-times routine professional learning during intern practice.Results A total of 138 nursing students completed the study. The overall score of nursing students’ professional identity and professional self-efficacy in the experimental group was better than those in the control group and the differences were statistically significant after the intervention（P<0.05）.Conclusion The intervention program based on ABC Theory and Broaden-and-Build Theory can improve intern nursing students’ professional identity and professional self-efficacy effectively.

Construction of nursing education knowledge system on dementia for geriatric practicing nurses

ZHAO Jingjing,WANG Bailing,YU Limin,HE Xiaoli,LI Ying,YAO Xinyu,MIAO Xiuxin

2019, 54(5): 715-720. DOI: 10.3761/j.issn.0254-1769.2019.05.016

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Objective To construct a nursing education knowledge system on dementia suitable for geriatric practicing nurses,and to provide reference for developing targeted training programs.Methods Based on literature research,semi-structured interviews and group discussion,the first draft of inquiry questionnaire was established. Delphi method was used to conduct two rounds of consultation with 21 experts in dementia-related fields.Results Response rate of two rounds of consultation was 100%, respectively. Experts’ authority coefficient was 0.900,judgment coefficient and familiarity coefficient was 0.820,and the coefficients of concordance were 0.425,0.256 for two levels of indicator. The final knowledge system consisted of six first-level indicators, and 81 second-level indicators.Conclusion The nursing education knowledge system on dementia for geriatric practicing nurses was scientific and practical, which can provide reference for making training programs on dementia.

Impact of ball holding duration on upper hemodynamics of axillary vein in patients with PICCs

DAI Feng,SU Xun,QIAO Aizhen,ZHANG Yuzhen,HU Kechun

2019, 54(5): 721-724. DOI: 10.3761/j.issn.0254-1769.2019.05.017

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Objective To investigate the effects of continuous ball holding on hemodynamics of upper limb axillary vein in cancer patients with PICCs, to provide scientific basis for ball holding exercise.Methods Eighty-five cancer patients after PICC catheterization were randomly selected from oncology department at a tertiary hospital in Beijing. Using before-after study design, we recorded the changes of venous vessel diameter, blood flow velocity and blood pressure with different ball holding duration under ultrasonic monitoring.Results In the resting state, the diameter of venous vessel was（3.98±0.66） mm, the peak velocity of blood flow was（13.49±4.92） cm/s, and the pressure of blood vessels was（0.06±0.04） mmHg. Compared with the resting state, the duration of ball holding had statistically significant impact on diameter, peak velocity and pressure of venous vessels（P<0.05）, which were all higher than the resting state. The diameter of the blood vessel was the largest when holding for 1s and releasing for 1s（4.36±0.68） mm, the maximum blood flow velocity（23.17±7.09） cm/s and the maximum blood pressure （0.17±0.13） mmHg occurred when holding for 2s and releasing for 2s.Conclusion Ball holding exercises can effectively enlarge the diameter of vein, increase blood flow velocity and muscle pressure on the vascular wall. We can guide cancer patients with PICCs to exercise according to the method of holding for 2s and releasing for 2s. The method is simple and feasible, and does not cause discomfort to the patients, which can be widely used in clinical practice.

Risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease：a meta-analysis

ZHU Xiaomin,LUO Jian,LI Miaomiao,XIE Lin,HU Xia

2019, 54(5): 746-752. DOI: 10.3761/j.issn.0254-1769.2019.05.026

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Objective To identify the risk factors of venous thromboembolism in patients with chronic obstructive pulmonary disease using meta-analysis.Methods We performed a systematic search in PubMed,Web of Science,Cochrane Library,Embase,MEDLINE,CMB,CNKI,Wanfang Data and VIP to collect studies about risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease published from inception to May 2018. Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria by two reviewers independently.Results Fourteen studies were recruited,including 316,297 cases. Fourteen risk factors were involved,among which advanced age,smoking,immobilization,diabetes mellitus and tumor were the main risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease.Conclusion Because of insufficient evidence on risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease and sample size of each study varied greatly,the effects of obesity,deep venous catheterization and PaO₂ abnormality are still inconclusive,and more high-quality studies are needed to supplement and improve for future research.

The effects of oropharyngeal colostrum administration in preterm infants：a systematic review

LI Yuanyuan,ZHAO Xu,LI Guangzhao,LIU Xiaoqin,ZHONG Xiuling,LI Minmin,WANG Liyuan,YANG Lijuan

2019, 54(5): 753-759. DOI: 10.3761/j.issn.0254-1769.2019.05.027

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Objective To systematically evaluate the effects of oral care using colostrum in preterm infants.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Web of Science,CINAHL,CBM,CNKI and Wanfang. We included all randomized controlled trials and clinical controlled trials which using colostrum in preterm infants’ oral care. The quality of articles was appraised by the Cochrane Handbook（5.1.0）,and RevMan 5.3 software was used to analyze the data.Results A total of 10 studies were included. The results showed that oral care using colostrum reduced the occurrence rate of sepsis[RR=0.54,95%CI（0.36,0.79）,P=0.002]and feeding intolerance[RR=0.59,95%CI（0.40,0.87）,P=0.008],shorten the time to reach full enteral feeding[MD=-3.70,95%CI（-6.38,-1.02）,P=0.007]. At the same time,the detection rate of pathogenic microorganisms and bacteria in oropharynx decreased,and the level of sIgA in saliva and urine increased. There was no significant difference in occurrence rate of necrotizing enterocolitis[RR=0.78,95%CI（0.43,1.42）,P=0.420],time to start enteral nutrition [MD=0.07,95%CI（-0.67,0.81）,P=0.850],and time to start oral feeding [MD=-2.45,95%CI（-4.99,0.09）,P=0.060].Conclusion Oral care using colostrum can reduce feeding related complications in preterm infants,accelerate feeding process to a certain degree,and enhance immune levels of preemies. More high-quality,large sample studies are needed in order to further explore the effects and the most effective way of oral care using colostrum in preterm infants.

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