中国实用儿科杂志

中国实用儿科杂志

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基于循证的临床质量改进对新生儿病房中早产儿临床结局的影响

  

  1. 重庆医科大学附属儿童医院新生儿诊治中心 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室， 重庆 400014
  • 出版日期:2020-05-06 发布日期:2020-05-18

Impacts of evidence-based practice for improving clinical quality on clinical outcomes of premature in Department of Neonatology

  1. Department of Neonatology，Children’s Hospital of Chongqing Medical University；Ministry of Education Key Laboratory of Child Development and Disorders；National Clinical Research Center for Child Health and Disorders；China International Science and Technology Cooperation Base of Child Development and Critical Disorders；Chongqing Key Laboratory of Pediatrics，Chongqing 400014，China
  • Online:2020-05-06 Published:2020-05-18

摘要： 目的　探讨基于循证的临床质量改进（evidence-based practice for improving quality，EPIQ）的有效性，特别是在新生儿重症监护病房中能否通过各个干预措施有效影响临床结局，实现临床质量改进。方法　检索Pubmed、 Cochrane、Embase数据库、万方数据库、维普数据库、中国知识资源总库（CNKI）中公开发表的基于循证的临床质量改进的临床研究，检索时间均为2002年1月1日至2019年6月1日。收集纳入文献的相关数据，应用二分类变量的常用Meta分析，使用Stata 12.0软件进行统计分析。结果　共纳入5篇英文文献。分析结果显示，EPIQ组院内感染（nosocomial infection，NI）（OR＝0.61，95%CI：0.46～0.81）的发生率低于对照组，对严重视网膜病变（OR＝0.72，95%CI：0.60～0.85）的发生率有明显的效果，但在减少支气管肺发育不良、严重脑损伤和坏死性小肠结肠炎的发病率以及早产儿的病死率差异无统计学意义。结论　EPIQ可有效识别改善新生儿病房早产儿临床结局的干预手段，提高临床质量。

关键词: 质量改进, 循证, 新生儿, 早产儿

Abstract: Objective　To evaluate the efficacy of evidence-based practice for improving quality（EPIQ），based on the research about the interventions’ improvements impacting on the clinical outcomes of patients in Neonatal Intensive Care Units（NICUs）. Methods　Databases searched included Pubmed，Cochrane，Embase，Wanfang，VIP and China National Knowledge Infrastructure（CNKI） between January 1，2002 and June 1，2019 using a forest plot of odds ratios（ORs） with a summary OR estimated and a random-effects model. Results　Five articles from Pubmed and Cochrane were enrolled. Further analysis showed post-EPIQ implementation NICUs had relatively lower morbidity rates in nosocomial infection（NI）（OR＝0.61，95%CI：0.46-0.81），severe retinopathy of premature（ROP）（OR＝0.72，95%CI：0.60-0.85），comparing with pre-EPIQ implementation or non-EPIQ NICUs. No statistically significant difference was found in morbidity of bronchopulmonary dysphasia（BPD），severe neurologic injury and necrotizing enterocolitis（NEC），and mortality of preterms. Conclusion　EPIQ implementation can significantly improve clinical outcomes of preterm newborns in Department of Neonatology，as well as confirmed corresponding practice changes.

Key words: quality improvement, evidence-based practice, neonate, premature