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目的比较不同管理模式下出院后早产儿管理率及家庭实施早期发育促进依从性(以下简称依从性)的差异,并探讨管理率及依从性的影响因素。方法采用方便抽样,选取广西及陕西各两个县,对研究地区一定时段出生的416例早产儿从出院后开始进行定期随访。广西对两县出生的146例早产儿采用分级分类管理,即县级妇幼保健院随访有高危因素的早产儿,乡卫生院随访其他早产儿;陕西由县级妇幼保健院负责随访两县出生的270例早产儿。两种模式实施的随访频率及内容均相同。结果县、乡分级分类管理组的早产儿管理率为86.3%,明显高于县级直接管理组的管理率57.0%(P<0.01);前者依从性也高于后者(P<0.01)。多因素分析结果显示,父母之一为看护人(OR=99.491)、早产儿有出生异常(OR=1.853),则管理率较高。父母之一为看护人(P<0.01)、家庭收入低(P<0.05)时依从性较好。结论在乡卫生院能够提供基本儿童保健服务的前提下,对出院后早产儿实施县、乡分级分类管理利于提高管理率及依从性。提倡父母参与早产儿养育及加强看护人的健康教育。
Objective To compare the differences in management rates of discharged preterm infants under different management modes and compliance with early childhood development promotion (hereinafter referred to as compliance), and to explore the influencing factors of management rate and compliance. Methods A total of 416 preterm infants who were born in a certain period of time in the study area were randomly assigned to regular follow-up after discharge. In Guangxi, 146 preterm infants born in both counties were managed by grading and classification, that is, preterm infants with high risk were followed up at county maternity and child care centers and township hospitals were followed up with other preterm infants. In Shaanxi, county-level MCH hospitals were responsible for the follow-up of the two counties 270 cases of premature children. Follow-up frequency and content were the same in both modes. Results The management rate of preterm infants in county-level classification management group was 86.3%, which was significantly higher than that of county-level direct management group (57.0%, P <0.01). The former also had higher compliance (P <0.01). Multivariate analysis showed that one of the parents was a caregiver (OR = 99.491), and a prenatal birth was abnormal (OR = 1.853), with a higher management rate. One of the parents was a caregiver (P <0.01), and family compliance was better when family income was lower (P <0.05). Conclusion The township hospitals can provide basic child health services under the premise of the discharge of preterm children county and township classification management helps to improve the management rate and compliance. Advocate parents to participate in the care of premature children and strengthen caregivers’ health education.