阶梯式亚专科培训模式在重症孕产妇救治中的效果评估

Effect evaluation of a stepped sub-specialist training model on the treatment of severely ill pregnant women

目的借助国家脱贫攻坚政策,在毕节示范区实施重症孕产妇救治阶梯式亚专科培训模式,评估该模式对当地重症孕产妇救治的临床效果。方法2020年6月,以广州医科大学附属第三医院为依托,在贵州省毕节市开展重症孕产妇救治阶梯式亚专科培训,培养市级产科重症救治骨干,并持续深入到各县各乡镇的所有助产机构。观察和了解该培训模式前后受训人员考核成绩与孕产妇临床相关质控指标及各项产科质控指标的变化。结果(1)培训前学员的平均理论成绩为(62.9±3.2)分,培训后的理论成绩为(81.8±4.0)分,差异有统计学意义(t=-15.748,P<0.001);培训前技能成绩为(57.5±3.8)分,培训后的平均技能成绩为(75.1±2.7)分,差异具有统计学意义(t=-16.292,P<0.001)。(2)毕节市2020年上半年的产后出血率、严重产后出血率、子痫发生率、羊水栓塞率、孕产妇死亡率分别为:34.66‰、8.39‰、8.58/万、7.22/万、1.455/10万;下半年对应数据分别为:31.92‰、4.65‰、5.55/万、0.61/万、1.069/10万,毕节全市2020年下半年的产后出血率、严重产后出血率、子痫发生率、羊水栓塞率、孕产妇死亡率明显低于上半年;下半年的危重症孕产妇发生率较上半年无明显降低。结论采用重症孕产妇救治阶梯式亚专科培训模式对改善危重症孕产妇的妊娠结局可能有积极影响。

Objective With the help of the national poverty alleviation policy,a stepped sub-specialist training model for the treatment of severely ill pregnant women was implemented in the Bijie Demonstration Area,and the clinical effect of this model on the treatment of local severely ill pregnant women was evaluated.Methods In June 2020,with the support of the Third Affiliated Hospital of Guangzhou Medical University,a stepped sub-specialist training model for the treatment of severe pregnant and lying-in women was carried out in Bijie City,Guizhou Province.The backbone of the municipal obstetrics for severe treatment was cultivated.This model was continued to carried out at all midwifery institutions in all counties and towns.The changes of trainees′assessment scores,clinical quality control indicators and obstetrical quality control indicators were compared before and after the training.Results The average theoretical score of the trainees before the training was(62.9±3.2)points,and the theoretical score after the training was(81.8±4.0)points.The difference was statistically significant(t=-15.748,P<0.001).The skills scores before the training was(57.5±3.8)points,and the average skill score after training was(75.1±2.7)points.The difference was statistically significant(t=-16.292,P<0.001).The postpartum hemorrhage rate,severe postpartum hemorrhage rate,eclampsia rate,amniotic fluid embolism rate,and maternal mortality rate in Bijie City in the first half of 2020 were 34.66‰,8.39‰,8.58,7.22,1.455,respectively.In the second half of the year of training,the data was:31.92‰,4.65‰,5.55,0.61,1.069,respectively.The postpartum hemorrhage rate,severe postpartum hemorrhage rate,eclampsia rate,amniotic fluid embolism rate,and maternal mortality rate in the second half of 2020 in Bijie City were significantly lower than in the first half of the year.The incidence of critically ill pregnant women in the second half of the year was not significantly lower than in of the first half.Conclusions The stepped sub-specialty training model for the treatment of severely ill pregnant women may have a positive effect on improving the pregnancy outcome of severely ill pregnant women.