CAJ | 학술논문

目的：对浙江省三级和二级医院新生儿窒息复苏及人员培训情况进行基线调查。方法采用分层随机抽样法在浙江省11个地级市中每个地级市以抽签法抽取5所医院参与调查，其中地级市医院2所，县级医院3所。自制调查问卷，内容包括新生儿复苏开展情况，人员培训，产房、手术室复苏设备情况，新生儿出生窒息发生和死亡情况。结果10/11个地级市49家医院纳入分析，其中三级医院23家（46.9％），二级医院26家。①49家医院均有开展新生儿窒息复苏抢救的能力，三级医院均定期举办新生儿复苏培训。三级医院 NICU 病房配备率高于二级医院（87.0％ vs 34.6％，P =0.0018）。②必备设备的配备：三级和二级医院产房和手术室在新生儿复苏气囊、辐射保温台、喉镜、气管导管和新生儿面罩的配备率均超过90％。高级设备的配备：三级医院产房和手术室血氧饱和仪配备率较高（72.7％），脐静脉导管、喉管、T组合复苏器和空氧混合器的配备率均低于50％。③无论是三级还是二级医院，儿科医生院内和院外培训率均最高，麻醉师培训率最低。除儿科医生外的其他各类接产人员院内和院外培训率在三级和二级医院间差异均有统计学意义（P均＜0.05）。④2004至2010年的年活产数在三级和二级医院中均呈逐年增加趋势。三级和二级医院新生儿年死亡率和出生窒息病死率均呈下降趋势，但总体上三级医院高于二级医院。二级医院重度窒息占出生窒息的比例总体上高于三级医院。结论需加强各类接产人员复苏培训，提高复苏人员的复苏技能及理论水平，购置必备的复苏设备，进一步改善各级医院现有的复苏条件。
목적：대절강성삼급화이급의원신생인질식복소급인원배훈정황진행기선조사。방법채용분층수궤추양법재절강성11개지급시중매개지급시이추첨법추취5소의원삼여조사，기중지급시의원2소，현급의원3소。자제조사문권，내용포괄신생인복소개전정황，인원배훈，산방、수술실복소설비정황，신생인출생질식발생화사망정황。결과10/11개지급시49가의원납입분석，기중삼급의원23가（46.9％），이급의원26가。①49가의원균유개전신생인질식복소창구적능력，삼급의원균정기거판신생인복소배훈。삼급의원 NICU 병방배비솔고우이급의원（87.0％ vs 34.6％，P =0.0018）。②필비설비적배비：삼급화이급의원산방화수술실재신생인복소기낭、복사보온태、후경、기관도관화신생인면조적배비솔균초과90％。고급설비적배비：삼급의원산방화수술실혈양포화의배비솔교고（72.7％），제정맥도관、후관、T조합복소기화공양혼합기적배비솔균저우50％。③무론시삼급환시이급의원，인과의생원내화원외배훈솔균최고，마취사배훈솔최저。제인과의생외적기타각류접산인원원내화원외배훈솔재삼급화이급의원간차이균유통계학의의（P균＜0.05）。④2004지2010년적년활산수재삼급화이급의원중균정축년증가추세。삼급화이급의원신생인년사망솔화출생질식병사솔균정하강추세，단총체상삼급의원고우이급의원。이급의원중도질식점출생질식적비례총체상고우삼급의원。결론수가강각류접산인원복소배훈，제고복소인원적복소기능급이론수평，구치필비적복소설비，진일보개선각급의원현유적복소조건。
Objective To evaluate the situation about carrying out neonatal resuscitation,equipments,personnel training in medical institutions and situations about newborn asphyxia and death in Zhejiang Province. Methods Five health care institutions (2 city-level and 3 county-level)were randomly selected from each city in total 11 cities. Questionnaire surveys were performed about carrying out neonatal resuscitations practice,personnel training and delivery room,operating room resuscitation equipments, situations about newborn asphyxia and death. Results In total of 49 hospitals from 10 cities were included in the survey. All of 49 (100%)hospitals had the ability to carry out neonatal resuscitation. Neonatologist or pediatrician would be the key personnel to resuscitate high-risk newborns in tertiary and secondary hospitals;89. 8% healthcare institutions would at least have one personnel trained for neonatal resuscitation at birth;the number of NICU in tertiary hospitals was more than that in secondary hospitals (87.0% vs34.6%,P =0.002),98.0% healthcare institutions would regularly deliver(or participant)neonatal resuscitation training. 79. 6% healthcare institutions would use training aids. Various confinements personnel training rate was above the county level but below hospital training rate(P<0. 001);Above the county level training pediatricians had the highest rate(P<0. 05). Delivery room neonatal resuscitation units equipped with airbags and radiation heat rate was 100%,laryngeal mask airway was with the lowest rate;theater masks newborn,neonatal resuscitation bag,laryngoscope,suction tube,endotracheal tube with a rate lower than the delivery room. Live birth per year showed a trend of increase year by year in tertiary and secondary hospitals from 2004 to 2010. Neonatal mortality rates and incidence of birth asphyxia declined in tertiary and secondary hospitals,and higher in tertiary. Severe asphyxia rate in secondary hospital was generally higher than that in tertiary hospital. Conclusion It's essential to establish regular and systematic training system,to enhance local medical personnel recovery skills and theoretical level,to purchase the necessary resuscitation equipments,and to improve neonatal resuscitation conditions for all level hospitals.