高龄经产妇急产院内急救流程再造实践及效果评价

Practice and effect evaluation of first aid procedure in the urgent labor of the elder multipara

目的 :观察高龄经产妇急产院内急救流程再造的应用效果,为高龄经产妇急产救治提供依据。方法 :通过成立高龄经产妇急产多学科救治小组,建立有效的组织管理体系,对改造前流程关键环节进行分析改进,制定并实施改造后管理方案。结果 :实施流程优化方案后,预检分诊时间由(4.45±0.40)min缩短至(4.20±0.29)min(P<0.05);高龄经产妇到院至产科医师接诊时间由(8.72±0.80)min缩短至(5.56±0.66)min(P<0.01),到院至用药时间由(15.62±0.64)min缩短至(11.36±1.00)min(P<0.01),从到院至超声检查时间由(15.58±0.71)min缩短至(11.47±0.95)min(P<0.01),从到院至化验结果判读时间由(34.94±0.65)min缩短至(30.95±1.29)min(P<0.01),从到院至产房/手术室时间由(25.75±1.02)min缩短至(18.92±1.29)min(P<0.01),发生难产时从产房转运至手术间/产房手术间时间由(4.97±0.47)min缩短至(1.75±0.67)min(P<0.01);高龄经产妇并发症的发生率由13.7%降低至1.9%(P<0.05),新生儿并发症的发生率由11.8%降低至1.9%(P<0.05)。结论 :优化后的高龄经产妇急产院内急救流程有效缩短院内救治时间,降低并发症的发生率。

Objective： To explore the application effect of the resuscitation process of the women of advanced reproductive age in the emergency obstetrics department, and to provide the basis for the emergency obstetric care for elder multipara. Methods： Through the establishment of the emergency medical group for the women with advanced reproductive age, we established an effective management system, then analyzed and improved the key steps of first aid procedure in the urgent labor of the elder multipara. Results： After implementing the new optimized plan, the pre-diagnosis triage time was shortened from （4.45±0.40） min to （4.20±0.29） min （P〈0.05）, and the obstetrician consultation time was shortened from （8.72±0.80） min to （5.56±0.66） min （P〈0.01）. The time from hospital to medication was shortened from （15.62±0.64） min to （11.36±1.00） min （P〈0.01）, and the time from hospital to ultrasound was shortened from （15.58±0.71） min to （11.47±0.95） min （P〈0.01）; the time from hospital to the interpretation of laboratory results was shortened from （34.94±0.65） min to （30.95± 1.29） min （P〈0.01）. The time from admission to delivery room/operating room was shortened from （25.75±1.02） min to （18.92± 1.29） min （P〈0.01）. The time from delivery room to operating room/delivery operating room during dystocia was shortened from （4.97±0.47） min to （1.75±0.67） min （P〈0.01）. The incidence of postpartum maternal complications decreased from 13.7% to 1.9% （P〈0.05）, and the incidence of neonatal complications decreased from 11.8% to 1.9% （P〈0.05）. Conclusion： The optimized maternal emergency treatment process could effectively shorten the time for treatment and reduces the incidence of complications.