建立危重新生儿转运网的初步尝试

Initial achievement for critical neonatal transportation

目的 探讨建立区域性新生儿转运网 ,降低新生儿死亡率、减少伤残及改善预后情况。方法 与北京市东城区所属医院建立绿色通道 ,1999年 11月～ 2 0 0 3年 5月共转诊新生儿 2 5 1例 ,早产儿 183例 (占72 .9% ) ,其中胎龄 2 6～ 30周 19例 ,出生体重 <15 0 0 g 2 8例 ;病种以呼吸系统疾病为主。 3年来共出诊 16 7例次 ,使用转运暖箱 10 2次 ,出动救护车 5 1次 ,参与复苏抢救 6 5次。结果 转诊人数逐年增多 ,2 5 1例新生儿中治愈 2 30例 (治愈率 91.6 % ) ,家长放弃治疗 17例 ,死亡 4例。结论 建立区域性三级转诊系统是降低新生儿病死率的重要环节 ,具备急救技术和训练有素的主动转运方式可使危重儿在生命的最初阶段得到及时和序贯治疗 ,从而全面提高救治质量 ;早产儿尽早转运、重视转运前急救是转运成功的保证 ;提倡胎儿于宫内时转运 。

Objective To establish regional critical neonatal transport network,and to reduce mortality rate, decrease disability and improve prognosis of newborn infants.Methods Having established regional critical neonatal transport network with some hospitals of dongcheng district in Beijing.There were 251 critical newborn infants by transport from November 1999 to May 2003,including 183 premature infants(72.9 %),19 babies with 26-30 weeks of gestational age,28 babies with birth weight < 1500 g, most babies with respiratory diseases. Recent 3 years,167 out-call of doctors,102 by transport is incubator and emergency ambulance,65 resuscitated in referring hospitals.Results The number of neonatal transport is increasing year after year,230 recurred(91.6 %),17 abandoned and 4 died in total 251 infants.Conclusions Establishing regional neonatal transport network in Ⅲ level is very important for reducing neonatal mortality rate. An active transport pattern with giving first-aid treatment and well-trained staff is necessary to rescue critical newborn infants in initial stage of life and improve the quality of treatment.It is an assurance for successful transportation to transfer premature infants as soon as early and pay attention to the details of stabilization before transport.It is recommended that the mother is transferred to the Ⅲ level center before delivery of a high-risk infant for reducing maternal and neonatal mortality rate.An appeal is being made for establishing the regional critical neonatal transport network in Ⅲ level and that is necessary to reducing maternal and neonatal mortality rate, improving prognosis of critical newborn infants, and enhancing quality of population.