农村地区产科出血综合防治干预研究

Research for intervention of the comprehensive prevention and treatment model of obstetric hemorrhage in rural area

目的探索在农村地区应用产科出血综合防治模式对降低产科出血发生的有效性。方法采用前瞻性研究方法,在53所助产机构应用＂产科出血综合防治模式＂,对比干预前后的各项指标变化,评价效果。结果干预后设置高危筛查门诊、开展高危筛查的机构比例及产科出血高危因素检出率升高（86.79%vs31.57%,96.23%vs 71.93%,48.98%vs 20.96%,χ^2=34.411、10.139、985.785,均P〈0.05）;产科出血报告率由1.28%提升到干预后的2.89%（χ^2=36.417,P〈0.01）,其中严重产科出血比例下降（9.26%vs40.54%,χ^2=32.209,P〈0.01）;集血器配置比例增加、产科出血测量方法改善,产科出血防治适宜技术应用得到推广,死于产科出血的孕产妇从干预前66.7%下降到0,取得了显著效果。结论在农村地区进行产科出血综合防治干预,提高了医务人员对产科出血的高危因素筛查、早期识别和及时救治的能力,降低了我国农村地区产科出血及所致的孕产妇死亡率。

Objective To explore the effectiveness of the comprehensive prevention and treatment model of obstetric hemorrhage on reducing the obstetric hemorrhage in rural area.Methods The prospective study was conducted in 53 midwifery organizations.The comprehensive prevention and treatment model of obstetric hemorrhage was adopted in these organizations and the difference of indicators before and after the intervention was used to evaluate the effectiveness of this model.Results The rate of setting high-risk factors screening clinic,conducting highrisk factors screening,and the detection rate of high-risk factors were increased from 31.57%,71.93%,and20.96% before the intervention to 86.79%,96.23% and 48.98%,respectively（theχ~2-value were 34.411,10.139,and 985.785 respectively and the average P〈0.01）.The reporting rate of obstetric hemorrhage increased from 1.28% before the intervention to 2.89% afterwards（χ~2=36.417,P=0.000）,of which the incidence of severe obstetric hemorrhage decreased significantly（9.26%% VS40.54,χ~2=32.209,P=0.000）.The use of the blood collector was increased,the measurement for obstetric hemorrhage was improved,and the appropriate treatment technology for obstetric hemorrhage prevention was popularized.The mortality rate of obstetric hemorrhage decreased from 66.7%to 0.Conclusion The promotion of the comprehensive prevention and treatment model of obstetric hemorrhage in rural area could improve the ability of medical staff on screening,early detection,and timely treatment of obstetric hemorrhage and reduce the mortality rate of obstetric hemorrhage in rural China.