模拟培训对高危妊娠剖宫产自决定手术至胎儿娩出时间的影响

Effect of simulation training on decision to delivery interval in high-risk pregnancy cesarean section

目的探讨模拟培训对高危妊娠剖宫产自决定手术至胎儿娩出时间(DDI)的影响,为产科模拟培训的推广与改进提供依据。方法选择2019年1月—2020年1月首都医科大学附属北京妇产医院50例高危妊娠剖宫产产妇纳入观察组,2017年11月—2018年10月50例高危妊娠剖宫产产妇纳入对照组。观察组产妇均接受模拟培训流程的紧急剖宫产;对照组产妇均接受常规流程的紧急剖宫产。比较两组决定手术至入室时间、入室至手术开始时间、手术开始至胎儿娩出时间与DDI,比较两组新生儿出生后1、5 min的新生儿Apgar评分,比较两组不良妊娠结局(产后出血、新生儿窒息、新生儿死亡)。结果观察组决定手术至入室时间、入室至手术开始时间、手术开始至胎儿娩出时间及DDI均短于对照组,差异均有高度统计学意义(均P<0.01);观察组出生后1、5 min的新生儿Apgar评分均高于对照组,差异均有高度统计学意义(均P<0.01);两组产后出血、新生儿死亡的发生率比较,差异无统计学意义(P>0.05);观察组新生儿窒息发生率低于对照组,差异有统计学意义(P<0.05)。结论模拟培训能提高产科医护人员的工作效率,进而缩短高危妊娠剖宫产产妇决定手术至入室时间、入室至手术开始时间、手术开始至胎儿娩出时间及DDI,且有利于改善新生儿的健康状况,降低新生儿窒息发生率。

Objective To explore the effect of simulation training on decision to delivery interval(DDI)in high-risk pregnancy cesarean section,and to provide a basis for the promotion and improvement of obstetric simulation training.Methods A total of 50 cases with high-risk pregnancy cesarean section in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2019 to January 2020 were selected as the observation group;50 case with high-risk pregnancy cesarean section from November 2017 to October 2018 were selected as the control group.The observation group was received emergency cesarean section simulation training process,and the control group was received emergency cesarean section with routine procedures.The time from determining surgery to admission,the time from admission to surgery,the time from surgery to delivery and DDI were compared between the two groups;the neonatal Apgar scores at one and five minutes after birth were compared between the two groups;and the adverse pregnancy outcomes(postpartum hemorrhage,neonatal asphyxia,neonatal death)were compared between the two groups.Results The time from determining surgery to admission,the time from admission to surgery,the time from surgery to delivery and DDI of the observation group were all shorter than the control group,the differences were all highly statistically significant(all P<0.01);neonatal Apgar scores at one and five minutes after birth in the observation group were higher than those in the control group,the differences were all highly statistically significant(all P<0.01).There were no significant differencs in the incidence of postpartum hemorrhage and neonatal death between the two groups(P>0.05);and the incidence of neonatal asphyxia in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Simulation training can improve the work efficiency of obstetric medical staff,and thus shorten the time from determining surgery to admission,the time from admission to surgery,the time from surgery to delivery and DDI of high-risk pregnancy cesarean section maternal,and it is conducive to improving neonatal health and reducing the incidence of neonatal asphyxia.