CAJ | 학술논문

目的了解我国医疗机构新生儿复苏工作的开展情况.方法 2011年10月1日至12月31日在全国11个省、直辖市、自治区及新疆生产建设兵团随机选取163所医疗机构(三级医院51所、二级医院88所、一级医院24所)进行调查,以产科床位数达到规定数量为调查医院的入选标准.采用信函调查了解各级医院新生儿复苏工作制度的建立、人员培训、设备配备等情况.通过t检验、方差分析和x2检验比较不同级别医院间的统计学差异.结果三级、二级及一级医院活产新生儿中窒息发生率分别为2.15％(3328/154 853)、1.41％(2829/200 731)及1.50％(701/46 695)(x2=298.599,P＜0.01);分娩现场死亡率分别为0.41‰(63/154 853)、0.24‰(48/200 731)及0.60‰(28/46 695)(x2=16.993,P＜0.01);24 h内死亡率分别为0.42‰(65/154 853)、0.24‰(49/200 731)及0.62‰(29/46 695),(x2=18.075,P＜0.01).86.5％(141/163)的医院定期举办或参加新生儿复苏培训,但仅有73.0％(119/163)的医院在培训中使用了新生儿复苏培训教具.各级医院新生儿复苏的基本设备的配备率(新生儿喉镜、辐射保温台等)较高,但新指南推荐设备(如脐静脉导管、T组合复苏器、血氧饱和度仪、空氧混合器)的配备不足,例如,三级、二级及一级医院脐静脉导管配备率分别为23.5％(12/51)、10.2％(9/88)及4.2％(1/24),差异有统计学意义(x2=6.992,P＜0.05).47.9％(78/163)的医院建立了新生儿重症监护病房,三级、二级及一级医院分别为80.4％(41/51)、34.1％(30/88)及27.2％(7/24)(x2=31.677,P＜0.01);80.4％(131/163)的医院(新生)儿科医生在高危产妇分娩现场等待分娩,三级、二级及一级医院分别为94.1％(48/51)、79.5％(70/88)及54.2％(13/24)(x2=16.591,P＜0.01);88.3％(144/163)的医院定期进行新生儿科重度窒息(或死亡)病例讨论,三级、二级及一级医院分别为94.1％(48/51)、92.0％(81/88)及62.5％ (15/24)(x2 =18.388,P＜0.01).结论基层医疗机构的培训和设备配备有待加强,需促进科室间协作制度的建立,以推动新生儿复苏工作的开展. 目的瞭解我國醫療機構新生兒複囌工作的開展情況.方法 2011年10月1日至12月31日在全國11箇省、直轄市、自治區及新疆生產建設兵糰隨機選取163所醫療機構(三級醫院51所、二級醫院88所、一級醫院24所)進行調查,以產科床位數達到規定數量為調查醫院的入選標準.採用信函調查瞭解各級醫院新生兒複囌工作製度的建立、人員培訓、設備配備等情況.通過t檢驗、方差分析和x2檢驗比較不同級彆醫院間的統計學差異.結果三級、二級及一級醫院活產新生兒中窒息髮生率分彆為2.15％(3328/154 853)、1.41％(2829/200 731)及1.50％(701/46 695)(x2=298.599,P＜0.01);分娩現場死亡率分彆為0.41‰(63/154 853)、0.24‰(48/200 731)及0.60‰(28/46 695)(x2=16.993,P＜0.01);24 h內死亡率分彆為0.42‰(65/154 853)、0.24‰(49/200 731)及0.62‰(29/46 695),(x2=18.075,P＜0.01).86.5％(141/163)的醫院定期舉辦或參加新生兒複囌培訓,但僅有73.0％(119/163)的醫院在培訓中使用瞭新生兒複囌培訓教具.各級醫院新生兒複囌的基本設備的配備率(新生兒喉鏡、輻射保溫檯等)較高,但新指南推薦設備(如臍靜脈導管、T組閤複囌器、血氧飽和度儀、空氧混閤器)的配備不足,例如,三級、二級及一級醫院臍靜脈導管配備率分彆為23.5％(12/51)、10.2％(9/88)及4.2％(1/24),差異有統計學意義(x2=6.992,P＜0.05).47.9％(78/163)的醫院建立瞭新生兒重癥鑑護病房,三級、二級及一級醫院分彆為80.4％(41/51)、34.1％(30/88)及27.2％(7/24)(x2=31.677,P＜0.01);80.4％(131/163)的醫院(新生)兒科醫生在高危產婦分娩現場等待分娩,三級、二級及一級醫院分彆為94.1％(48/51)、79.5％(70/88)及54.2％(13/24)(x2=16.591,P＜0.01);88.3％(144/163)的醫院定期進行新生兒科重度窒息(或死亡)病例討論,三級、二級及一級醫院分彆為94.1％(48/51)、92.0％(81/88)及62.5％ (15/24)(x2 =18.388,P＜0.01).結論基層醫療機構的培訓和設備配備有待加彊,需促進科室間協作製度的建立,以推動新生兒複囌工作的開展.
목적 료해아국의료궤구신생인복소공작적개전정황.방법 2011년10월1일지12월31일재전국11개성、직할시、자치구급신강생산건설병단수궤선취163소의료궤구(삼급의원51소、이급의원88소、일급의원24소)진행조사,이산과상위수체도규정수량위조사의원적입선표준.채용신함조사료해각급의원신생인복소공작제도적건립、인원배훈、설비배비등정황.통과t검험、방차분석화x2검험비교불동급별의원간적통계학차이.결과 삼급、이급급일급의원활산신생인중질식발생솔분별위2.15％(3328/154 853)、1.41％(2829/200 731)급1.50％(701/46 695)(x2=298.599,P＜0.01);분면현장사망솔분별위0.41‰(63/154 853)、0.24‰(48/200 731)급0.60‰(28/46 695)(x2=16.993,P＜0.01);24 h내사망솔분별위0.42‰(65/154 853)、0.24‰(49/200 731)급0.62‰(29/46 695),(x2=18.075,P＜0.01).86.5％(141/163)적의원정기거판혹삼가신생인복소배훈,단부유73.0％(119/163)적의원재배훈중사용료신생인복소배훈교구.각급의원신생인복소적기본설비적배비솔(신생인후경、복사보온태등)교고,단신지남추천설비(여제정맥도관、T조합복소기、혈양포화도의、공양혼합기)적배비불족,례여,삼급、이급급일급의원제정맥도관배비솔분별위23.5％(12/51)、10.2％(9/88)급4.2％(1/24),차이유통계학의의(x2=6.992,P＜0.05).47.9％(78/163)적의원건립료신생인중증감호병방,삼급、이급급일급의원분별위80.4％(41/51)、34.1％(30/88)급27.2％(7/24)(x2=31.677,P＜0.01);80.4％(131/163)적의원(신생)인과의생재고위산부분면현장등대분면,삼급、이급급일급의원분별위94.1％(48/51)、79.5％(70/88)급54.2％(13/24)(x2=16.591,P＜0.01);88.3％(144/163)적의원정기진행신생인과중도질식(혹사망)병례토론,삼급、이급급일급의원분별위94.1％(48/51)、92.0％(81/88)급62.5％ (15/24)(x2 =18.388,P＜0.01).결론 기층의료궤구적배훈화설비배비유대가강,수촉진과실간협작제도적건립,이추동신생인복소공작적개전.
Objective To analyze the current status of neonatal resuscitation in medical institutions in China.Methods With the number of obstetric beds as the inclusion criteria,the survey was conducted in 163 medical institutions randomly selected in 11 provinces (including 51 tertiary hospitals,88 secondary hospitals and 24 primary hospitals) from October 1 to December 31 in 2011.The mail-questionnaire was sent to collect information about system establishment,personnel training,neonatal resuscitation equipment etc.Statistical data was analyzed by t-test,variance analysis and Chi-square test.Results The incidence of neonatal asphyxia among live birth babies was 2.15％ (3328/154 853) in tertiary hospitals,1.41％ (2829/200 731) in secondary hospitals and 1.50％ (701/46 695) in primary hospitals (x2=298.559,P＜0.01).The mortality rate during delivery was 0.41‰ (63/154 853),0.24‰ (48/200 731) and 0.60‰ (28/46 695) at the three different level hospitals,respectively (x2=16.993,P＜0.01).The mortality rate within 24 hours after delivery was 0.42‰ (65/154 853) in tertiary hospitals,0.24‰ (49/200 731) in secondary hospitals and 0.62‰ (29/46 695) in primary hospitals (x2 18.075,P＜0.01).About 86.5％ (141/163) of the included hospitals maintained routine neonatal resuscitation trainings,but only 73.0％ (119/163) applied resuscitation training equipments during the trainings.The outfit rate of basic neonatal resuscitation equipments (such as neonatal laryngoscope,radiant heater) was high in most hospitals,but the outfit rate of equipments recommended by the new guideline (such as umbilical venous catheter,T piece and oxygen saturation meter) was low.For example,the outfit rate of umbilical venous catheter was 23.5％ (12/51),10.2％ (9/88) and 4.2％ (1/24) in tertiary,secondary and primary hospitals respectively (x2 =6.992,P ＜ 0.05).47.9％ (78/163) of the hospitals had set up neonatal intensive care unit,with the proportion in tertiary,secondary and primary hospitals being 80.4％ (41/51),34.1％ (30/88) and 27.2％ (7/24),respectively (x2=31.677,P＜0.01).Most of the hospitals (80.4％,131/163) could ensure the pediatricians being presented in the delivery room for high risk women,and the proportion was 94.1％ (48/51),79.5％ (70/88) and 54.2％ (13/24) in tertiary,secondary and primary hospitals,respectively (x2 =16.591,P＜0.01).There were 88.3％ (144/163) of the hospitals had routine neonatal resuscitation case audit,with the proportion in the three different level hospitals being 94.1％ (48/51),92.0％ (81/88) and 62.5％ (15/24),respectively (x2 =18.388,P＜0.01).Conclusions Strengthen the training,equipment and system establishment in primary medical institutions is conducive to promote neonatal resuscitation.