危重孕产妇救治网络建设评估及政策建议

Evaluation of construction of critically ill pregnant woman rescue network and policy recommendations

目的了解目前全国危重孕产妇救治网络建设情况,为实现每个省、市、县都有标准化规范化的危重孕产妇中心,并形成有效运转的救治网络提供政策建议。方法在东部、中部、西部分别选取一个省份(浙江、江西、四川),对省、市、县三级危重孕产妇救治中心基本情况、建设进展及问题成效等多方面进行调查,并结合访谈法提出政策建议。结果在调研省份中四川省危重孕产妇救治中心建设率较低,地(市)级建设率为90.48%,全国范围内危重孕产妇救治中心及网络建设进度不一致,且救治能力存在较大差异;浙江大学医学院附属妇产科医院、四川人民医院拥有独立的孕产妇ICU(MICU)之外,其他救治中心均未设立独立的MICU。产科监护床位及医务人员缺乏,且无相应的激励措施;高危危重孕产妇比例增加,危重孕产妇三级救治网络体系尚不成熟,缺乏科学的转运程序和转运规范,信息化建设滞后。结论国家层面制定危重孕产妇救治中心建设的相关政策文件,提高危重孕产妇救治中心的救治能力;提高产科医务人员相应的待遇,加大产科卫生资源的配置;建立完善的动态信息化系统以及网络救治体系,实现对危重孕产妇的实时监测。

Objective To understand the construction of critically ill pregnant woman rescue network in China,offer policy recommendations for establishment of standardized maternal centers in each province,city,and county and formation of effective rescue network.Methods In the eastern,central,and western regions,three provinces（ Zhejiang,Jiangxi,and Sichuan） were selected,respectively.The basic situations,construction progress,and problem effectiveness in critically ill pregnant woman rescue centers at province,city,and county levels were surveryed,then policy recommendations were put forward based on interview. Results Among the three provinces,the construction rate of critically ill pregnant woman rescue centers in Sichuan was low,which was 90. 48% in centers at city level. The progress of critically ill pregnant woman rescue centers and network construction was inconsistent in China,and the rescue ability varied significantly.Among the centers in the three provinces,only Obstetrics and Gynecology Hospital Affiliated to Medical College of Zhejiang University,Sichuan Provincial People＇s Hospital have independent Maternal Intensive Care Unit（ MICU）. Obstetric monitoring beds and medical personnel were insufficient,and there was no corresponding incentive measures. The proportions of high-risk critically ill pregnant women increased. Three-level rescue network of critically ill pregnant women was immature,which lacked scientific transport procedures and transport norms,the information construction lagged. Conclusion The government should develop related policies of construction of critically ill pregnant woman rescue centers,and the rescue capacity of construction of critically ill pregnant woman rescue centers should be improved,the remuneration of obstetric medical staff should be improved,the allocation of obstetric health resources should be enhanced. Perfect dynamic information system and network rescue system should be established to achieve real-time monitoring of critically ill pregnant women.