2021年体外循环手术与全国灌注师现况调查

National investigation on the status of cardiac surgery undergoing extracorporeal circulation and perfusionists in 2021

目的通过分析来源于国家级数据库的相关数据,了解全国体外循环手术与灌注师工作情况。方法数据来源于全国医疗质量数据抽样调查系统(NCIS),纳入2021年抽样调查的1639家三级医院和2649家二级医院。NCIS数据库提取数据包括:心外科临床医师人数、心外科手术总例数、体外循环手术例数、体外循环手术间数量、灌注师人数、体外膜氧合(ECMO)设备数及2021年应用ECMO救治的病例数。根据年体外循环手术量将全国各中心分为四组,比较不同规模中心的体外循环手术及灌注师情况。结果不同规模中心存在以下特点:(1)不同规模中心的体外循环占比无明显差异;(2)大规模中心的心外科临床医师与体外循环灌注师比例高于小规模中心;(3)体外循环年手术量100~299例的中小规模的中心体外循环手术间灌注师配比人数最多;(4)规模越大的中心,体外循环灌注师每年转机手术总例数越多;(5)规模越大的中心,ECMO例数越多,但不同中心的异质性较大。结论通过对来源于全国数据库的数据分析,可以帮助了解全国体外循环手术与灌注师工作情况,为各中心体外循环质控工作的开展及体外循环专职人员的合理配比提供依据。

Objective To understand the situation of cardiopulmonary bypass surgery and perfusionists in China by analyzing the data from the national database.Methods The data was extracted from the National Clinical Improvement System(NCIS).1639 tertiary hospitals and 2649 secondary hospitals were included in the survey in 2021.The data extracted from the NCIS database included the number of cardiac surgeons,the total number of cardiac surgery procedures,the number of extracorporeal circulation(ECC)operations,the number of operation rooms where ECC operations can be done,the number of perfusionists,the number of ECMO devices and the number of cases underwent ECMO in 2021.The centers were divided into four groups according to the number of ECC operations performed per year.The ECC operations and perfusion specialists were compared among centers of different sizes.Results The following characteristics were found in centers of different sizes:(1)There was no significant difference in the proportion of ECC in centers of different sizes;(2)The ratio of cardiac surgeons to perfusionists was higher in large-scale centers than that in small-scale ones;(3)Small and medium-sized centers with 100-299 cases of ECC surgery per year had the largest ratio of perfusionists to operating rooms;(4)The larger the size of the center,the more ECC surgeries per year were conducted by perfusionists;(5)The larger the center,the more ECMO were established,but the heterogeneity among different centers was large.Conclusion By analyzing the national database,it can help to understand the situation of ECC and perfusionists in China.And it may provide information for the quality control of ECC,and the reasonable allocation of cardiopulmonary bypass.