新生兒低體溫預防和處理的最佳證據總結

Summary of the best evidence for the prevention and treatment of neonatal hypothermia

SU Lina，YANG Xuelan，FANG Xiaochun，ZHOU Liping，ZOU Wenxia*Guangdong Provincial Hospital for Women and Children Health Care，Guangdong 510000 China*Corresponding Author ZOU Wenxia，E-mail：Zouwenxia3861@126.com

Abstract Objective：To retrieve，evaluate，and summarize the best evidence for the prevention and treatment of neonatal hypothermia in China and abroad，in order to provide a reference for clinical practice and reduce the incidence of neonatal hypothermia.Methods：The "PICO" strategy was used to establish the question，and the "6S" evidence model was used to systematically retrieve relevant literature，including clinical decision-making，systematic review，evidence summary，clinical practice guidelines，etc.The search time limit was from the establishment of the database to October 20，2023.Two researchers who had received evidence-based training independently conducted literature quality evaluation and evidence extraction.Results：A total of 45 articles were included，including 4 clinical decision-making articles，18 systematic reviews，15 guidelines，2 expert consensus articles，and 6 evidence summaries.A total of 45 pieces of best evidence were summarized from 9 aspects：risk factors，preparation before delivery，management during and after delivery，neonatal resuscitation，neonatal transfer，neonatal rewarming，intervention measures after entering the NICU or ward，temperature monitoring，and quality management.According to the feasibility，suitability，clinical significance，and effectiveness attributes of the evidence，39 A-level and 6 B-level recommended pieces of evidence were determined.Conclusions：The summarized best evidence for the prevention and management of neonatal hypothermia in China and abroad can provide an evidence-based basis for clinical medical staff.

Keywords neonate;hypothermia;prevention;evidence-based nursing;best evidence;evidence summary

摘要 目的：檢索、評價并總結國內外關于新生兒低體溫預防和處理的最佳證據，為臨床實踐提供參考，降低新生兒低體溫的發生。方法：采用“PICO”方法確立問題，按“6S”證據模型系統檢索相關文獻，包括臨床決策、系統評價、證據總結、臨床實踐指南等，檢索時限為建庫至2023年10月20日。由2名經過循證培訓的研究人員獨立進行文獻質量評價與證據提取。結果：共納入45篇文獻，包括臨床決策4篇、系統評價18篇、指南15篇、專家共識2篇、證據總結6篇，總結危險因素、分娩前準備、分娩時及分娩后處理、新生兒復蘇、新生兒轉運、新生兒復溫、進入新生兒重癥監護病房（NICU）或病房后的干預措施、體溫監測、質量管理9個方面，共45條最佳證據，根據證據的可行性、適宜性、臨床意義、有效性屬性，確定39條A級、6條B級推薦證據。結論：總結的國內外新生兒低體溫預防和管理最佳證據，可為臨床醫務人員提供循證依據。

關鍵詞 新生兒；低體溫；預防；循證護理；最佳證據；證據總結

doi：10.12102/j.issn.2095-8668.2024.21.004

新生兒低體溫通常定義為新生兒體溫<36.5 ℃［1］。目前，新生兒低體溫仍是全球性問題，全球新生兒低體溫發生率為52.5%［2］。我國新生兒低體溫發生率為31.0%［3］，早產兒低體溫發生率為63.5%，極低出生體重兒和超低出生體重兒低體溫發生率分別為89.3%和89.6%［4］。新生兒由于體溫調節中樞尚未發育成熟，體表面積大，皮下脂肪較少等因素，極易通過蒸發、輻射、對流、傳導等途徑迅速丟失熱量［5］。新生兒從母體較高的宮內環境溫度娩出至產房溫度（22～26 ℃），皮膚溫度每分鐘下降0.3 ℃，直腸溫度每分鐘下降0.1 ℃，導致其在短時間內體溫下降2～3 ℃，體熱丟失可達0.837 J［6］。……