早产儿应用袋鼠式护理的研究进展

PAGEPAGE1早产儿应用袋鼠式护理的研究进展摘要袋鼠式护理（kangaroomothercare，KMC）是临床上一种主要针对早产儿的抚触护理方式。已有研究证实袋鼠式护理可改善早产儿体温调节，促进氧和，增加深睡眠，减少哭闹，减少疼痛，促进神经系统成熟，降低低出生体重儿的患病率和死亡率。袋鼠式护理实施方法简单安全，在发达国家已逐渐成为一种常规护理方式广泛应用，而在我国袋鼠式护理尚处于研究阶段。本文通过查阅袋鼠式护理在国内外应用的相关文献，对袋鼠式护理应用于早产儿的相关研究进行了综述，为袋鼠式护理在我国的开展及应用提供一定的借鉴。关键词：袋鼠式护理；早产儿；检测随着新生儿医疗技术的发展，早产儿特别是低出生体重儿（lowbirthweightinfant，LBW）的发生率逐年上升ADDINEN.CITE<EndNote><Cite><Author>Howson</Author><Year>2013</Year><RecNum>815</RecNum><DisplayText><styleface="superscript">[1]</style></DisplayText><record><rec-number>815</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">815</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Howson,C.P.</author><author>Kinney,M.V.</author><author>McDougall,L.</author><author>Lawn,J.E.</author><author>BornTooSoonPretermBirthAction,Group</author></authors></contributors><titles><title>Borntoosoon:pretermbirthmatters</title><secondary-title>ReprodHealth</secondary-title></titles><periodical><full-title>ReprodHealth</full-title></periodical><pages>S1</pages><volume>10Suppl1</volume><edition>2013/01/01</edition><keywords><keyword>Female</keyword><keyword>GlobalHealth</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>*Infant,Premature</keyword><keyword>MaternalWelfare/*trends</keyword><keyword>Pregnancy</keyword><keyword>PregnancyOutcome</keyword><keyword>PrematureBirth/*epidemiology</keyword><keyword>Research</keyword></keywords><dates><year>2013</year></dates><isbn>1742-4755(Electronic) 1742-4755(Linking)</isbn><accession-num>24625113</accession-num><urls><related-urls><url>/pubmed/24625113</url></related-urls></urls><custom2>PMC3828581</custom2><electronic-resource-num>10.1186/1742-4755-10-S1-S1</electronic-resource-num></record></Cite></EndNote>[1]。多数低出生体重儿出生后即被送至新生儿重症监护室(NeonatalIntensiveCareUnit，NICU)中接受治疗，其可能接触一系列不良刺激，可对早产儿造成一系列不良影响。袋鼠式护理（kangaroomothercare，KMC）又称为皮肤接触护理或袋鼠妈妈护理，是一种更人性化的护理模式，指早产儿出生后将其裸露放在父亲或母亲前胸进行持续皮肤接触，从生后或出院后开始实施，坚持此方式直到校正胎龄40周。2015年世界卫生组织指出袋鼠式护理可作为一种安全有效的方案替代传统新生儿护理方法，特别在资源不足的情况下，该方法可有效降低低出生体重儿的患病率和死亡率，改善早产儿生长发育情况及预后ADDINEN.CITE<EndNote><Cite><Author>Chan</Author><Year>2016</Year><RecNum>816</RecNum><DisplayText><styleface="superscript">[2]</style></DisplayText><record><rec-number>816</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">816</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Chan,G.J.</author><author>Labar,A.S.</author><author>Wall,S.</author><author>Atun,R.</author></authors></contributors><auth-address>DepartmentofGlobalHealthandPopulation,HarvardTHChanSchoolofPublicHealth,677HuntingtonStreet,Boston,Massachusetts,02115,UnitedStatesofAmerica(USA). SavingNewbornLives,SavetheChildren,Washington,USA.</auth-address><titles><title>Kangaroomothercare:asystematicreviewofbarriersandenablers</title><secondary-title>BullWorldHealthOrgan</secondary-title></titles><periodical><full-title>BullWorldHealthOrgan</full-title></periodical><pages>130-141J</pages><volume>94</volume><number>2</number><edition>2016/02/26</edition><keywords><keyword>Culture</keyword><keyword>FamilyRelations</keyword><keyword>HealthEducation/economics/*organization&administration</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>InfantMortality</keyword><keyword>Kangaroo-MotherCareMethod/*psychology</keyword><keyword>*Perception</keyword><keyword>SocialSupport</keyword><keyword>SocioeconomicFactors</keyword><keyword>TimeFactors</keyword></keywords><dates><year>2016</year><pub-dates><date>Feb1</date></pub-dates></dates><isbn>1564-0604(Electronic) 0042-9686(Linking)</isbn><accession-num>26908962</accession-num><urls><related-urls><url>/pubmed/26908962</url></related-urls></urls><custom2>PMC4750435</custom2><electronic-resource-num>10.2471/BLT.15.157818</electronic-resource-num></record></Cite></EndNote>[2]。一、袋鼠式护理的实施方法实施袋鼠式护理前应先选择一个安静、温暖、隐私性好的环境，控制室温在24-26℃，湿度需大于40%，配有柔软舒适的沙发、软靠枕、毛毯及轻柔的音乐。袋鼠式护理实施前应对父母进行宣教，实施时患儿俯卧与父亲或母亲胸前，保持头高15-30°，整个过程中父母可观察并抚触婴儿，给婴儿播放舒缓的音乐或轻声呼唤婴儿。病情不稳定的早产儿可进行间断性护理，医护人员应指导家长学会观察婴儿，包括临床表现及监护系统反应，护士需随时观察婴儿状态，如出现肤色改变、生命体征不平稳等不耐受表现时应立即停止。结束后应准确记录袋鼠式护理的持续时间、患儿耐受情况、以及袋鼠式护理期间发生的问题，采取的措施及效果ADDINEN.CITE<EndNote><Cite><Author>Bailey</Author><Year>2012</Year><RecNum>836</RecNum><DisplayText><styleface="superscript">[3]</style></DisplayText><record><rec-number>836</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001841">836</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Bailey,S.</author></authors></contributors><auth-address>DepartmentofAnaesthesia,MaidstoneandTunbridgeWellsNHSTrust,MaidstoneHospital,Maidstone,UK.sgbailey@.uk</auth-address><titles><title>Kangaroomothercare</title><secondary-title>BrJHospMed(Lond)</secondary-title></titles><periodical><full-title>BrJHospMed(Lond)</full-title></periodical><pages>278-81</pages><volume>73</volume><number>5</number><edition>2012/05/16</edition><keywords><keyword>BodyTemperatureRegulation</keyword><keyword>BreastFeeding</keyword><keyword>ChildDevelopment</keyword><keyword>CrossInfection/prevention&control</keyword><keyword>Humans</keyword><keyword>*Infant,LowBirthWeight</keyword><keyword>Infant,Newborn</keyword><keyword>Kangaroo-MotherCareMethod/*methods/organization&administration/psychology</keyword><keyword>*Mother-ChildRelations</keyword><keyword>TreatmentOutcome</keyword></keywords><dates><year>2012</year><pub-dates><date>May</date></pub-dates></dates><isbn>1750-8460(Print) 1750-8460(Linking)</isbn><accession-num>22585327</accession-num><urls><related-urls><url>/pubmed/22585327</url></related-urls></urls><electronic-resource-num>10.12968/hmed.2078</electronic-resource-num></record></Cite></EndNote>[3]。二、袋鼠式护理的作用（一）袋鼠式护理对呼吸、循环系统的影响早产儿呼吸及循环中枢发育不成熟，自我调节能力较差，容易发生呼吸暂停、心动迟缓等危机生命事件。研究表明KMC对于婴儿可起抚慰作用，父母与患儿的皮肤接触可稳定心率，减少呼吸暂停以及心动迟缓的发生，增加氧和和气体交换ADDINEN.CITE<EndNote><Cite><Author>Parsa</Author><Year>2018</Year><RecNum>817</RecNum><DisplayText><styleface="superscript">[4]</style></DisplayText><record><rec-number>817</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">817</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Parsa,P.</author><author>Karimi,S.</author><author>Basiri,B.</author><author>Roshanaei,G.</author></authors></contributors><auth-address>ChronicDiseases(HomeCare)ResearchCenter,HamadanUniversityofMedicalSciences,Hamadan,Iran. StudentResearchCommittee,HamadanUniversityofMedicalSciences,Hamadan,Iran. FacultyofMedicine,HamadanUniversityofMedicalSciences,Hamadan,Iran. FacultyofPublicHealth,HamadanUniversityofMedicalSciences,Hamadan,Iran.</auth-address><titles><title>TheeffectofkangaroomothercareonphysiologicalparametersofprematureinfantsinHamadanCity,Iran</title><secondary-title>PanAfrMedJ</secondary-title></titles><periodical><full-title>PanAfrMedJ</full-title></periodical><pages>89</pages><volume>30</volume><edition>2018/10/23</edition><keywords><keyword>Adult</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>*Infant,Premature</keyword><keyword>*IntensiveCareUnits,Neonatal</keyword><keyword>Iran</keyword><keyword>*Kangaroo-MotherCareMethod</keyword><keyword>Male</keyword><keyword>SurveysandQuestionnaires</keyword><keyword>YoungAdult</keyword><keyword>Kangaroocare</keyword><keyword>physiologicalindices</keyword><keyword>prematureinfants</keyword></keywords><dates><year>2018</year></dates><isbn>1937-8688(Electronic)</isbn><accession-num>30344873</accession-num><urls><related-urls><url>/pubmed/30344873</url></related-urls></urls><custom2>PMC6192712</custom2><electronic-resource-num>10.11604/pamj.204428</electronic-resource-num></record></Cite></EndNote>[4]。熊小云等选取114例超未成熟儿进行随机对照试验发现与常规护理组相比袋鼠式护理组患儿呼吸暂停次数明显减少，用氧事件缩短，生存质量提高ADDINEN.CITE<EndNote><Cite><Author>熊小云</Author><Year>2019</Year><RecNum>846</RecNum><DisplayText><styleface="superscript">[5]</style></DisplayText><record><rec-number>846</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001866">846</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>熊小云</author><author>谢小华</author><author>杨传忠</author><author>孙盼盼</author><author>陈丽莲</author><author>张剑</author><author>汪云云</author><author>邓丽萍</author></authors></contributors><auth-address>广州医科大学护理学院;南方医科大学附属深圳妇幼保健院新生儿重症监护室;深圳市第二人民医院(深圳大学第一附属医院)护理部;安徽医科大学护理学院;</auth-address><titles><title>无创辅助通气超未成熟儿应用袋鼠护理改善呼吸功能的效果%J南昌大学学报(医学版)</title></titles><pages>59-63+71</pages><volume>59</volume><number>03</number><keywords><keyword>袋鼠式护理</keyword><keyword>超未成熟儿</keyword><keyword>无创辅助通气</keyword></keywords><dates><year>2019</year></dates><isbn>2095-4727</isbn><call-num>36-1323/R</call-num><urls></urls><remote-database-provider>Cnki</remote-database-provider></record></Cite></EndNote>[5]。而刘晓瑜等对60例先天性心脏病根治或姑息手术患儿为研究对象，并将其随机分为常规护理组和袋鼠式护理组，其研究发现与常规护理组相比袋鼠式护理组腹胀及呼吸道并发症发生率低，ICU治疗时间短，提示袋鼠式护理科有利于体外循环术后婴儿心肺功能的恢复，缩短治疗时间，有一定的应用前景ADDINEN.CITE<EndNote><Cite><Author>刘晓瑜</Author><Year>2018</Year><RecNum>844</RecNum><DisplayText><styleface="superscript">[6]</style></DisplayText><record><rec-number>844</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001866">844</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>刘晓瑜</author><author>张红</author><author>李秋燕</author><author>林飞雪</author><author>李鹏</author><author>胡艳宁</author></authors></contributors><auth-address>广西中医药大学;广西中医药大学附属瑞康医院;</auth-address><titles><title>袋鼠式护理在婴儿体外循环术后快速康复中的应用%J护士进修杂志</title></titles><pages>841-843</pages><volume>33</volume><number>09</number><keywords><keyword>袋鼠式护理</keyword><keyword>婴儿</keyword><keyword>体外循环术后</keyword><keyword>快速康复</keyword></keywords><dates><year>2018</year></dates><isbn>1002-6975</isbn><call-num>52-1063/R</call-num><urls></urls><remote-database-provider>Cnki</remote-database-provider></record></Cite></EndNote>[6]。（二）袋鼠式护理对体温的影响早产儿体温调节中枢发育不成熟，体表面积相对较大，散热快而棕色脂肪储存少，临床上进行喂奶、皮肤护理、治疗操作过程中开关暖箱，可导致箱内温度下降，导致早产儿体温下降。相关研究发现应用袋鼠式护理后可稳定患儿心率、呼吸频率、动脉血氧饱和度以及温度ADDINEN.CITE<EndNote><Cite><Author>Parsa</Author><Year>2018</Year><RecNum>817</RecNum><DisplayText><styleface="superscript">[4]</style></DisplayText><record><rec-number>817</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">817</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Parsa,P.</author><author>Karimi,S.</author><author>Basiri,B.</author><author>Roshanaei,G.</author></authors></contributors><auth-address>ChronicDiseases(HomeCare)ResearchCenter,HamadanUniversityofMedicalSciences,Hamadan,Iran. StudentResearchCommittee,HamadanUniversityofMedicalSciences,Hamadan,Iran. FacultyofMedicine,HamadanUniversityofMedicalSciences,Hamadan,Iran. FacultyofPublicHealth,HamadanUniversityofMedicalSciences,Hamadan,Iran.</auth-address><titles><title>TheeffectofkangaroomothercareonphysiologicalparametersofprematureinfantsinHamadanCity,Iran</title><secondary-title>PanAfrMedJ</secondary-title></titles><periodical><full-title>PanAfrMedJ</full-title></periodical><pages>89</pages><volume>30</volume><edition>2018/10/23</edition><keywords><keyword>Adult</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>*Infant,Premature</keyword><keyword>*IntensiveCareUnits,Neonatal</keyword><keyword>Iran</keyword><keyword>*Kangaroo-MotherCareMethod</keyword><keyword>Male</keyword><keyword>SurveysandQuestionnaires</keyword><keyword>YoungAdult</keyword><keyword>Kangaroocare</keyword><keyword>physiologicalindices</keyword><keyword>prematureinfants</keyword></keywords><dates><year>2018</year></dates><isbn>1937-8688(Electronic)</isbn><accession-num>30344873</accession-num><urls><related-urls><url>/pubmed/30344873</url></related-urls></urls><custom2>PMC6192712</custom2><electronic-resource-num>10.11604/pamj.204428</electronic-resource-num></record></Cite></EndNote>[4]，袋鼠式护理可作为一种经济易行的方式一定程度上预防新生儿低体温的发生ADDINEN.CITEADDINEN.CITE.DATA[7]。（三）袋鼠式护理对婴儿睡眠质量影响早产儿脑发育不成熟、昼夜节律紊乱，可表现为不同程度的睡眠-觉醒紊乱。而规律的睡眠模式有助于早产儿神经成熟，降低负性情绪，促进认知、语言及行为能力的发展ADDINEN.CITEADDINEN.CITE.DATA[8]。有研究证实与接收常规护理的早产儿相比，接收袋鼠式护理的早产儿睡眠时间更长，睡眠质量更高ADDINEN.CITEADDINEN.CITE.DATA[9]。Scher等的研究中发现接受袋鼠式护理的早产儿其快速眼动睡眠期更少，睡眠更安静，呼吸更规律，有利于早产儿大脑发育成熟ADDINEN.CITE<EndNote><Cite><Author>Scher</Author><Year>2009</Year><RecNum>823</RecNum><DisplayText><styleface="superscript">[10]</style></DisplayText><record><rec-number>823</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">823</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Scher,M.S.</author><author>Ludington-Hoe,S.</author><author>Kaffashi,F.</author><author>Johnson,M.W.</author><author>Holditch-Davis,D.</author><author>Loparo,K.A.</author></authors></contributors><auth-address>DepartmentofPediatrics,RainbowBabiesandChildren'sHospital,Cleveland,OH44106,USA.Mark.Scher@UH</auth-address><titles><title>Neurophysiologicassessmentofbrainmaturationafteran8-weektrialofskin-to-skincontactonpreterminfants</title><secondary-title>ClinNeurophysiol</secondary-title></titles><periodical><full-title>ClinNeurophysiol</full-title></periodical><pages>1812-8</pages><volume>120</volume><number>10</number><edition>2009/09/22</edition><keywords><keyword>Brain/*growth&development/*physiology</keyword><keyword>Electroencephalography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>Infant,Premature/*physiology</keyword><keyword>Male</keyword><keyword>PilotProjects</keyword><keyword>Skin/innervation</keyword><keyword>Sleep/physiology</keyword><keyword>Touch/*physiology</keyword></keywords><dates><year>2009</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1872-8952(Electronic) 1388-2457(Linking)</isbn><accession-num>19766056</accession-num><urls><related-urls><url>/pubmed/19766056</url></related-urls></urls><custom2>PMC2928473</custom2><electronic-resource-num>10.1016/j.clinph.2009.08.004</electronic-resource-num></record></Cite></EndNote>[10]。（四）袋鼠式护理对操作性疼痛的缓解早产儿已具备感知和记忆疼痛的能力，而对早产儿的抢救和治疗过程中反复的疼痛刺激不仅导致心率加快、氧化应激增多，还可对婴儿产生远期不良影响，早期的经验可使大脑的结构和功能发生重组，导致今后疼痛反应的改变，因此减轻早产儿疼痛非常重要，而研究发现袋鼠式护理疗法可有效缓解有床操作中的疼痛ADDINEN.CITE<EndNote><Cite><Author>Field</Author><Year>2017</Year><RecNum>824</RecNum><DisplayText><styleface="superscript">[11]</style></DisplayText><record><rec-number>824</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">824</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Field,T.</author></authors></contributors><auth-address>TouchResearchInstitute,UniversityofMiami/MillerSchoolofMedicine,UnitedStates;FieldingGraduateUniversity,UnitedStates.Electronicaddress:tfield@.</auth-address><titles><title>Pretermnewbornpainresearchreview</title><secondary-title>InfantBehavDev</secondary-title></titles><periodical><full-title>InfantBehavDev</full-title></periodical><pages>141-150</pages><volume>49</volume><edition>2017/09/13</edition><keywords><keyword>BreastFeeding</keyword><keyword>CognitionDisorders/etiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>Infant,Premature/*physiology</keyword><keyword>Massage</keyword><keyword>PainManagement</keyword><keyword>Pain,Procedural/*complications/prevention&control</keyword><keyword>Punctures/*adverseeffects</keyword><keyword>Sucrose/administration&dosage</keyword><keyword>*Interventions</keyword><keyword>*Painfulprocedures</keyword><keyword>*Pretermnewborn</keyword></keywords><dates><year>2017</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1934-8800(Electronic) 0163-6383(Linking)</isbn><accession-num>28898671</accession-num><urls><related-urls><url>/pubmed/28898671</url></related-urls></urls><electronic-resource-num>10.1016/j.infbeh.2017.09.002</electronic-resource-num></record></Cite></EndNote>[11]。Nimbalker等研究发现袋鼠式护理可缓解足跟针刺引起的早产儿的疼痛ADDINEN.CITE<EndNote><Cite><Author>Nimbalkar</Author><Year>2013</Year><RecNum>825</RecNum><DisplayText><styleface="superscript">[12]</style></DisplayText><record><rec-number>825</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">825</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Nimbalkar,S.M.</author><author>Chaudhary,N.S.</author><author>Gadhavi,K.V.</author><author>Phatak,A.</author></authors></contributors><auth-address>NeonatalUnit,DepartmentofPediatrics,PramukhswamiMedicalCollege,Karamsad,Gujarat388325,India.somu_somu@</auth-address><titles><title>KangarooMotherCareinreducingpaininpretermneonatesonheelprick</title><secondary-title>IndianJPediatr</secondary-title></titles><periodical><full-title>IndianJPediatr</full-title></periodical><pages>6-10</pages><volume>80</volume><number>1</number><edition>2012/05/01</edition><keywords><keyword>Cross-OverStudies</keyword><keyword>Female</keyword><keyword>Heel/*physiopathology</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>Infant,Premature</keyword><keyword>Infant,Premature,Diseases/*therapy</keyword><keyword>*Kangaroo-MotherCareMethod</keyword><keyword>Male</keyword><keyword>PainManagement/*methods</keyword><keyword>PainMeasurement</keyword><keyword>Punctures</keyword><keyword>TreatmentOutcome</keyword></keywords><dates><year>2013</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0973-7693(Electronic) 0019-5456(Linking)</isbn><accession-num>22544676</accession-num><urls><related-urls><url>/pubmed/22544676</url></related-urls></urls><electronic-resource-num>10.1007/s12098-012-0760-6</electronic-resource-num></record></Cite></EndNote>[12]。而Pandita等研究发现袋鼠式护理可有效减轻疫苗接种引起的婴儿的疼痛及哭闹ADDINEN.CITEADDINEN.CITE.DATA[13]。（五）袋鼠式护理对神经发育影响早产儿生后处于神经系统发育关键时期，此时期大脑在结构和功能上具有很强可塑性，极易受周围环境影响，而袋鼠式护理可一定程度上促进早产儿神经系统发育成熟ADDINEN.CITE<EndNote><Cite><Author>Head</Author><Year>2014</Year><RecNum>827</RecNum><DisplayText><styleface="superscript">[14]</style></DisplayText><record><rec-number>827</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000352">827</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Head,L.M.</author></authors></contributors><auth-address>EmoryUniversityNellHodgsonWoodruffSchoolofNursing,Atlanta,Georgia.</auth-address><titles><title>Theeffectofkangaroocareonneurodevelopmentaloutcomesinpreterminfants</title><secondary-title>JPerinatNeonatalNurs</secondary-title></titles><periodical><full-title>JPerinatNeonatalNurs</full-title></periodical><pages>290-9;quizE3-4</pages><volume>28</volume><number>4</number><edition>2014/10/28</edition><keywords><keyword>ChildDevelopment</keyword><keyword>Cognition/physiology</keyword><keyword>Humans</keyword><keyword>Infant,Newborn</keyword><keyword>*Infant,Premature/physiology/psychology</keyword><keyword>*Kangaroo-MotherCareMethod/methods/psychology</keyword><keyword>*NeurodevelopmentalDisorders/etiology/physiopathology/prevention&</keyword><keyword>control/psychology</keyword><keyword>*Stress,Physiological</keyword><keyword>TreatmentOutcome</keyword></keywords><dates><year>2014</year><pub-dates><date>Oct-Dec</date></pub-dates></dates><isbn>1550-5073(Electronic) 0893-2190(Linking)</isbn><accession-num>25347107</accession-num><urls><related-urls><url>/pubmed/25347107</url></related-urls></urls><electronic-resource-num>10.1097/JPN.0000000000000062</electronic-resource-num></record></Cite></EndNote>[14]。Karraa等使用超声观察袋鼠式护理前后早产儿大脑中动脉脑血流量的变化发现袋鼠式护理可改善早产儿脑血流量，促进早产儿神经系统发育成熟ADDINEN.CITEADDINEN.CITE.DATA[15]。而谢冠文等ADDINEN.CITE<EndNote><Cite><Author>谢冠文</Author><Year>2020</Year><RecNum>845</RecNum><DisplayText><styleface="superscript">[16]</style></DisplayText><record><rec-number>845</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001866">845</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>谢冠文</author></authors></contributors><auth-address>深圳市宝安区人民医院新生儿科;</auth-address><titles><title>袋鼠式护理在缺氧缺血性脑病新生儿中的应用效果%J中国当代医药</title></titles><pages>251-253</pages><volume>27</volume><number>01</number><keywords><keyword>袋鼠式护理</keyword><keyword>缺氧缺血性脑病</keyword><keyword>神经发育</keyword><keyword>体格发育</keyword><keyword>营养不良</keyword></keywords><dates><year>2020</year></dates><isbn>1674-4721</isbn><call-num>11-5786/R</call-num><urls></urls><remote-database-provider>Cnki</remote-database-provider></record></Cite></EndNote>[16]及贺琳琅ADDINEN.CITE<EndNote><Cite><Author>贺琳琅</Author><Year>2019</Year><RecNum>842</RecNum><DisplayText><styleface="superscript">[17]</style></DisplayText><record><rec-number>842</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001866">842</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>贺琳琅</author></authors></contributors><auth-address>河北省沧州市妇幼保健院;</auth-address><titles><title>袋鼠式护理对缺氧缺血性脑病新生儿神经发育的疗效%J世界最新医学信息文摘</title></titles><pages>261-262</pages><volume>19</volume><number>23</number><keywords><keyword>袋鼠式护理</keyword><keyword>缺氧缺血性脑病</keyword><keyword>新生儿</keyword><keyword>神经发育</keyword></keywords><dates><year>2019</year></dates><isbn>1671-3141</isbn><call-num>11-9234/R</call-num><urls></urls><remote-database-provider>Cnki</remote-database-provider></record></Cite></EndNote>[17]等对缺氧缺血性脑病的研究中证实对缺氧缺血脑病患儿实施袋鼠式护理可促进患儿神经发育，降低神经系统损害。（六）袋鼠式护理对母乳喂养的影响早产儿母亲的乳汁如同宫内胎盘的功能的延续，其营养价值和生理学功能专门适合早产儿，已有大量研究证实早产母乳优于任何形式配方奶，并且摄入母乳量越多，早产儿获益越大。尽早在新生儿重症监护病房开展母乳喂养可有效降低如喂养不耐受、坏死性小肠结肠炎、支气管肺发育不良、生长和神经发育迟缓等疾病的发生概率，而研究发现袋鼠式护理可有效提高母乳喂养率ADDINEN.CITEADDINEN.CITE.DATA[18]。李晓莉等的研究发现对剖宫产产妇实施袋鼠式护理科有效缩短产妇首次泌乳时间，促进乳汁分泌ADDINEN.CITE<EndNote><Cite><Author>李晓莉</Author><Year>2019</Year><RecNum>843</RecNum><DisplayText><styleface="superscript">[19]</style></DisplayText><record><rec-number>843</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584001866">843</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>李晓莉</author></authors></contributors><auth-address>丹东市妇女儿童医院护理部;</auth-address><titles><title>袋鼠式护理干预促进新生儿母乳喂养的效果分析%J中国医药指南</title></titles><pages>230</pages><volume>17</volume><number>28</number><keywords><keyword>母乳喂养</keyword><keyword>新生儿</keyword><keyword>袋鼠式护理</keyword></keywords><dates><year>2019</year></dates><isbn>1671-8194</isbn><call-num>11-4856/R</call-num><urls></urls><remote-database-provider>Cnki</remote-database-provider></record></Cite></EndNote>[19]。其原因可能是袋鼠式护理过程中，母亲可与婴儿充分进行肌肤接触，婴儿触摸压蹭母亲乳房的行为可促进催乳素的分泌ADDINEN.CITE<EndNote><Cite><Author>Badr</Author><Year>2017</Year><RecNum>831</RecNum><DisplayText><styleface="superscript">[20]</style></DisplayText><record><rec-number>831</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000583">831</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Badr,H.A.</author><author>Zauszniewski,J.A.</author></authors></contributors><auth-address>CaseWesternReserveUniversity,FrancesPayneBoltonSchoolofNursing,10900EuclidAvenue,Cleveland,OH44106-4904,USA. KingAbdulAzizUniversity,SchoolofNursing,Jeddah,P.O.Box80200,21589,SaudiArabia. CaseWesternReserveUniversity,FrancesPayneBoltonSchoolofNursing,2120CornellRoad,Cleveland,OH44106,USA.</auth-address><titles><title>Kangaroocareandpostpartumdepression:Theroleofoxytocin</title><secondary-title>IntJNursSci</secondary-title></titles><periodical><full-title>IntJNursSci</full-title></periodical><pages>179-183</pages><volume>4</volume><number>2</number><edition>2017/01/05</edition><keywords><keyword>Depression</keyword><keyword>Hormones</keyword><keyword>Literaturereview</keyword><keyword>Postpartumhealth</keyword></keywords><dates><year>2017</year><pub-dates><date>Apr10</date></pub-dates></dates><isbn>2352-0132(Electronic) 2352-0132(Linking)</isbn><accession-num>31406740</accession-num><urls><related-urls><url>/pubmed/31406740</url></related-urls></urls><custom2>PMC6626107</custom2><electronic-resource-num>10.1016/j.ijnss.2017.01.001</electronic-resource-num></record></Cite></EndNote>[20]，进而促进母亲乳汁分泌，有利于母乳喂养的实施。1.袋鼠式护理对母亲的影响袋鼠式护理增加了母亲与早产儿接触的频率和时间，可充分提高早产儿母亲的护理水平，从而有效缩短住院时间，一定程度上减轻经济负担ADDINEN.CITEADDINEN.CITE.DATA[21]。此外，袋鼠式护理在降低产后抑郁风险中起到重要作用。有研究发现在袋鼠式护理实施过程中，婴儿趴伏在母亲胸口，通过哺乳和皮肤接触刺激母亲催产素的释放，从而缓解产后疼痛及因不能照顾婴儿而产生的焦虑情绪，减少产后抑郁症的发生ADDINEN.CITE<EndNote><Cite><Author>Badr</Author><Year>2017</Year><RecNum>831</RecNum><DisplayText><styleface="superscript">[20]</style></DisplayText><record><rec-number>831</rec-number><foreign-keys><keyapp="EN"db-id="pxx00t0fjwxdaae0vwovtzpk0ratpvwrt5dd"timestamp="1584000583">831</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Badr,H.A.</author><author>Zauszniewski,J.A.</author></authors></contributors><auth-address>CaseWesternReserveUniversity,FrancesPayneBoltonSchoolofNursing,10900EuclidAvenue,Cleveland,OH44106-4904,USA. KingAbdulAzizUniversity,SchoolofNursing,Jeddah,P.O.Box80200,21589,SaudiArabia. CaseWesternReserveUniversity,FrancesPayneBoltonSchoolofNursing,2120CornellRoad,Cleveland,OH44106,USA.</auth-address><titles><title>Kangaroocareandpostpartumdepression:Theroleofoxytocin</title><secondary-title>IntJNursSci</secondary-title></titles><periodical><full-title>IntJNursSci</full-title></periodical><pages>179-183</pages><volume>4</volume><number>2</number><edition>2017/01/05</edition><keywords><keyword>Depression</keyword><keyword>Hormones</keyword><keyword>Literaturereview</keyword><keyword>Postpartumhealth</keyword></keywords><dates><year>2017</year><pub-dates><date>Apr10</date></pub-dates></dates><isbn>2352-0132(Electronic) 2352-0132(Linking)</isbn><accession-num>31406740</accession-num><urls><r