公立综合医院计划性剖宫产的过程质量分析

Analysis of the Process Quality of Planned Caesarean Section in Public General Hospitals

目的分析上海市浦东新区区属公立综合性医院计划性剖宫产诊疗的过程质量。方法根据原卫生部提出的计划性剖宫产临床路径要求,对浦东新区7所区属公立综合性医院计划性剖宫产病案进行评价。结果 (1)浦东新区区属公立综合性医院计划性剖宫产诊疗基本符合国家对计划性剖宫产临床路径的要求。(2)无临床指征的计划性破宫产率较高(42.47%)。(3)各类医院表现不一,北区二级医院剖宫产产妇使用2种或3种抗菌药物的比例显著较高(28.24%),三级医院剖宫产产妇全部实施腰麻。结论浦东新区卫生行政部门和医院应进一步加强计划性剖宫产质量管理,降低无临床规范临床指征剖宫产率,规范抗菌药物使用和麻醉方式选择。

Objective To analyze the process quality of planned caesarean section in public general hospitals of Pudong New Area in Shanghai. Methods Planned caesarean section records of 7 public general hospitals of Pudong New Area were evaluated according to the guideline issued by primary Ministry of Public Health. Results （1） The diagnosis and treatment of planned caesarean section in public general hospitals of Pudong New Area was basically compliant with the requirements of Clinical Pathways for planned caesarean section of China. （2） The proportion of pregnant women with no clinical indications was quite high （42.47%） . （3） The performance of different kinds of hospitals was different. The proportion of pregnant women who used 2 or 3 kinds of antibiotics in north secondary hospitals was higher than pregnant women in other hospitals （28.24%） . Besides, all pregnant women in tertiary hospital implemented spinal anesthesia. Conclusion Health administrative departments and hospital in Pudong New Area should strengthen the quality management. The proportion of planned caesarean section pregnant women with no clinical indications should be reduced. Antibiotics should be selected appropriately, and anesthesia should be stan- dardized.