对新生儿窒息新法复苏实施强化培训效果的评价

Efficacy of the intensive training of new resuscitation technique on newborn infants with asphyxia

目的 探讨理论与操作相结合的强化培训模式对落实新法窒息复苏规范操作、提高复苏质量、降低新生儿窒息发生率和病死率的影响。方法 采用理论与实践相结合、技术骨干“一对一”、“手把手”操作指导的培训模式进行窒息复苏方法培训，比较强化培训前后市、镇（区）医院ABCD复苏的规范操作、复苏用药及治疗转归情况。结果 （1）培训前新生儿窒息发生率为2．67％，培训后第1年窒息发生率为2．21％，比培训前明显下降，差异有统计学意义（χ^2=12．581，P〈0．01）；培训后第2、3年窒息发生率分别为2．44％和2．45％，虽比培训前下降，但差异无统计学意义。培训前规范复苏为51．3％，培训后第1年提高至75．7％，第2、3年分别降至62．7％和51．6％，差异均有统计学意义（P均〈0．01）；（2）培训前复苏中用药的患儿占63．8％，培训后第1、2和3年分别降至45．0％、50．0％和49．2％，差异有统计学意义（P〈0．01）；（3）市、镇（区）医院经初步复苏后需要继续复苏者分别为89．9％和85．7％，规范复苏分别为83．7％和48．6％，使用一种或多种药物复苏分别为42．2％和79．2％，其中不合理用药分别为15．3％和39．4％，差异均有统计学意义（P均〈0．01）；（4）培训前新生儿窒息病死率为9．05％，培训后降至5．08％，差异有统计学意义（P〈0．05）。市、镇（区）医院培训后治疗转归情况好于培训前，差异有统计学意义（P均〈0．05）。结论 在行政干预下，采用理论与实践相结合的重点培训模式可明显提高新生儿窒息复苏培训效果。但复苏技术仍存在误区和不规范操作，镇（区）医院仍是复训的重点，复训间隔时间不能超过两年。

Objective To investigate the efficacy of intensive training of new resuscitation technique on the newborn infants with asphyxia. Methods The doctors were intensively trained on the new resuscitation technique with the combination of the theory and practice. And the situations of formal ABCD resuscitation technique performance, the drug administration and patient prognosis before and after the training were compared. Results （1） Before training, the incidence of neonate asphyxia was 2. 67 %, and decrease to 2. 21% one year after （χ^2 = 12. 581, P〈0. 01）;But no similar results were found at the second and the third year after training. Before training, the rate of formal resuscitation performing was 51.3 %, improved to 75.7 % one year after and decreased to 62.7 % at the second year and 51.6% at the third year（P〈0.05）. （2） The rate of drugs administration was decreased to 45.0% （first year）, 50.0% （second year） and 49.2% （third year） after training compared with that before （63.8%） （P〈0. 01）. （3） The percentage of the patients requiring continuing resuscitation after primary treatment was 89.9 % in city hospital and 85.7 % in town hospital, while the formal resuscitation was performed on 83.7% and 48. 6% of the patients, respectively （P〈0. 01）. And the rate of one or more drugs administration was 42.2% and 79.2 % respectively, while unreasonable administration rate was 15.3% and 39.4%, respectively （P〈0. 01）. （4） The mortality of neonatal asphyxia in city hospital decreased from 9.05 % before training to 5.08 % after training （P〈0.01）. The prognosis of neonate asphyxia in city and town hospital were improved significantly, respectively（P〈0.05）. Conclusions With the governmental intervention, the intensive training approach can improve the efficacy of training. But there are still some mistakes and unstandard manipulations during the implementation of the resuscitation technique. The re-training of the doctors in town hospital is very important, and the interval of re-training should not be longer than 2 vears.