先天性心脏病患儿母乳喂养干预方案的构建及初步应用研究

doi:10.3761/j.issn.0254-1769.2024.22.002

摘要/Abstract

摘要：

目的构建先天性心脏病（congenital heart disease，CHD）患儿母乳喂养干预方案，并探讨其初步应用效果。方法以能力-机会-动机-行为模型为理论基础，通过文献检索和半结构式访谈，形成干预方案初稿，遴选8名相关领域专家进行论证，确定方案内容。采用连续抽样法，选取2023年5月4日—6月24日在上海市某三级甲等儿童专科医院心胸疾病诊疗门诊就诊、日龄≤14 d的CHD患儿及其母亲作为研究对象。采用区组随机化分组法，将其分为试验组、对照组，每组各16例。试验组在常规护理的基础上，实施CHD患儿母乳喂养干预方案；对照组接受常规护理及母乳喂养宣教。在CHD患儿1、3月龄时，比较两组纯母乳喂养率、母乳喂养量占总喂养量的百分比、年龄别体重Z评分和年龄别身长Z评分。结果共进行1轮专家论证，有效问卷回收率为100%，专家权威系数为0.94。CHD患儿母乳喂养干预方案包括能力、机会、动机3个维度，以及喂养信号的识别、母乳喂养技巧、母乳喂养的维持、母乳喂养常见问题与解决对策、母乳管理、建立母乳喂养家庭支持、提供母乳喂养医学信息支持、提高母亲对母乳喂养益处的认知水平、母乳喂养量的监测和记录、患儿生长发育的评估和指导等10个条目及其具体内容。方案初步应用结果显示，两组不同时间点纯母乳喂养率、母乳喂养量占总喂养量的百分比、年龄别体重Z评分和年龄别身长Z评分比较，组间效应均具有统计学意义（P<0.05）。简单效应分析结果显示，干预前两组纯母乳喂养率、母乳喂养量占总喂养量的百分比、年龄别体重Z评分和年龄别身长Z评分比较，差异均无统计学意义（P>0.05）；干预后患儿3月龄时，试验组纯母乳喂养率高于对照组，差异具有统计学意义（P=0.003）；干预后患儿1、3月龄时，试验组母乳喂养量占总喂养量的百分比高于对照组，差异具有统计学意义（P<0.05）；干预后患儿3月龄时，试验组年龄别体重Z评分高于对照组，差异具有统计学意义（P=0.037）；干预后患儿1、3月龄时，试验组年龄别身长Z评分高于对照组，差异具有统计学意义（P<0.05）。结论该研究构建的CHD患儿母乳喂养干预方案内容全面，可行性和可接受度较强。实施该方案有助于促进CHD患儿的母乳喂养、改善其生长发育。

关键词: 先天性心脏病, 新生儿, 母乳喂养, 能力-机会-动机-行为模型, 儿科护理学

Abstract:

Objective To construct an intervention programme for breastfeeding among mothers of infants with congenital heart disease and to verify its effect. Methods Taking the capability-opportunity-motivation-behaviour model as the theoretical basis，the first draft of the intervention programme was formed through literature search and semi-structured interviews，and 8 experts in the relevant fields were selected to conduct expert validation and determine the content of the program. By the consecutive sampling method，infants and their mothers who attended the cardiothoracic disease clinic of a tertiary-level children’s specialist hospital in Shanghai from 4 May to 24 June 2023，with a day-old age of ≤14 d and a confirmed diagnosis of CHD，were selected as the study subjects. They were divided into an experimental group and a control group，with 16 cases in each group，by the method of randomized grouping by district. The experimental group received breastfeeding intervention for mothers of infants with CHD on the basis of routine care；the control group received routine care and basic disease education and breastfeeding counselling. At 1 and 3 months of the infants with CHD，the 2 groups were compared in terms of exclusive breastfeeding rate，daily human milk as a percentage of total feeds，weight for age Z-score and height for age Z-score. Results A total of 1 round of expert validation was conducted，with a valid questionnaire recovery rate of 100% and an expert authority coefficient of 0.94. The breastfeeding intervention programme for mothers of infants with CHD is a comprehensive approach that encompasses 3 key dimensions，including capability，opportunity，and motivation. The programme is designed to enhance mothers’ ability to recognize feeding signals，master breastfeeding techniques，and maintain successful breastfeeding practices. It also addresses common breastfeeding challenges and provides effective solutions. Additionally，it includes strategies for breastmilk management and fosters family support for breastfeeding. The programme offers medical information support on breastfeeding and aims to elevate mothers’ understanding of its benefits. It involves systematic monitoring and recording of breastfeeding volumes，as well as thorough assessments and guidance on infant growth and development，including but not limited to the 10 specific entries related to the infant’s progress. The results of the generalized estimating equations and repeated measures analysis of variance revealed statistically significant between-group differences（P<0.05） in the rates of exclusive breastfeeding，the proportion of daily human milk as a percentage of total feeds，and the weight-for-age（WAZ） and height-for-age（HAZ） z-scores of infants across the 2 groups at various time points. The results of simple effect analysis showed that the differences in exclusive breastfeeding rate，the proportion of daily human milk as a percentage of total feeds，WAZ and HAZ between the 2 groups before intervention were not statistically significant（P>0.05）. At the age of 3 months of the infants after the intervention，the rate of exclusive breastfeeding in the experimental group was higher than that in the control group，and the difference was statistically significant（P=0.003）. The proportion of daily human milk as a percentage of total feeds for infants in the intervention group at 1 and 3 months of age was higher than that in the control group，with a statistically significant difference（P<0.05）. At 3 months of age，WAZ of the experimental group was higher than that of the control group，and the difference was statistically significant（P=0.037）；HAZ of the experimental group was higher than that of the control group at 1 and 3 months of age after intervention，and the difference was statistically significant（P<0.05）. Conclusion The breastfeeding intervention programme for mothers of infants with CHD，constructed on the basis of the COM-B model in this study，was comprehensive，feasible and acceptable. Implementation of the programme has potential positive effects on increasing exclusive breastfeeding rates and the daily human milk as a percentage of total feeds，and may also have a positive impact on WAZ and HAZ of infants.

Key words: Congenital Heart Disease, Neonate, Breast Feeding, Capability, Opportunity and Motivation Behavior Model, Pediatric Nursing

章琪, 顾莺, 王慧美, 孙瑜, 张雪萍, 任玥宏, 朱孟欣, 邢岚. 先天性心脏病患儿母乳喂养干预方案的构建及初步应用研究[J]. 中华护理杂志, 2024, 59(22): 2700-2709.

ZHANG Qi, GU Ying, WANG Huimei, SUN Yu, ZHANG Xueping, REN Yuehong, ZHU Mengxin, XING Lan. Construction and initial application of a intervention programme for breastfeeding in infants with congenital heart disease[J]. Chinese Journal of Nursing, 2024, 59(22): 2700-2709.

图/表 3

表1 先天性心脏病患儿母乳喂养干预方案

Table 1 Intervention programme on breastfeeding for mothers of infants with CHD

表2 两组一般资料比较

Table 2 Baseline information of participants in 2 groups

表3 两组不同时间点纯母乳喂养率、母乳喂养量占总喂养量的百分比、年龄别体重Z评分、年龄别身长Z评分比较

Table 3 Comparison of exclusive breastfeeding rate, daily human milk as a percentage of total feeds, weight for age Z-score and height for age Z-score at different time points between the 2 groups

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