目的 评价基于信息—动机—行为技巧模型（information motivation behavioral skills model,IMB）的链式管理对促进早产儿母乳喂养的干预效果。方法 选取2022年1月—6月入住湖南省某三级甲等医院新生儿重症监护室符合纳入标准的88例早产儿母亲为研究对象,2022年1月—3月的44例为对照组,2022年4月—6月的44例为试验组,对照组接受常规母乳喂养支持护理,试验组接受基于IMB的链式管理。比较两组母亲母乳喂养知识、婴儿喂养态度、母乳喂养自我效能得分和6个月内早产儿纯母乳喂养率、再入院率等的差异。结果 干预后,试验组母乳喂养知识得分高于对照组（t=-4.747,P<0.001）、婴儿喂养态度得分高于对照组（t=-17.321,P<0.001）、母乳喂养自我效能得分高于对照组（t=-2.352,P=0.021）;试验组早产儿矫正月龄1个月内纯母乳喂养率（95.2%）高于对照组（73.8%）,差异有统计学意义（χ2=7.372,P=0.007）,3个月内纯母乳喂养率（88.1%）高于对照组（69.0%）,差异有统计学意义（χ2=4.525,P=0.033）,6个月内纯母乳喂养率（66.7%）高于对照组（40.5%）,差异有统计学意义（χ2=5.791,P=0.016）;试验组早产儿6个月内再入院率（2.3%）低于对照组（16.7%）（χ2=4.974,P=0.030）。结论 IMB结合链式管理可提高早产儿矫正月龄6个月内纯母乳喂养率,降低再入院率。
Objective To evaluate the effectiveness of chain management based on the Information-Motivation-Behavioral Skills model（IMB） on promoting breastfeeding in preterm infants. Methods We selected 88 mothers of premature infants admitted to a tertiary hospital in Hunan province from January to June 2022 as the study objects,44 cases meeting the inclusion criteria from January to March 2022 as the control group,44 cases from April to June 2022 as the intervention group. The control group received routine breastfeeding support care,and the intervention group received chain management based on IMB model. Maternal breastfeeding knowledge,infant feeding attitude,breastfeeding self-efficacy scores and exclusive breastfeeding rates and readmission rate of preterm infants within 6 months were compared between the two groups. Results The intervention group scored higher breastfeeding knowledge than the control group（t=-4.747,P<0.001）,higher infant feeding attitude than the control group（t=-17.321,P<0.001）,higher breastfeeding self-efficacy than the control group（t=-2.352,P=0.021） after intervention. The rate of exclusive breastfeeding within 1 month of corrected age in the intervention group（95.2%） was higher than that in the control group（73.8%）,with statistically significant difference（χ2=7.372,P=0.007）. The rate of exclusive breastfeeding within 3 months（88.1%） was higher than the control group（69.0%）,with statistically significant difference（χ2=4.525,P=0.033）. The rate of exclusive breastfeeding within 6 months（66.7%） was higher than the control group（40.5%）,with statistically significant difference（χ2=5.791,P=0.016）. The premature infant readmission rate within 6 months in the intervention group（2.3%） was lower than that in the control group （16.7%）（χ2=4.974,P=0.030）. Conclusion IMB model combined with chain management can improve the rate of exclusive breastfeeding within 6 months of corrected age and reduce the readmission rate.
[1] World Health Organization. Born too soon:The global action report on preterm birth.[EB/OL].(2012-11-30)[2024-1-4]. https://www.who.int/publications/i/item/9789241503433.
[2] Poulimeneas D,Bathrellou E,Antonogeorgos G,et al.Feeding the preterm infant:an overview of the evidence[J]. Int J Food Sci Nutr,2021,72(1):4-13.
[3] Brødsgaard A,Andersen BL,Skaaning D,et al.From expressing human milk to breastfeeding-an essential element in the journey to motherhood of mothers of prematurely born infants[J]. Adv Neonatal Care,2022,22(6):560-570.
[4] Keir A,Rumbold A,Collins CT,et al.Breastfeeding outcomes in late preterm infants:a multi-centre prospective cohort study[J]. PLoS One,2022,17(8):e0272583.
[5] 王丹妮,韦婷,罗小婷,等. 445例早产儿6个月内纯母乳喂养影响因素分析[J]. 中华全科医学,2021,19(10):1685-1688.
Wang DN,Wei T,Luo XT,et al.Analysis of influencing factors of exclusive breastfeeding within 6 months in 445 preterm infants[J]. Chin J Gener Prac,2021,19(10):1685-1688.
[6] Bakır E, Çavuǫlu H,Mengen E. Effects of the information-mo-tivation-behavioral skills model on metabolic control of ado-lescents with type 1 diabetes in Turkey:randomized controlled study[J]. J Pediatr Nurs,2021,58:e19-e27.
[7] 吕忠美,杨小华,席巍,等. 链式管理在农村空巢老年糖尿病患者胰岛素注射中的应用研究[J]. 中华护理杂志,2022,57(23):2904-2911.
Lü ZM,Yang XH,Xi W,et al.Effect of chain management on insulin injection management ability of rural empty nest elderly diabetic patients[J]. Chin J Nurs,2022,57(23):2904-2911.
[8] 顾瓅,李双双,周金君,等. 链式早产儿母乳喂养促进方案在NICU的实施[J]. 护理学杂志,2020,35(10):1-5.
Gu L,Li SS,Zhou JJ,et al.Implementation of the chain-like breast-feeding promotion program for preterm infants in neonatal intensive care unit[J]. J Nurs Sci,2020,35(10):1-5.
[9] 赵旻. 北京地区初产妇母乳喂养自我效能及其影响因素的研究[D]. 北京:北京协和医学院,2008.
Zhao M.Factors Associated with breastfeeding self-efficacy among Beijing new mother. Beijing:Peking Union Medical College,2008.
[10] 戴红霞,刘樱. 中文版IOWA婴儿喂养态度量表信度及效度分析[J]. 中国护理管理,2013,13(3):42-45.
Dai HX,Liu Y.Reliability and validity analysis of the Chinese version of the IOWA infant feeding attitude scale[J]. Chin Nurs Manag,2013,13(3):42-45.
[11] 刘延锦,王敏,董小方. 中文版母乳喂养自我效能简式量表的信效度研究[J]. 中国实用护理杂志,2016,32(18):1361-1364.
Liu YJ,Wang M,Dong XF.Reliability and validity of Chinese version of the Breastfeeding Self-efficacy Scale Short Form[J]. Chin J Prac Nurs,2016,32(18):1361-1364.
[12] 曹云,李正红,韩树萍,等. 新生儿重症监护室母乳使用专家共识[J]. 中国循证儿科杂志,2021,16(3):171-178.
Cao Y,Li ZH,Han SP,et al.Expert consensus on newborn intensive-care unit breast milk use[J]. Chin J Evid Based Pediatr,2021,16(3):171-178.
[13] Tseng JF,Chen SR,Au HK,et al.Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate:a single-blind,randomised controlled study[J]. Int J Nurs Stud,2020,111:103770.
[14] 栾丹丹,于秀荣,蔺香云. 早产儿母亲泌乳Ⅱ期启动时间与产后早期泌乳量的相关性研究[J]. 中华现代护理杂志,2018,24(8):874-879.
Luan DD,Yu XR,Lin XY.Correlation between the onset time of lactation period Ⅱ and lactation yield of the early stage after delivery in preterm's mothers[J]. Chi J of mod nurs,2018,24(8):874-879.
[15] 任素英,于晔,甘雨霞,等. 住院早产儿母乳喂养集束化管理效果探讨[J]. 护理研究,2018,32(2):283-285.
Ren SY,Yu Y,Gan YX,et al.Hospitalized premature breastfeeding cluster management effect is discussed in this paper[J]. Chin Nurs Res,2018,32(2):283-285.
[16] 秦怀雪,赖冬梅,刘璇,等. 基于健康信念模型的院内健康教育对早产儿母乳喂养行为的影响[J]. 中国健康教育,2019,35(2):175-178.
Qin HX,Lai DM,Liu X,et al.Effect of health education in hospital on breastfeeding of premature infants based on health belief model[J]. Chin J Health Educ,2019,35(2):175-178.
