如皋市民营一级医院新生儿复苏现状分析

Current status of neonatal resuscitation in private primary medical institutions in Rugao

目的了解民营一级医院新生儿复苏情况。方法通过调查表、现场考察核实、档案资料筛查等方法 ,调查41家民营一级医院新生儿复苏人员配备、设备、培训、新生儿窒息死亡儿童抢救处理、危重儿转送等情况。结果 41家医院产妇数占全市产妇总数的58.20%(7 100/12 200)。妇产科医务人员199人,其中执业医师145人,中级及以上职称者82人,专职儿科医生35人。均配备有较齐全的新生儿复苏设备。新生儿复苏专题培训1次,现场考核合格率为36.59%(15/41),按产妇人数分类:≥300例的医院合格率为77.78%(7/9)、200~299例的医院合格率为20%(1/5)、100~199例的医院合格率为45.45%(5/11)、1~99例的医院合格率为12.5%(2/16),差异有统计学差异(x^2=11.55,P<0.05)。年度新生儿窒息死亡率为9.79/万(12/12 257),有高危因素者占91.67%(11/12),75%的新生儿窒息得到复苏处理(9/12),44.44%的复苏处理记录规范(4/9)。60.98%的医院选择救护车转送危重新生儿(25/41)。结论基层、农村是新生儿复苏推广应用的重点,民营一级医院务必贯彻落实新生儿复苏指南(2011年北京修订),卫生行政部门务必加强宏观调控,构建新生儿复苏培训与救治体系。

Objective To analyze the neonatal resuscitation in private primary medical institutions in Rugao. Methods Questionnaire, field investigation and archives screening methods were used to survey personnel, equipment, training, rescue treatment of neonatal asphyxia and transferring infants with critical illness in 41 private primary medical institutions. Results The number of lying-in women in these 41 hospitals accounted for 58. 20% （7 100/12 200） of the total number in the city. There were 199 personnel in the department of obstetrics and gynecology, including 145 practicing physicians, 82 staff with intermediate or above professional title, and 35 full-time pediatric physicians. Good neonatal resuscitation equipments were equipped. Neonatal resuscitation training was held for one time, and the pass rate of on-site examination was 36. 59% （15/41）. Classified by number of lying-in women, the pass rate of the hospital with more than 300 lying-in women was 77. 78% （7/9）, that of the hospital with 200-299 lying-in women was 20% （1/5）, that of the hospital with 100-199 lying-in women was 45. 45% （5/11）, and that of the hospital with 1-99 lying-in women was 12. 5% （2/16）. The difference among them was significant （χ2 =11. 55,P〈0. 05）. Annual asphyxia neonatal mortality was 9. 79/10 000 （12/12 557）, including 91. 67% with high risk factors （11/12）. Resuscitation treatment was provided for 75% （9/12） newborns with asphyxia, and 44. 44% （4/9） of them were normatively recorded. There were 60. 98% hospitals choosing to transfer high-risk newborns with ambulance. Conclusion The countryside is the key of neonatal resuscitation promotion. The Neonatal Resuscitation Guidelines （ 2011 amended in Beijing ） must be implemented in private primary medical institutions. Health administrative department should strengthen macro-regulation and build a neonatal resuscitation training and treatment system.