山东省儿童重症监护病房(抢救单元)现状调查与分析

Investigation and analysis on the status of pediatric intensive care unit in Shandong province

目的了解山东省儿童重症监护病房(PICU)(抢救单元)的发展现状。方法山东省医学会儿科学分会急救学组、山东省医师协会儿童重症医师分会以及山东省妇幼保健协会儿童急危重症医学分会设定问卷调查表, 2021年3月至9月由学组成员组织山东省16地市的综合性医院、儿童医院以及妇幼保健院参与调查。按照2016年《中国儿童重症监护病房分级建设与管理的建议》(简称2016年建议)将PICU进行分级, 比较不同级别监护病房的救治能力并分析不同级别PICU在省内的分布。结果 (1)总体情况:16地市共99家医院纳入调查, 平均6.2家/市, 34家位于鲁中地区, 23家位于胶东地区, 27家位于鲁南地区, 15家位于鲁北地区。32家医院设有独立的PICU。根据2016年建议, 9家PICU为Ⅰ级, 19家PICU为Ⅱ级, 4家PICU为Ⅲ级。鲁中地区设有的独立PICU最多, 为14家, 且Ⅱ级和Ⅲ级PICU主要集中在鲁中地区。另有58家医院为儿科病房中设有重症抢救单元。另外9家医院既无独立PICU, 也未设置儿科重症抢救单元。(2)人员及设备配置情况:32家独立PICU共有医生252人, 医生/床位比为0.54∶1, 护士总数539人, 护士/床位比为1.2∶1。32家PICU均配备了有创呼吸机, 16家(50.0%)配有血液净化仪, 4家(12.5%)配有体外膜肺氧合设备。(3)技术开展情况:32家PICU均已开展有创机械通气, 而胃肠外营养、血气分析、亚低温治疗、持续血液净化、体外膜肺氧合等技术的开展率分别是83.3%、66.7%、45.2%、50.0%、12.5%。(4)救治能力:PICU收治的首位病种为呼吸系统疾病(40.9%), 其次为神经系统疾病(24.8%)。2019年1月1日至2020年12月31日, Ⅰ级、Ⅱ级、Ⅲ级PICU收治的危重患儿院内病死率分别为34.2%(40/117)、24.9%(51/205)、18.2%(169/930)。结论山东省独立PICU的设置数量及床位数仍不足, 且在省内分布不均衡;医护人员和设备的配置以及重症技术的开展情况仍有待提高。

Objective To investigate the organization and development of pediatric intensive care units(PICUs)in Shandong province.Methods March to September 2021,a questionnaire was set up by the Subspecialty Group of Emergency,the Society of Pediatrics,Shandong Provincial Medical Association,Pediatric Critical Care Association in Shandong Medical Doctor Association and Children′s Emergency and Critical Medicine Commision of Shandong Women and Children Health Care Association,which was then sent to the members of these groups(including general hospitals,children′s hospitals and maternal and child health care centers in 16 cities of Shandong province).The level of PICUs were classified according to the"Recommendations for the Construction and Management of China′s Pediatric Intensive Care Units(2016)".The distribution and the treatment capabilities of different levels of PICUs were analyzed.Results(1)Overall situation:A total of 99 hospitals in 16 cities were included,with an average of 6.2 hospitals per city.Among them,34 hospitals were located in central Shandong,23 hospitals were located in Jiaodong,27 hospitals were located in southern Shandong,and 15 hospitals were located in northern Shandong.Thirty-two hospitals had independent PICU.According to the Recommendations for the Construction and Management of China′s Pediatric Intensive Care Units(2016),nine PICUs were classified as gradeⅠ,19 PICUs are classified as gradeⅡand 4 PICUs were classified as gradeⅢ.There were a maximum of 14 independent PICUs in central Shandong,and theⅡandⅢPICUs were mainly concentrated in central Shandong.Another 58 hospitals had special monitoring units in pediatric wards,and the other nine hospitals neither had independent PICUs nor monitoring units.(2)Personnel and equipments:All of 32 PICUs were equipped with invasive ventilator,16(50.0%)of them equipped with blood purification equipment,and 4 PICUs(12.5%)equipped with extracorporeal membrane oxygenation equipment.There were 252 doctors and 539 nurses in these 32 independent PICUs with the doctor/bed ratio 0.54∶1 and the nurse/bed ratio 1.2∶1.(3)Technical developments:32 PICUs had carried out invasive mechanical ventilation,while parenteral nutrition,blood gas analysis,mild hypothermia treatment,continous blood purification,extracorporeal membrane oxygenation was respectively carried out in 83.3%,66.7%,45.2%,50.0%,12.5%of these PICUs.(4)Treatment ability:The most common type of disease admitted to PICU was respiratory system disease(40.9%),followed by nervous system disease(24.8%).From January 1,2019 to December 31,2020,the in-hospital mortality rates of critically ill children admitted to PICUs of gradeⅠ,gradeⅡ,and gradeⅢwere 34.2%(40/117),24.9%(51/205),and 18.2%(169/930),respectively.Conclusion In recent years,the number of independent PICUs in Shandong Province has increased but is still insufficient and uneven geographical distribution.There still lack specific medical staff and equipment in these PICUs.More investments are needed for the development of treatment capability for critically ill children.