大连地区重症医学发展概况调查

Investigation of the present critical care medicine in Dalian

目的 :了解大连地区二级及以上医院重症医学科建设现状,为大连地区重症医学的建设及发展提供参考,促进重症医疗资源的合理利用。方法 :采用网络问卷的形式,分别收集大连地区2011年11家及2015年17家综合重症监护病房(ICU)的资源情况,并进行对比分析。结果 :(1)2015年各ICU床位数、ICU床位数/医院总床位数、ICU单间数/ICU床位数、ICU医师数/ICU床位数比值、ICU护士数/ICU床位数比值分别为(19.00±12.99)张、(1.74±1.23)%、(16.64±19.51)%、(0.56±0.34)、(1.92±0.47),与2011年相比差异无统计学意义(P>0.05)。2015年大连地区三级医院的ICU医师数/ICU床位数比值与2011年相比差异具有统计学意义(P<0.05)。(2)2015年,大连地区ICU医师职称以主治医师为主(33.33%)、文化程度以硕士为主(58.93%)。(3)ICU管理模式以封闭式为主(94.12%)。(4)所有ICU均配备床旁监护仪、有创呼吸机、抗栓泵、除颤仪,但其他设备部分ICU配置不足。(5)2015年开展血液净化治疗技术、床旁超声技术及进行APACHEⅡ评分的单位的比例较2011年增加,差异具有统计学意义(P<0.05),而其他技术如主动脉内球囊反搏术(IABP)、床旁心脏起搏、高频通气(HFV)、体外膜肺氧合(ECMO)等项目则开展率较低。结论 :大连地区重症医学科建设较前已有长足发展,但距国家标准仍存在差距,在床位数、医护队伍、设备、技术技能方面亟待提高。

Objective： To investigate the current status of intensive care units （ICUs）and critical care medicine （ CCM ） at secondary and above hospitals in Dalian, and to provide support for the construction and development of ICUs and promote the reasonable use of critical medical resources. Methods ： Network questionnaire survey was conducted and information about 11 fundamental ICUs in 2011 and 17 ICUs in 2015 was collected and compared. Results： （ 1 ）The number of beds in each ICUs, the ratio of ICUs beds to total hospital beds, the ratio of independent ICUs wards to ICUs beds, the ratio of ICUs physicians to ICUs beds, the ratio of ICUs nurses to ICUs beds was （ 19.00 ± 12.99 ）, （ 1.74± 1.23 ）%, （ 16.64 ± 19.51 ）%, （ 0.56 ± 0.34 ） and （ 1.92± 0.47 ）, respectively. The difference between parameters of 2015 and those of 2011 was not significant（ P〉O.05 ）. Compared with 2011, the ratio of ICUs physicians to ICUs beds in tertiary hospitals was significantly decreased in 2015 （ P〈0.05 ）. （ 2 ）A total of 33.33% of ICUs physicians were attending doctors, and 58.93% had master degree in 2015. （ 3 ）The management mode of ICUs was mainly closed（ 94.12% ）. （ 4 ）All the ICUs had bedside monitor, invasive mechanical ventilator, antithrombotic pump and defibrillation apparatus, whereas other devices were not well equipped. （ 5 ） Compared with 2011, the utilization of blood purification technology, bedside ultrasound technology and application of APACHE II scores increased significantly in 2015 （P〈O.05）. However, the utilization of the other technologies, including intra-aortic balloon pump（ IABP ）, bedside cardiac pacing, high frequency ventilation （ HFV ）and extracorporeal membrane oxygenation （ ECMO ） was relatively low. Conclusion： The ICUs in Dalian has been developed quickly, but there was still a gap between current status and national standard. The number of ICUs beds, physicians and nurses, equipment and technology need to be improved.