CAJ | 학술논문

目的探讨我院建立首都区域性综合主动型新生儿转运网络(ANTN)组织在提高新生儿救治水平中的作用以及中心NICU建设在ANTN中的重要性.方法用回顾性统计学分析的方法,分析我院在建设ANTN过程中网络管理方法和分析有关网络建设效果的新生儿资料.结果新生儿转运网络规模逐渐扩大,网络医院由早期阶段(2004年7月至2006年6月)的19家增加到成熟阶段(2006年7月至2008年5月)的93家,转运患儿数由587例增加到2797例;新生儿转运成功率成熟阶段较早期阶段明显增高(χ~2=21.69,P<0.001);在成熟阶段出现低体温、低血精、高血糖以及明显酸中毒的例数明显降低(P分别<0.01、0.05、0.01和0.05).新生儿病死率明显降低,治愈率明显增高(χ~2值分别为8.23和7.66;P均<0.01);中心NICU的规模明显扩大,转运的早产儿的比例,特别是胎龄小于32周小早产的比例以及低出生体重儿人数成熟阶段较初级阶段明显增多(P均<0.05),新生儿窒息及RDS的发生率明显降低(P<0.05,P<0.01);提高了早产儿、新生儿窒息以及吸入综合征的治愈率(P均<0.05).结论 ANTN可以提高各级NICU的整体实力,对减低新生儿病死率至关重要;中心NICU具有专业的医护人员、科学的救治流程、丰富的临床实践经验及先进的设备,在ANTN中起主导作用.
목적 탐토아원건립수도구역성종합주동형신생인전운망락(ANTN)조직재제고신생인구치수평중적작용이급중심NICU건설재ANTN중적중요성.방법 용회고성통계학분석적방법,분석아원재건설ANTN과정중망락관리방법 화분석유관망락건설효과적신생인자료.결과 신생인전운망락규모축점확대,망락의원유조기계단(2004년7월지2006년6월)적19가증가도성숙계단(2006년7월지2008년5월)적93가,전운환인수유587례증가도2797례;신생인전운성공솔성숙계단교조기계단명현증고(χ~2=21.69,P<0.001);재성숙계단출현저체온、저혈정、고혈당이급명현산중독적례수명현강저(P분별<0.01、0.05、0.01화0.05).신생인병사솔명현강저,치유솔명현증고(χ~2치분별위8.23화7.66;P균<0.01);중심NICU적규모명현확대,전운적조산인적비례,특별시태령소우32주소조산적비례이급저출생체중인인수성숙계단교초급계단명현증다(P균<0.05),신생인질식급RDS적발생솔명현강저(P<0.05,P<0.01);제고료조산인、신생인질식이급흡입종합정적치유솔(P균<0.05).결론 ANTN가이제고각급NICU적정체실력,대감저신생인병사솔지관중요;중심NICU구유전업적의호인원、과학적구치류정、봉부적림상실천경험급선진적설비,재ANTN중기주도작용.
Objective To evaluate the clinical function and significance of establishing a regional active neonatal transport network(ANTN)in Beijing.Method rrhe authors retrospectively studied intensive care and the role of ANTN system in management of critically ill neonates and compared the outcome of newborn infants transported to our NICU before and after we established standardized NICU and ANTN system(phase 1:July 2004 to June 2006 vs phase 2:July 2006 to May 2008).Result The number of neonatal transport significantly increased from 587 during phase 1 to 2797 during phase 2.Success rate of transport and the total cure rate in phase 2 were 97.85%and 91.99%respectively.which were significantly hjgher than those in phase 1(94.36%and 88.69%,respectively,P<0.01).The neonatal mortality significantly decreased in phase 2 compared with that in phase 1(2.29%vs 4.31%.P<0.01).The capacity of our NICU was enlarged following the development of ANTN.There are 200 beds for level 3 infants in phase 2.but there were only 20 beds in phase 1.Significantly less patients in the phase 2 had hypothermia,acidosis and the blood glucose instability than those in phase 1(P<0.01,0.05,0.01 and 0.05,respectively).The proportion of preterm infants transposed to our NICU were higher in phase 2 compared with that in phase 1.especially infants whose gestational age was below 32 weeks.The proportions of asphyxia and respiratory distress syndrome were lower in phase 2 than that in phase 1.but the total care rates of these two diseases had no significant changes between the two phases.The most important finding was that the improvement of outeome of premature infants and those with asphyxia and aspiration syndrome was noted following the development of ANTN.Conclusion Establishing regional ANTN for a tertiary hospital is very important to elevate the total level in management of critically ill newborn infants.It plays a very important role in reducing mortality and improving total outcomes of rlewborn infants.There are still some problems remained to solve after four years practice in order to optimize the ANTN to meet needs of the development of neonatology.