我国17省市儿科ICU调查

The survey of ICU for neonates and children in China

目的 分析近 1 0年我国儿科重症监护病房 (ICU)状况、存在问题并提出建议。 方法 向全国近 4 0所儿科床位 1 0 0张以上的医院发出调查表。 结果 分布于 1 7省市的 2 7所医院回复 ,内科ICU共 4 4个 :儿童重症监护 (PICU) 1 8个、新生儿重症监护 (NICU) 2 0个、P及NICU6个。ICU平均床位1 2 (6～ 4 0 )张 ,每张床位有 0 4 3(0 4 3～ 1 2 5 )台呼吸机 ,0 5 6 (0 2～ 1 4 )台多功能监护仪。床位和医师及护士比分别为 1 :0 75和 1 :1 37。 5 1 9%的医院开展转运。 2 0 0 0年共收治病人 1 5 80 5人 ,病死率 4 6 %(0 9%～ 1 0 4 % ) ,体重轻于 1 0 0 0g和 1 0 0 0～ 1 5 0 0g的早产儿存活率分别为 4 2 2 %、 75 1 % ,心肺复苏存活率 71 4 %。结论 我国三级医院儿科ICU正稳步发展 ,与 92年比较 ,人员、设备有所改善。转运工作未广泛开展 ,一些ICU床位被非危重病人占据。建议ICU建立分级管理制度 ,积极开展转运 ,开展前瞻性危重评分预测死亡 。

Objective To investigate the organization and development of intensive care units for neonates and children(ICUs),and to make recommendations for the development of ICUs in china.Methods A written questionnaire was sent to 40 hospitals with more than 100 pediatric beds.Results Twenty seven of the 40 hospitals responded.All 27 hospitals were tertiary hospitals,linked to 17 provinces and municipalities in China.There were 44 medical ICUs in total,including 18 PICU,20 NICU and 6P/NICU.The mean ICU beds were 12(6 40).Each ICU bed was on average equipped with 0 43(0 13 1 25)ventilator,with 0 56(0 2 1 4)multifunctional monitor.The bed to physician ratio and bed to nurse ratio were 1:0 75 and 1:1 37,respectively.Transport service was provided in 51 9% of 27 hospitals.Altogether there were 15 805 admissions during 2000.The mortality rate was 4 6%(0 9 10 4).The survival rate of premature under 1 000gm or 1 500gm were 42 2% and 75 1% respectively and of patients after cardiopulmonary resuscitation was 71 4%.Conclusions ICUs in tertiary hospital have developed steadily in China in the past decades.The ICU equipment and staff have improved compared to 1992,but still does not meet international standards.Regionalization of pediatric critical care services is not fully implemented.Many of th ICU beds were occupied by low risk patients.We recommend that ICUs set up intermediate care units.Criteria of admission and discharge from ICU should be applied conscientiously.ICUs should develop transport services.A prospective study of risk adjusted outcome should be conducted in order to assess the effectiveness of critical care for neonates and childern in china.