新疆维吾尔自治区二级（含）以上医院重症加强治疗病房基本建设情况的调查分析

A survey of present basic constructive situation of intensive care units in second and tertiary grade hospitals in Xinjiang Uygur Autonomous Region

目的调查新疆维吾尔自治区二级（含）以上医院重症加强治疗病房（ICU）基本建设情况的现状，为全疆ICU建设提供依据。方法选择2012年12月至2013年4月新疆维吾尔自治区49家二级（含）以上医院作为调查对象，通过问卷方式抽样调查二级（含）以上医院ICU的基本情况，问卷内容主要包括医疗单位基本情况、ICU建设基本情况、ICU人力资源情况、ICU设备配备情况。结果发放问卷49份，回收49份，回收率为100％。全疆已建立ICU的二级（含）以上医院共49家，建设各类ICU66个。①医疗单位基本情况：二级甲等（二甲）医院占59．2％，三级甲等（三甲）医院占34．7％；医院行政归属以地方医院比例较大（占67．3％）；医院规模以500张以上床位的医院为主（占57．14％），设置编制床位共41403张，开放床位35442张，床位开放率为85．60％。②ICU建设基本情况：ICU建设时间主要集中在2000年以后，其中2000年至2010年共建设37个，2010年至2012年共建设12个；开放时床位相对较少，10张床位以下规模的ICU占79．00％。接受调查的66家ICU中，综合ICU的比重最大，达43个；其次是急诊ICU7个；神经外科及心外科ICU最少，仅各有1个。66家ICU共设置床位765张，实际开放床位808张，ICU规模以5～20张为主，占全部ICU的71％。全疆各级医院ICU目前床位开放使用情况均在80％以上，其中56％的医院几乎处于满运转状态。③ICU人力资源情况：全疆ICU医师总数达484人，全职医护比例达到1：3．50，床位医师比例为1：0．55，床位护士比例为1：0．92；人员职称以住院医师为主，各层次职称梯度良好；学历层次以本科为主体，硕士以上人才较少；医师专业背景主要为重症医学专业、急诊医学专业、呼吸内科专业，专业相关性良好；ICU医师专业学习的主要方式为国内进修，本专业继续教育情况普遍较差，多数医师每年仅参加1次继续教育项目或未参加；获得中国重症医学专科资质认证资质的医师仅占23．56％。③ICU设备配备情况：按ICU建设指南的要求，必备设备中以床边监护仪（703台）、呼吸机（516台）、静脉输液泵（702台）配备比例最高；选配设备中以肠内营养泵（89台）、血糖检测仪（57台）及防褥疮床垫（54台）配备数量最多，脑电双频指数监护仪（2台）、体外膜肺氧合（ECMO，1台）、胃黏膜二氧化碳张力pHi测定仪（0台）配备数量最少。结论新疆全区ICU建设尚处于发展中阶段，仍需进一步加强规范化建设；人力资源及设备等区域分布失衡，需进一步调整以利于全区ICU发展。

Objective To collect the data of present basic constructive situation of intensive care units （ICUs） in second and tertiary grade hospitals in Xinjiang Uygur Autonomous Region and to provide a data base beneficial to the construction of ICUs in the whole region. Methods The information including basic situation of ICUs in a total of 49 second and tertiary grade hospitals as samples in Xinjiang Uygur Autonomous Region were investigated by questionnaire survey from December 2012 to April 2013. The contents of questionnaire chiefly included the basic situations of hospitals, ICU constructions, ICU human resources and allocation of equipments. Results Forty-nine questionnaires were sent out, and all of them gave answers, the recovery rate being 100%. In the whole region of Xinjiang, there were 49 second and tertiary grade hospitals with establishment of 66 various types of ICUs. @ Medical unit basic situation： the second grade A hospitals accounted for 59.2%, and the tertiary grade A hospitals, 34.7%. There was a larger proportion of local hospitals （67.3%）; most of the hospitals had beds over 500 （57.14%）, the designed hospital bed number was 41 403, and 35 442 beds were open up for service （85.60%）. @ The ICU basic construction situation： the construction of ICUs concentrated mainly after the year 2000, from 2000 to 2010, a total of 37 units, and from 2010 to 2012, 12 units were constructed; when they opened to the public, the beds were relatively few, and the ICUs containing less than 10 beds occupied 79.00%. In the 66 ICUs surveyed, there were 43 general ICUs, accounting the largest proportion, followed by 7 emergency ICUs, and the least were 1 neurosurgery and 1 cardiac surgery ICU. In the 66 ICUs, all together 765 beds were prepared, but actually 808 beds were opening up to public; most of ICUs had 5 - 20 beds, accounting for 71% in all the ICUs. At present, in the whole Xinjiang region, the rate of beds in ICUs in various grades of hospitals opening to the outside for use accounted for more than 80% of which 56% ICUs were almost turning round fully. （~） ICU human resources situation： totally, there were 484 doctors in ICUs in the whole region, the ratio of full-time doctor to nurses was 1 ： 3.50, the ratio for bed to physician 1 ： 0.55 and the ratio for bed to nurse 1 ： 0.92. The title of doctor was primarily resident, and the various title gradient levels were good. Most doctors graduated from a regular medical college, and the doctors having obtained a master degree were few. The physician professional backgrounds were mainly critical disease medicine, emergency medicine and respiratory medicine, the professional relevance being good; the chief way of ICU physicians to engage in advanced study of their professional training was in China, and generally they joined professional continuing education programs poorly, mostly joining once a year or non at all. The physicians who obtained the identification of Chinese critical care medicine specialist accounted only for 23.56%. （~） ICU equipment allocation situation： according to the requirements of ICU construction guidelines, the equipments must he allocated including bedside monitors （703 units）, ventilators （516 units） and infusion pumps （702 units）, occupying the highest proportion. In the optional equipments, there were enteral nutritional pump （89 stations）, blood glucose monitoring device （57 units） and anti-decubitus mattresses （54 units）, the proportion being the largest, bispectral index monitor （2 units）, extracorporeal membrane oxygenation （ECMO, 1 table） and gastric mucosal carbon dioxide tension pHi meter （0 unit）, the proportion being the least or non at all. Conclusions In the whole Xinjiang region, the construction of ICUs is still at the developing stage, and needs to further strengthen the standardized construction. The human resources, equipments, etc. are not distributed in balance, and it is necessary to move forward the adjustment to benefit the development of ICUs in the whole region.