基层医院开展远程胎儿监护的现状与思考

Reflection and investigation on the current situation of remote fetal monitoring system in primary hospital

目的：探讨基层医院开展远程胎儿监护的可行性及服务模式。方法采用问卷法对江苏省内71所不同级别的医院，进行助产人力资源现状和远程胎儿监护系统临床应用情况调查；随机整群抽样对基层医院130名孕产妇进行匿名问卷调查；通过对维普、万方等数据平台的文献检索，针对远程胎儿监护设备类型、运行模式和临床使用情况及存在问题等进行调查。结果二级医院产科医师充足与不充足分别为10名（24．39％）、31名（75．61％），三级医院分别为8名（61．53％）、5名（38．46％），二、三级医院差异有统计学意义（χ2＝4．572，P ＜0．05）；二、三级医院助产士均明显不足，但差异无统计学意义（χ2＝0．219，P ＞0．05）。不同文化程度、居住地、职业的孕产妇对远程胎儿监护的开展需求较为迫切，认可度较高，但认知水平不全面，其中大专以上、技术人员和城市孕妇需求最为迫切，差异均有统计学意义（均 P ＜0．05）。全国范围内使用远程胎儿监护设备的大多为三级医院，3G 网络数据传输方式使用时间短，范围小。结论现有监护系统和服务模式已不能满足实施远程胎儿监护的要求，基层医院医护人员专业素质和孕产妇综合素质是重要的影响因素。基层医院应积极推广和应用远程胎儿监护，孕产期医疗保健服务及健康教育应引起全社会的关注。

Objective To study the feasibility and care mode of remote fetal monitoring at primary hospital. Methods A questionnaire survey was administered to 71 hospitals of different levels in Jiangsu province.Question-naire content included human resources status of midwifery,the remote fetal monitoring system and its clinical applica-tion;anonymous questionnaire survey was conducted to 130 maternal women by random cluster sampling;investigation of remote fetal monitoring device type,operation mode,clinical usage and existing problems was done through the doc-ument retrieval of VIP and Wanfang data platform.Results In grade Ⅱhospital,obstetricians sufficient and insuffi-cient were 10 cases （24.39%）,31 cases（75.6%）,respectively,and in grade Ⅲ hospital were 8 cases （61.53%）, 5 cases （38.46%）,respectively,there was statistically significant difference between grade Ⅱ and grade Ⅲ hospital （χ2 =4.572,P ＆lt;0.05）;In grade Ⅱ and grade Ⅲ hospital midwives were obviously insufficient,but there was no sta-tistically significant difference between grade Ⅱ and grade Ⅲ hospital（χ2 =0.219,P ＆gt;0.05）.Different cultural lev-el,place of residence,occupation of maternal demand for the development of remote fetal monitoring were urgent and higher degree of acceptance,but the cognition was not comprehensive,college degree or above,technical personnel and urban pregnant women that their need for remote fetal monitoring were the most urgent.There were significant differ-ences（all P ＆lt;0.01）.The use of remote fetal monitoring equipment was mostly at tertiary hospital nationwide.3G net-work way to transfer data had short time and small scope.Conclusion The existing monitoring system and service mode can not meet the requirements of the implementation of remote fetal monitoring,medical personnel professional quality and maternal comprehensive quality are the main influencing factors.The primary hospitals should actively pro-mote the application of remote fetal monitoring,maternal health care services and health education should arouse the attention of the whole society.