产前超声筛查技术规范化管理与效果评价

Standardized management and assessment of prenatal ultrasound screening

目的 探讨产前超声筛查技术规范化培训考核及管理在提高出生缺陷检出率中的效果。方法 根据对北京市超声产前筛查／诊断技术进行规范化管理程度，将2004年度至2009年度分为3个不同的管理阶段（年度指前一年10月1日至统计年度9月30日）。应用检出率描述不同管理阶段5199例出生缺陷监测个案的产前超声筛查情况。采用正确率描述2009年超声人员的超声图片认读情况。应用SPSS11．5软件分析2007年10月至2009年9月参加培训考核的707人的基本情况，通过X2检验比较超声考核通过组和未通过组在相关变量中分布的差异，探讨产前超声筛查人员操作水平的相关影响因素。结果 随着培训考核方式的不断改进，不同阶段的出生缺陷个案超声产前畸形检出率逐渐提高，2004年度至2005年度为32．43％，2005年度至2007年度为44．81％，2007年度至2009年度为60．71％。2009年187人对各类出生缺陷超声图片认读的正确率由高至低分别为腹裂、总唇裂、脐膨出、神经管缺陷、严重的先天性心脏病、肢体短缩，与同年各类型产前超声筛查的出生缺陷检出率相一致。产前超声筛查人员技术水平的影响因素中，考核通过组与未通过组比较，大学及以上文化程度者的比例高（52．8％和47．2％），每月超声筛查量≥50例者比例高（50．5%和49．5％），从事产科超声工作〉3年者多（52．5％和47．5％），在产前诊断机构进修者比例高（64．7％和35．3％）。结论 产前超声筛查技术规范化培训与管理有效地提高了出生缺陷产前超声检出率。产前超声筛查技术水平与操作人员学历水平及是否相对固定从事产前超声检查工作有关。

Objective To evaluate the effect of standardized training and management of prenatal ultrasound screening on birth defects. Methods According to the degree of standardized training and management of prenatal ultrasound screening, the period from March 2004 to December 2009 were divided into three different management stages. Detection rate was applied to describe the prenatal ultrasound screening of 5199 birth defects cases delivered during the three different management stages. Accuracy rate was used to describe the ultrasonographic diagnosis made by staffs in 2009. SPSS 11. 5 software was used to analyze the information of 207 staffs participated in the training and assessment activities from October 2007 to September 2009. Related factors of prenatal ultrasound operating skills of staffs were analyzed by comparing the distributing discrepancy of the different variables between qualified and unqualified group with Chi-square test. Results The detection rate of prenatal ultrasonographic screening on birth defects increased with the improvement of training and assessment methods, which was 32. 43% from March 2004 to September 2005, 44.81% from October 2005 to September 2007 and 60. 71%from October 2007 to December 2009 respectively. In 2009, 187 doctors were tested on abnormal ultrasound photographs identification. The accurate rates were 80.0% for gastroschisis, 78.8% for cleft clip, 75.8%for omphalocele, 71.8%for neural tube defects, 50.0% for severe congenital heart diseases, 31.0% for acromicria, which were in similar sequence as the diagnostic rate identified by prenatal ultrasound in 2009. Among the staffs attending the prenatal ultrasound screening assessment, more had education background at least university level （52.8% vs 47.2%）, more performed ≥50 ultrasound screenings per month （50.5% vs 49.5%）, more had been working on obstetric ultrasound over 3 yrs （52.5% vs 47.5%） and more had been trained in higher level of hospitals focused on prenatal diagnosis （64.7%vs 35.3%） in the qualified group than in the unqualified group. Conclusions Standardized training and management of prenatal ultrasonographic screening could effectively improve the diagnosis rate of birth defects. The quality of prenatal ultrasound screening is related to the staff＇s education background and whether they are engaged in the position.