基于过程管理视角的1430例转诊高危孕产妇病种分布及结局分析

Analysis of the Distribution and Outcome of 1430 Cases of High-risk Pregnant and Lyingin Women Referred to the Hospital--based on the Perspective of Process Management

目的:通过分析高危孕产妇转诊资料,了解病种分布和结局,基于过程管理理论视角,从转诊前的机制建设、转诊过程中的规范化诊疗及转诊后的经验总结三个方面总结转诊经验。方法:回顾性分析2020-2021年通过门诊、急诊转诊至某医院的1 430例高危孕产妇的临床资料,统计分析患者年龄、转诊孕周、病种分布、术式选择、转归结局等指标。结果:平均转诊年龄29.9±5.2岁,平均转诊孕周24.6±10.0周;病种分布依次为:妊娠并发症(40.2%)、妊娠合并子宫瘢痕(23.4%)、胎儿附属物异常(15%)、妊娠期合并的非产科的其他系统的疾病(5.2%)、妊娠监督(4%);术式选择:1 430例转诊患者中,剖宫产占比56.3%、顺产占比29.5%、妊娠监督占比8.8%、产后转诊占比1%、自然流产和其他术后病人占比4.4%。治愈占比66.3%、好转占比32.4%、转至其他科室占比1.0%、未愈占比0.3%。结论:高危孕产妇的早期转诊与规范化救治是降低孕产妇和围生儿死亡率的关键,应完善统筹城乡的孕产妇转诊网络,及时总结推广经验,提高救治能力。

Objective:To analyze the referral data of high-risk pregnant women,understand the distribution and outcome of the dis-ease,and from the perspective of process management theory,summarize the referral experience from three aspects:mechanism con-struction before referral,standard diagnosis and treatment in the referral process,and experience summary after discharge.Methods:The clinical data of 1430 high-risk pregnant and lying-in women who were transferred to the certain hospital through outpatient and emergency services from 2020-2021 were retrospectively analyzed,and the age of the patients,the gestational weeks of referral,the dis-tribution of disease types,and the selection of operation methods were statistically analyzed.Results:The average age of referral was 29.9±5.2 years old,and the average gestational age of referral was 24.6±10.0 weeks;The distribution of diseases was as follows:preg-nancy complications(40.2%),pregnancy with uterine scar(23.4%),fetal appendage anomalies(15.0%),pregnancy with non-obstetric diseases(5.2%),and pregnancy supervision(4%);Operation type selection:Of 1430 referral patients,cesarean section accounted for 56.3%,spontaneous delivery accounted for 29.5%,pregnancy supervision accounted for 8.8%,postpartum referral accounted for 1%,spontaneous abortion and other postoperative patients accounted for 4.4%;66.3%were cured,32.4%improved,1.0%were transferred to other departments,and 0.3%were not cured.Conclusion:The early referral and standardized treatment of high-risk pregnant and ly-ing-in women is the key to reduce the mortality rate of pregnant and lying-in women and perinatal infants.We should improve the re-ferral network of pregnant and lying-in women in urban and rural areas,summarize and promote experience in time,and improve the treatment ability.