中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2011年
3期
151-155
,共5页
徐韬%王惠珊%宫丽敏%叶鸿瑁%虞人杰%黄醒华%王立新%王丹华%曹玉莲%李明珠%朱小瑜
徐韜%王惠珊%宮麗敏%葉鴻瑁%虞人傑%黃醒華%王立新%王丹華%曹玉蓮%李明珠%硃小瑜
서도%왕혜산%궁려민%협홍모%우인걸%황성화%왕립신%왕단화%조옥련%리명주%주소유
窒息,新生儿%复苏术%评价研究
窒息,新生兒%複囌術%評價研究
질식,신생인%복소술%평개연구
Asphyxia neonatorum%Resuscitation%Evaluation studies
目的 评价在医疗机构开展新生儿窒息复苏领导小组试点干预的效果.方法 在江西、辽宁和湖南3个省每省选择省级医院1所、市级医院2所、县级医院1所进行干预,即建立院内新生儿窒息复苏领导小组,探索人员培训与复训的模式,促进和落实产、儿科合作制度的建立和运作,对新生儿窒息病例进行常规记录和病例讨论;对建立院内新生儿窒息复苏领导小组前后新生儿窒息抢救过程和新生儿窒息发生率的变化情况进行分析,评价干预效果.结果 (1)试点期间新生儿窒息的发生情况:试点期间共完整记录315例窒息病例,其中轻度窒息占89.5%(282例),重度窒息占10.5%(33例).1 min Apgar评分在县级医院最低,为(5.40±1.56)分,其次是省级医院和市级医院,分别为(5.63±1.67)分和(6.03±1.41)分.(2)不符合新生儿窒息复苏指南的操作比例:不符合复苏指南操作的病例数占全部窒息病例数的47.9%(151/315),其中不符合复苏指南正压通气操作的病例数占36.5%(115/315).(3)试点前后窒息发生率比较:省级医院和市级医院窒息发生率在试点后分别为2.66%和1.67%,比试点前(分别为4.23%和2.83%)有所下降(χ2=5.021和4.948,P＜0.05),重度窒息发生率也均有所下降,但差异没有统计学意义(χ2=3.001和0.966,P＞0.05).县级医院窒息发生率由2.48%下降为1.22%,但差异无统计学意义(χ2=2.989,P=0.084),重度窒息发生率由0.39%下降为0.00%,差异有统计学意义(χ2=2.567,P=0.035).结论 通过在医疗机构内建立新生儿窒息复苏领导小组,可加强院内新生儿窒息复苏培训,促进科室间协调,提高医疗机构新生儿窒息抢救技术水平,降低新生儿窒息发生率.
目的 評價在醫療機構開展新生兒窒息複囌領導小組試點榦預的效果.方法 在江西、遼寧和湖南3箇省每省選擇省級醫院1所、市級醫院2所、縣級醫院1所進行榦預,即建立院內新生兒窒息複囌領導小組,探索人員培訓與複訓的模式,促進和落實產、兒科閤作製度的建立和運作,對新生兒窒息病例進行常規記錄和病例討論;對建立院內新生兒窒息複囌領導小組前後新生兒窒息搶救過程和新生兒窒息髮生率的變化情況進行分析,評價榦預效果.結果 (1)試點期間新生兒窒息的髮生情況:試點期間共完整記錄315例窒息病例,其中輕度窒息佔89.5%(282例),重度窒息佔10.5%(33例).1 min Apgar評分在縣級醫院最低,為(5.40±1.56)分,其次是省級醫院和市級醫院,分彆為(5.63±1.67)分和(6.03±1.41)分.(2)不符閤新生兒窒息複囌指南的操作比例:不符閤複囌指南操作的病例數佔全部窒息病例數的47.9%(151/315),其中不符閤複囌指南正壓通氣操作的病例數佔36.5%(115/315).(3)試點前後窒息髮生率比較:省級醫院和市級醫院窒息髮生率在試點後分彆為2.66%和1.67%,比試點前(分彆為4.23%和2.83%)有所下降(χ2=5.021和4.948,P＜0.05),重度窒息髮生率也均有所下降,但差異沒有統計學意義(χ2=3.001和0.966,P＞0.05).縣級醫院窒息髮生率由2.48%下降為1.22%,但差異無統計學意義(χ2=2.989,P=0.084),重度窒息髮生率由0.39%下降為0.00%,差異有統計學意義(χ2=2.567,P=0.035).結論 通過在醫療機構內建立新生兒窒息複囌領導小組,可加彊院內新生兒窒息複囌培訓,促進科室間協調,提高醫療機構新生兒窒息搶救技術水平,降低新生兒窒息髮生率.
목적 평개재의료궤구개전신생인질식복소령도소조시점간예적효과.방법 재강서、료녕화호남3개성매성선택성급의원1소、시급의원2소、현급의원1소진행간예,즉건립원내신생인질식복소령도소조,탐색인원배훈여복훈적모식,촉진화락실산、인과합작제도적건립화운작,대신생인질식병례진행상규기록화병례토론;대건립원내신생인질식복소령도소조전후신생인질식창구과정화신생인질식발생솔적변화정황진행분석,평개간예효과.결과 (1)시점기간신생인질식적발생정황:시점기간공완정기록315례질식병례,기중경도질식점89.5%(282례),중도질식점10.5%(33례).1 min Apgar평분재현급의원최저,위(5.40±1.56)분,기차시성급의원화시급의원,분별위(5.63±1.67)분화(6.03±1.41)분.(2)불부합신생인질식복소지남적조작비례:불부합복소지남조작적병례수점전부질식병례수적47.9%(151/315),기중불부합복소지남정압통기조작적병례수점36.5%(115/315).(3)시점전후질식발생솔비교:성급의원화시급의원질식발생솔재시점후분별위2.66%화1.67%,비시점전(분별위4.23%화2.83%)유소하강(χ2=5.021화4.948,P＜0.05),중도질식발생솔야균유소하강,단차이몰유통계학의의(χ2=3.001화0.966,P＞0.05).현급의원질식발생솔유2.48%하강위1.22%,단차이무통계학의의(χ2=2.989,P=0.084),중도질식발생솔유0.39%하강위0.00%,차이유통계학의의(χ2=2.567,P=0.035).결론 통과재의료궤구내건립신생인질식복소령도소조,가가강원내신생인질식복소배훈,촉진과실간협조,제고의료궤구신생인질식창구기술수평,강저신생인질식발생솔.
Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.
