应用严重产科并发症审评方法提高基层产科服务质量  

The study of improving the quality of obstetric care through severe obstetric complication audit

作　　者：吴久玲[1] 张凤霞[2] 王临虹[1] 张海燕[3] 林小宁[3] 王山米[4] 张建华[5] 杨锡娣[6] 

机构地区：[1]中国疾病预防控制中心妇幼保健中心,北京100013 [2]北京市海淀区妇幼保健院 [3]重庆市妇幼保健院 [4]北京大学人民医院 [5]重庆医学院附属二院 [6]重庆医学院附属一院

出　　处：《中国妇幼保健》2006年第24期3354-3357,共4页Maternal and Child Health Care of China

摘　　要：目的：探索应用严重产科并发症审评方法提高基层产科服务质量的有效性，以利于降低严重产科并发症的发生率。方法：选择重庆市孕产妇死亡率较高的一个县作为研究地点，采用整群抽样的方法，收集研究地点2004年1月～2006年3月期间所有提供助产技术服务的医疗机构救治的全部严重产科并发症病例，对其病历资料进行调查，并在2005年4月～2006年3月期间，应用严重产科并发症审评方法定期对部分典型病例的整个医疗过程进行审评。对审评前后产科服务质量的提高情况进行效果评价。结果：审评前，严重产科并发症的发生率为12.79‰（74例），其中严重产科出血、重度子痫前期和子痫、子宫破裂的发生率分别为8.47‰、4.32‰、0.17‰；审评后，严重产科并发症的发生率为14.17‰（64例），其中产科出血、重度子痫前期和子痫、子宫破裂的发生率分别为8.41‰、6.42‰、0.00‰。审评前后比较发现，审评后产后出血、妊娠高血压综合征的规范化管理明显加强（P〈0.001）；严重产科并发症病例的围产儿死亡率由189.26‰降至53.57‰（P〈0.01）；严重产科并发症孕产妇例数与孕产妇死亡例数之比由19：1升至32：1，产科服务质量有了明显提高。结论：应用严重产科并发症审评方法定期对所发生病例进行审评，有助于提高产科服务质量。Objective： To explore the effectiveness of severe obstetric complication audit on improving the quality of obstetric care in order to reduce the severe maternal morbidity （SMM）. Methods： With the method of cluster sampling, selected a county with a high maternal mortality rate （MMR） in Chongqing as study site, collected all cases of severe obstetric complications in the hospitals in whole county during January 2004 to March 2006 and investigated their medical records. The regular audit of some typical cases has been conducted during April 2005 to March 2006. There was an effect evaluation of improving obstetric care through the comparisons before and after audit. Results： Before the audit, the incidence of severe obstetric complication was 12.79‰ （74 cases）, including severe obstetric hemorrhage （8.47‰）, preeclampsia/eclampsia （4.32‰） and uterus rupture （0.17‰）. After the audit, the incidence was 14.17‰ （64 cases）, and the rates of severe obstetric hemorrhage, preeclampsia/eclampsia, uterus rupture were 8.41‰, 6.42‰, 0.00‰ respectively. Comparing to the stage of before audit, the standard of management level on postpartum hemorrhage and precclampsia/eclampsia have been enhanced significantly （P 〈 0.01）, the perinatal mortality had reduced from 189.26‰ to 53.57‰ （P 〈 0.01）, and the rate of severe maternal morbidity to mortality had increased from 19：l to 32：1. The quality of obstetric care made much more progress. Conclusion： It is benefit for improving the quality of obstetric care by regularly using the method of severe obstetric complication audit.

关 键 词：产科并发症 服务质量 孕产妇 

分 类 号：R714[医药卫生—妇产科学]