摘要
目的总结家长放弃治疗后死亡的新生儿及父母情况,分析家长放弃治疗的原因及情感需求,为降低新生儿死亡率及父母负性情绪提供参考依据。方法采用回顾性研究方法,收集湖南省儿童医院2019年1月至2021年12月报告的放弃治疗后死亡的新生儿及母亲资料,分析一般资料、围产期高危因素、住院疾病发生等情况,并对2021年2月至12月间放弃后死亡新生儿的父母进行半结构式访谈,了解家长放弃治疗原因及其情感需求。结果共172例放弃后死亡新生儿纳入分析,其中男103例(59.88%),早产儿74例(43.02%);脐带、胎盘及羊水异常分别为21例(12.21%)、39例(22.67%)以及25例(14.53%),出生窒息31例(18.02%),其中重度窒息18例(10.46%);母亲孕晚期感染、妊娠期高血压、妊娠期糖尿病分别为21例(12.21%)、35例(20.35%)以及30例(17.44%)。死因前三位为败血症(18.02%)、先天畸形(16.86%)、重症肺炎(10.47%)。父母放弃治疗主要原因是患儿疾病危重且不可逆性进展,父母内心有较强临终关怀的情感需求。结论放弃治疗后死亡的新生儿围产高危因素多,败血症是首要死亡原因,加强围产保健是根本。父母临终关怀需求强烈,对此类特殊新生儿实施以家庭为中心的临终疗护模式具有现实意义。
Objective To summarize the situation of dead newborns and their parents after parents gave up treatment,and analyze the reasons and emotional needs of parents who gave up treatment,so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021.The general information,perinatal risk factors,and the incidence of in-hospital diseases were analyzed.Then,semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021.Understand why parents give up treatment and their emotional needs.Results A total of 172 newborns died after giving up were included in the analysis,including 103 males(59.88%)and 74 premature infants(43.02%);Umbilical cord,placenta and amniotic fluid abnormalities were 21 cases(12.21%),39 cases(22.67%)and 25 cases(14.53%),respectively.Birth asphyxia was 31 cases(18.02%),including severe asphyxia in 18 cases(10.46%);There were 21(12.21%),35(20.35%)and 30(17.44%)cases of maternal infection in the third trimester,hypertension in pregnancy and diabetes in pregnancy,respectively.The top three causes of death were septicemia(18.02%),congenital malformation(16.86%)and severe pneumonia(10.47%).The main reason why parents give up treatment was that the child′s disease was critical and irreversible,and parents had strong emotional needs for hospice care in their hearts.Conclusions There are many high risk factors of perinatal death of newborns after giving up treatment.Sepsis is the primary cause of death,and strengthening perinatal health care is fundamental.Parents have a strong demand for hospice care,so it is of practical significance to implement family-centered hospice care model for such special newborns.
作者
陈牡花
唐倩
朱丽辉
庄严
高喜容
彭小明
张娜
黄瑞文
Chen Muhua;Tang Qian;Zhu Lihui;Zhuang Yan;Gao Xirong;Peng Xiaoming;Zhang Na;Huang Ruiwen(Department of Neonatology,Hunan Children′s Hospital,Changsha 410000,China;Nursing Department,Hunan Cancer Hospital,Changsha 410013,China;School of Nursing,Hunan University of Traditional Chinese Medicine,Changsha 410208,China)
出处
《中国医师杂志》
CAS
2023年第1期51-55,共5页
Journal of Chinese Physician
基金
湖南省卫生健康委科研课题(202114042345)。
关键词
婴儿
新生
疾病
停止治疗
婴儿死亡
双亲
情感需求
Infant,newborn,diseases
Withholding treatment
Infant death
Parents
Emotional needs
