改进产前地中海贫血预防控制项目管理流程的效果评价

Evaluation on the Effect of Improving the Management Process of Prenatal Thalassemia Prevention and Control Project

目的:探讨改进地中海贫血预防控制项目管理流程对提高地中海贫血产前初筛完成率,降低严重地中海贫血儿出生的影响。方法:选取2018年1月至12月(改进地中海贫血预防控制项目管理流程前)在深圳市第二人民医院初次产检行地中海贫血产前筛查的夫妇设为对照组,2019年1月至12月(改进地中海贫血预防控制项目管理流程后)在深圳市第二人民医院初次产检行产前地中海贫血筛查的夫妇设为观察组。对照组夫妇首次产检常规按照深圳市地中海贫血预防控制项目管理流程执行地中海贫血初筛:行双方血常规检查,有一方或双方的平均红细胞体积(MCV)和(或)平均红细胞血红蛋白含量(MCH)异常,需双方再次返院进行血红蛋白电泳分析,若双方血常规的MCV和MCH均无异常,则地中海贫血初筛正常完成;观察组实施改进后的地中海贫血初筛流程:在夫妇进行血常规采血的同时,两人各多抽取一管血留作备用,若一方或双方的MCV或(和)MCH异常,可立即进行双方血红蛋白电泳分析,若双方血常规的MCV和MCH无异常,则地中海贫血初筛正常完成,预留血样丢弃或告知孕妇夫妻可用作其他检验项目。比较两组夫妇血常规异常率、后续1个月内血红蛋白电泳分析检测率、地中海贫血初筛完成率、分娩孕前未诊断的中重型地中海贫血患儿情况等,评价改进产前地中海贫血预防控制项目管理流程的效果。结果:最终观察组纳入2851对夫妇,对照组纳入3012对夫妇。对照组夫妇的产前初筛完成率为90.11%,观察组夫妇为99.93%,高于对照组,差异具有统计学意义(P<0.05);对照组血常规异常夫妇的血红蛋白分析率为67.54%,观察组为100.00%,组间比较,差异具有统计学意义(P<0.05)。对照组分娩1例中重型α地中海贫血患儿,且孕妇在分娩孕前未诊断,观察组则无;两组均不存在中重型β地中海贫血患儿。结论:改进地中海贫血预防控制项目管理流程可有效提高血红蛋白电泳分析检测率和地中海贫血产前初筛完成率,有利于降低严重地中海贫血儿数量。

Objective To explore the effect of improving the management process of thalassemia prevention and control project on improving the completion rate of prenatal screening for thalassemia and reducing the birth of children with severe thalassemia.Methods A total of couples who underwent prenatal screening for thalassemia for the first time in Shenzhen Second People’s Hospital from January to December 2018(before improving the management process of thalassemia prevention and control project)were selected as the control group.From January to December 2019(after improving the management process of thalassemia prevention and control project),the couples who performed prenatal thalassemia screening at the first antenatal examination in Shenzhen Second People’s Hospital were set as the observation group.The first routine antenatal examination of the couples in the control group were routinely screened for thalassemia according to the management process of the thalassemia prevention and control project in shenzhen:the blood routine examination of both parties showed that the mean corpuscular volume(MCV)and(or)mean corpuscular hemoglobin content(MCH)of one or both parties were abnormal,both parties should return to the hospital again for hemoglobin electrophoresis analysis.If the MCV and MCH of blood routine examination of both parties were normal,the primary screening of thalassemia was normally completed.The observation group implemented the improved primary screening process of thalassemia:while the couples were taking blood from blood routine tests,each of them took one more tube of blood for standby.If the MCV or(and)MCH of one or both parties were abnormal,hemoglobin electrophoresis analysis of both parties could be carried out immediately.If the MCV and MCH of the blood routine tests of both parties were normal,the primary screening of thalassemia was completed normally.The reserved blood samples were discarded or informed to the pregnant couple that it can be used as other test items.Compare the abnormal rate of blood routine examination,the detection rate of hemoglobin electrophoresis analysis within the following month,the completion rate of primary screening for thalassemia,and the situation of children with moderate and severe thalassemia not diagnosed before delivery and pregnancy between the two groups,and evaluate the effect of improving the management process of prenatal thalassemia prevention and control project.Results Finally,2851 couples were included in the observation group and 3012 couples were included in the control group.The completion rate of prenatal screening was 90.11%in the control group and 99.93%in the observation group,which was higher than that in the control group,and the difference was statistically significant(P<0.05).The hemoglobin analysis rate of the couples with abnormal blood routine examination in the control group was 67.54%,and 100.00%in the observation group.the difference between the two groups was statistically significant(P<0.05).One child with moderate and severeα-thalassemia was born in the control group,and the pregnant woman was not diagnosed before delivery,while there was no case in the observation group.There were no children with moderate and severeβ-thalassemia in the two groups.Conclusion The improvement of the management process of thalassemia prevention and control project can effectively improve the detection rate of hemoglobin electrophoresis analysis and the completion rate of prenatal screening for thalassemia,which is conducive to reducing the number of infants with severe thalassemia.