我国4县开展新生儿复苏长效机制试点干预效果评价

Effect of a pilot intervention on setting up long-term mechanism of neonatal resuscitation training in 4 counties in China

【目的】评价在县级医疗机构开展新生儿复苏长效机制试点干预的效果,以便总结经验,在全国基层医疗机构推广。【方法】采用随机对照的研究方法,选择在中澳卫生与艾滋病项目确定的4个对照县进行调查并与干预县进行比较。调查内容包括医务人员新生儿复苏相关知识与自信心水平、新生儿复苏制度建设、新生儿窒息发生及死亡变化情况。【结果】1)干预县新生儿科医生参加高危分娩术前讨论、分娩现场等待分娩、参加新生儿窒息病例评审等制度建立率均在90%以上,对照县均低于55%。2)干预县和对照县医务人员新生儿复苏知识平均得分分别为(9.19±1.18)和(8.40±1.52)分(t=3.922,P<0.001),自信心平均得分分别为(57.33±2.50)和(54.09±8.19)分(t=3.541,P=0.001);对照县医务人员核心知识的回答正确率均低于70%,且均显著低于干预县。3)干预县新生儿窒息发生率由8.83%下降至5.99%(χ2=11.300,P=0.001),因窒息死于分娩现场率由27.60/105下降至5.03/105(χ2=3.142,P=0.076);对照县这两个率的变化均无统计学意义。【结论】通过在县级医疗机构建立新生儿复苏工作机制,可加强院内新生儿复苏培训、促进科室间协调,提高医务人员技术水平,降低新生儿窒息发生率和死亡率。

[Objective] To evaluate the effect of a pilot intervention on setting up long-term mechanism of neonatal resuscitation training in 4 counties in China. [Methods] A random control survey was conducted in the intervention counties and 4 randomly selected control counties in the China-Australia Health HIV/AIDS Facility（CAHHF）project to evaluate the impact of intervention. The contents of the survey included knowledge and self-confidence score of health pro- viders,in-hospital regulations and rules,and changes of asphyxia incidence and mortality. [Results] 1） Over 90~ of in- tervention hospitals had carried out neonatal resuscitation related regulations requiring that trained paediatricians participate in case discussion of high-risk delivery and onsite resuscitation, while in control hospitals less than 55% had such require- ments. 2） The average knowledge score of health providers in the intervention and control counties were 9.19± 1.18 and 8. 40±1.52 respectively （t=3. 922,P〈0. 001）. The average self-confidence score in the two groups were 57.33±2.50 and 54.09±8.19 respectively （t=3. 541 ,P=0. 001）. For some core questions,the correct answer rates were less than 700/00 in the control group and was significantly lower than that in the intervention group. 3） The incidence of birth asphyxia （defined as Apgar score^7） decreased from 8.83% to 5.99% （χ2=11. 300,P=0. 001） in the intervention counties,and the intrap- artum-related deaths in the delivery room decreased from 27.60/10s to 5.03/105 （χ2 = 3. 142, P = 0. 076）. No significantly changes of asphyxia incidence and mortality were found in the control counties. [Conclusions] Setting up long-term mechanism of neonatal resuscitation training is an effective method to strengthen in-hospital training, promote department coordination, build up capability for neonatal resuscitation and therefore,can decrease the incidence of neonatal asphyxia.