临床路径管理新模式在母婴阻断项目中的应用研究

Application of new model of clinical path management on the prevention of AIDS,syphilis and hepatitis B

目的统计分析湖南省岳阳市妇幼2012-2016年终报表,探讨分析路径管理新模式在预防艾滋病、梅毒、乙肝母婴传播项目应用中的成效。方法采用回顾性分析方法,选择2012年1月-2016年12月岳阳市收治产妇及分娩新生儿作为研究对象,分析岳阳市母婴阻断公共卫生项目近几年实施成效,探讨项目目前存在的问题及改进措施。结果岳阳市在实施母婴阻断临床路径管理后,HIV、梅毒、乙肝抗体检测的孕妇检测率、孕期检测率在原来的基础上有了较大提升,孕期检测率分别由2012年的82.42%、81.54%、84.9%提升至2016年的97.07%、97.05%、97.5%,梅毒感染孕产妇干预率、新生儿阻断率由2012年的69.87%、96.63%,到2016年分别提升至100%、99.46%,乙肝感染孕产妇所生新生儿注射乙肝免疫球蛋白率由85.46%提高至99.88%。结论本模式通过采取加强领导、加强培训与宣传、制定检测流程、加大财政投入等一系列措施,提高了岳阳市整合服务管理能力,最大程度减少了艾滋病、梅毒和乙肝母婴传播所造成的儿童感染。但仍然存在不足之处,亟需改进,应进一步提高预防艾滋病、梅毒、乙肝母婴传播项目实施效果,从而有效改善妇女、儿童的生活质量及健康水平。

Objective To analysis the data of year-end statements about women and children from 2012 to 2016 in Yueyang city of Hunan province, in order to explore the application effect of clinical path management in the prevention of AIDS, syphilis and hepatitis B （PMTCT） program. Methods Retrospective analysis was used in this study; the women for delivering and their newborn were selected as research objects which were hospitalized in the hospitals of Yueyang city from January 2012 to December 2016, and to analysis the implementation effect of PMTCT public health project in recent years in Yueyang, in order to find the existing problems and improvement measures of the project. Results After the implementation of PMTCT clinical path management, the detection rate of pregnancy women and during the pregnancy of HIV, syphilis and hepatitis B antibody have been greatly improved, and the detection rate during pregnancy from 82.42%, 81.5 4% and 84.9% in 2012 rose to 97.07% , 97.05% and 97.5% in 2016 respectively ; the intervention rate of syphilis infection among pregnant women and the children infection rate was 69.87% and 96.63% in 2012, and rose to 100% and 99.46% in 2016 ; hepatitis B infection among pregnant women in neonates born to hepatitis B immune globulin ratio increased from 85. 46% to 99. 88%. Conclusion Clinical path management adopted a series of measures which contains strengthening leadership, strengthening training and propaganda, making the detection process, increasing financial investment, those measures improved the city integrated service management capabilities and minimized children infection caused by AIDS, syphilis and hepatitis B mother to child transmission, but there are still shortcomings need to be improved, to further improve implementation effect of preventing AIDS, syphilis and HBV mother to child transmission in our city, so as to improve the life quality of women and children＇s health effectively.