基层新生儿复苏技术培训模式的探索及效果评价

Primary neonatal recovery technology training model explore and effect evaluate

目的探索基层推广"新生儿复苏"技术培训的方法。方法 1选取新生儿窒息发生率较高的山区县和川区县各一个作为研究地区,选择经济基础相当的山、川区县各一个作为对照地区;2采取问卷调查和现场调查相结合的方式,对研究地区和对照地区进行调查;3对两个地区县级以上医疗保健机构产儿科、麻醉科医护人员统一进行规范化"新生儿复苏"培训,培训后完成理论和操作考核;4对研究地区采取驻县专家蹲点的形式,定期深入助产机构,对业务人员进行新生儿复苏技术现场培训,对制度的建立进行督导,对照地区无上述措施。结果 1培训后业务人员知识知晓率(t=6.223,P=0.000)及复苏流程操作的掌握程度(t=6.538,P=0.000)与培训前相比明显提高。半年后,研究地区业务人员知识知晓率(t=1.848,P=0.076)及复苏流程操作(t=1.364,P=0.185)保持较好,对照地区业务人员知识知晓率(t=7.41,P=0.000)及复苏流程操作(t=13.82,P=0.000)明显下降,差异均有统计学意义;2研究地区新生儿窒息发生率由2.07%下降至1.48%(χ2=7.41,P=0.006),窒息死亡率由164.43/10万下降至54.63/10万(χ2=4.03,P=0.0447);对照地区上述变化无统计学意义;3研究地区医疗保健机构新生儿复苏设备配备齐全,建立了院内新生儿复苏制度,对照地区部分机构手术室设备不全,尚未建立院内新生儿复苏制度。结论采取驻县专家蹲点的形式,有助于基层人员新生儿复苏技能的提高,促进院内新生儿复苏制度的建立,有利于降低新生儿窒息发生率和窒息死亡率。

Objective To explore a practical and feasible technical training method of＂recovery＂newborn in primary institution.Method 1 One Mountain area and one Sichuan county which had high incidence of neonatal asphyxia were selected as study areas,at the same time,two economic base quite 1 Mountain area and 1 Sichuan county which had same economic base with study areas were also selected as control areas. 2 Questionnaire survey and field investigation carried out in study areas and control areas. 3 In the study areas and control areas,the staffs of pediatrics,anesthesia who from medical and health institutions above the county level all participated in standardization ＂ neonatal recovery training,and completed theory and operation test. 4 In study areas,experts cased in midwifery institutions in the county level and carried out neonatal resuscitation technology on-site training; supervise the condition of system establishment. In control areas,the methods did not carry out. Results 1 After training,the staffs＇ knowledge aware and master degree of recovery process operation were all improved than before the training; After six months,the staffs in study area keep the knowledge aware and recovery process operation well,but the knowledge aware and recovery process operation of the staffs in control areas decreased,the difference was statistically significant. 2 In study areas,the incidence of neonatal asphyxia fell from2. 07% to 1. 48%（ χ2= 7. 41,P = 0. 006）,the incidence of suffocation death dropped from 54. 63 /105 to 164. 43 /105to（ χ2= 4. 03,P = 0. 0447）. 3Health care institutions in study area were equipped with neonatal resuscitation equipment completely,and established hospital neonatal recovery system; but in control areas,some health care institutions were not equipped with neonatal resuscitation equipment completely,and did not establish hospital neonatal recovery system. Conclusion Experts casing in county is contribute to help staffs improve neonatal resuscitation technology and promote the hospital establishment neonatal recovery system,and in order to reduce the incidence of neonatal asphyxia and the suffocation deaths.