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【目的】评价在县级医疗机构开展新生儿复苏长效机制试点干预的效果,以便总结经验,在全国基层医疗机构推广。【方法】采用随机对照的研究方法,选择在中澳卫生与艾滋病项目确定的4个对照县进行调查并与干预县进行比较。调查内容包括医务人员新生儿复苏相关知识与自信心水平、新生儿复苏制度建设、新生儿窒息发生及死亡变化情况。【结果】1)干预县新生儿科医生参加高危分娩术前讨论、分娩现场等待分娩、参加新生儿窒息病例评审等制度建立率均在90%以上,对照县均低于55%。2)干预县和对照县医务人员新生儿复苏知识平均得分分别为(9.19±1.18)和(8.40±1.52)分(t=3.922,P<0.001),自信心平均得分分别为(57.33±2.50)和(54.09±8.19)分(t=3.541,P=0.001);对照县医务人员核心知识的回答正确率均低于70%,且均显著低于干预县。3)干预县新生儿窒息发生率由8.83%下降至5.99%(χ2=11.300,P=0.001),因窒息死于分娩现场率由27.60/105下降至5.03/105(χ2=3.142,P=0.076);对照县这两个率的变化均无统计学意义。【结论】通过在县级医疗机构建立新生儿复苏工作机制,可加强院内新生儿复苏培训、促进科室间协调,提高医务人员技术水平,降低新生儿窒息发生率和死亡率。
【Objective】 To evaluate the effect of pilot intervention in long-term mechanism of neonatal resuscitation in county-level medical institutions in order to summarize the experience and promote it in primary medical institutions in China. 【Methods】 A randomized controlled study was conducted to select four control counties identified by the China-Australia Health and AIDS Project and compared with the intervention counties. The survey included the level of knowledge and confidence of medical staff in neonatal resuscitation, the establishment of a newborn recovery system, the occurrence of neonatal asphyxia and changes in mortality. 【Results】 1) The intervention rate of neonate pediatricians participating in preoperative discussion of high-risk delivery, delivery site waiting for childbirth, participation in neonatal asphyxia case evaluation system establishment rate of more than 90%, control county are less than 55%. 2) The average score of knowledge of neonatal resuscitation among medical staffs in intervention counties and control counties were (9.19 ± 1.18) and (8.40 ± 1.52) points respectively (t = 3.922, P <0.001), and the average self-confidence scores were 57.33 ± 2.50 And (54.09 ± 8.19) points respectively (t = 3.541, P = 0.001). The accuracy rate of the core knowledge of medical staff in the control county was less than 70%, which were significantly lower than that of the intervention county. 3) The incidence of neonatal asphyxia in interventional counties decreased from 8.83% to 5.99% (χ2 = 11.300, P = 0.001), and the rate of asphyxiation due to childbirth decreased from 27.60 / 105 to 5.03 / 105 (χ2 = 3.142, P = 0.076 ). There was no significant difference between the two rates in the control county. 【Conclusion】 Through establishing the working mechanism of neonatal resuscitation in county-level medical institutions, it is possible to strengthen the training of neonatal resuscitation in hospital, promote the coordination among departments, improve the technical level of medical staff and reduce the incidence of neonatal asphyxia and mortality.