基于IMB模型的综合干预对母婴分离早产儿母亲泌乳Ⅱ期启动时间及泌乳量的影响

Effect of Comprehensive Intervention Based on IMB Model on the Start-Up Time of Lactation Phase II and Lactation Volume of Mothers of Premature Infants with Maternal Infant Separation

摘要: 目的：探讨基于信息–动机–行为技巧(IMB)模型的综合干预对母婴分离早产儿母亲泌乳II期启动时间、泌乳量及母乳喂养率的影响，为改善NICU早产儿母乳喂养提供实证依据。方法：采用便利抽样法，选取2022年1月至2024年12月在我院NICU住院的母婴分离早产儿母亲作为研究对象。按入院时间顺序分组，将2022年1月~2023年6月的46例设为对照组，2023年7月~2024年12月的46例设为干预组。对照组接受NICU常规母乳喂养指导和心理护理；干预组在此基础上接受基于IMB模型的综合干预，包括：信息干预(制作母乳喂养手册、播放泌乳原理视频)、动机干预(个体化访谈、树立榜样母亲、建立喂养信心)、行为技巧干预(床旁手把手教授吸奶器使用、手法挤奶、乳房按摩技巧)，干预持续至产后14天。比较两组产妇的泌乳II期启动时间、产后24 h泌乳量、产后第7天及第14天的纯母乳喂养率，并采用母乳喂养自我效能感量表评估干预前后的差异。结果：最终对照组43例、干预组44例完成研究。(1) 泌乳启动时间：干预组泌乳II期启动时间为(52.37 ± 8.62) h，显著短于对照组的(68.45 ± 12.38) h，差异有统计学意义(P < 0.01)。(2) 泌乳量：干预组产后24 h泌乳量为(326.54 ± 42.37) mL，显著高于对照组的(245.68 ± 38.56) mL (P < 0.01)。(3) 母乳喂养率：干预组产后第7天及第14天的纯母乳喂养率分别为77.27% (34/44)和70.45% (31/44)，显著高于对照组的53.49% (23/43)和44.19% (19/43)，差异均有统计学意义(P < 0.05)。(4) 自我效能：干预后，干预组母乳喂养自我效能感总分为(124.58 ± 10.24)分，显著高于对照组的(101.37 ± 12.56)分(P < 0.01)。结论：基于IMB模型的综合干预能有效缩短母婴分离早产儿母亲的泌乳II期启动时间，增加产后早期泌乳量，提高纯母乳喂养率及母乳喂养自我效能。该模式值得在NICU母乳喂养支持工作中推广应用。

Abstract: Objective: To explore the effect of comprehensive intervention based on information motivation behavior skills (IMB) model on the start-up time of lactation phase II, lactation volume and breastfeeding rate of mothers of premature infants with maternal infant separation, so as to provide empirical evidence for improving breastfeeding of premature infants in NICU. Methods: Convenient sampling method was used to select the mothers of premature infants who were separated from their mothers in NICU of our hospital from January 2022 to December 2024 as the research objects. 46 cases from January 2022 to June 2023 were set as the control group, and 46 cases from July 2023 to December 2024 were set as the intervention group. The control group received NICU routine breast feeding guidance and psychological nursing; On this basis, the intervention group received comprehensive intervention based on the IMB model, including: information intervention (making breastfeeding manual, playing lactation principle video), motivation intervention (individualized interview, setting an example mother, building feeding confidence), behavior skills intervention (hand-in-hand teaching of breast pump use, manual milking, breast massage skills at the bedside), and the intervention lasted until 14 days after delivery. The start-up time of lactation phase II, the amount of lactation in 24 hours after delivery, the rate of exclusive breastfeeding on the 7th and 14th day after delivery were compared between the two groups, and the difference before and after intervention was evaluated by breastfeeding self-efficacy scale. Results: 43 cases in the control group and 44 cases in the intervention group completed the study. (1) Lactation start-up time: the start-up time of lactation phase II in the intervention group was (52.37 ± 8.62) h, which was significantly shorter than (68.45 ± 12.38) h in the control group, and the difference was statistically significant (P < 0.01). (2) Lactation volume: the 24 h postpartum lactation volume in the intervention group was (326.54 ± 42.37) ml, which was significantly higher than (245.68 ± 38.56) ml in the control group (P < 0.01). (3) Breastfeeding rate: the pure breastfeeding rate on the 7th and 14th day after delivery in the intervention group were 77.27% (34/44) and 70.45% (31/44), respectively, which were significantly higher than 53.49% (23/43) and 44.19% (19/43) in the control group, and the differences were statistically significant (P < 0.05). (4) Self efficacy: after the intervention, the total score of breastfeeding self-efficacy in the intervention group was (124.58 ± 10.24), which was significantly higher than (101.37 ± 12.56) in the control group (P < 0.01). Conclusion: Comprehensive intervention based on IMB model can effectively shorten the start-up time of lactation phase II for mothers of premature infants with mother infant separation, increase early postpartum lactation, and improve the rate of exclusive breastfeeding and breastfeeding self-efficacy. This model is worthy of promotion and application in NICU breastfeeding support.