区域性综合主动型新生儿转运网络组织的应用研究  

Establishment of regional active neonatal transport network

作　　者：孔祥永[1] 高昕[1] 尹晓娟[1] 洪小杨[1] 方焕生[1] 王自珍[1] 李爱华[1] 罗分平[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院新生儿科,100700

出　　处：《中华儿科杂志》2010年第1期4-8,共5页Chinese Journal of Pediatrics

基　　金：首都发展基金资助（2005-3044）

摘　　要：目的探讨我院建立首都区域性综合主动型新生儿转运网络（ANTN）组织在提高新生儿救治水平中的作用以及中心NICU建设在ANTN中的重要性。方法用回顾性统计学分析的方法，分析我院在建设ANTN过程中网络管理方法和分析有关网络建设效果的新生儿资料。结果新生儿转运网络规模逐渐扩大，网络医院由早期阶段（2004年7月至2006年6月）的19家增加到成熟阶段（2006年7月至2008年5月月）的93家，转运患儿数由587例增加到2797例；新生儿转运成功率成熟阶段较早期阶段明显增高（χ2=21．69，P〈0．001）；在成熟阶段出现低体温、低血糖、高血糖以及明显酸中毒的例数明显降低（P分别〈0．01、0．05、0．01和0．05）。新生儿病死率明显降低，治愈率明显增高（χ2值分别为8．23和7．16；P均〈0．01）；中心NICU的规模明显扩大，转运的早产儿的比例，特别是胎龄小于32周小早产的比例以及低出生体重儿人数成熟阶段较初级阶段明显增多（P均〈0．05），新生儿窒息及RDS的发生率明显降低（P〈0．05，P〈0．01）；提高了早产儿、新生儿窒息以及吸入综合征的治愈率（P均〈0．05）。结论ANTN可以提高各级NICU的整体实力，对减低新生儿病死率至关重要；中心NICU具有专的医护人员、科学的救治流程、丰富的临床实践经验及先进的设备，在ANTN中起主导作用。Objective T evaluate the clinical function and significance of establishing a regional active neonatal transport network （ANTN） in Beijing. Method The authors retrospectively studied intensive care and the role of ANTN systen in management of critically ill neonates and compared the outcome of newborn infants transported to out NICU before and after we established standardized NICU and ANTN system （phase 1 ： July 2004 to Jure 2006 vs phase 2 ： July 2006 to May 2008 ）. Result The number of neonatal transport significantly inc ＇eased from 587 during phase 1 to 2797 during phase 2. Success rate of transport and the total cure rate in hase 2 were 97.85% and 91.99% respectively, which were significantly higher than those in phase 1 （ 94 36% and 88. 69% , respectively, P 〈 0. 01 ）. The neonatal mortality significantly decreased in phase 2 compared with that in phase 1 （2. 29% vs 4. 31%, P 〈 0. 01 ）. The capacity of our NICU was enlarged following the development of ANTN. There are 200 beds for level 3 infants in phase 2, but there were only 20 beds in phase 1. Significantly less patients in the phase 2 had hypothermia, acidosis and the blod glucose instability than those in phase 1 （ P 〈 0. 01, 0. 05, 0. 01 and 0.05, respectively）. The proportien of preterm infants transported to our NICU were higher in phase 2 compared with that in phase 1, especially infants whose gestational age was below 32 weeks. The proportions of asphyxia and respira 3ry distress syndrome were lower in phase 2 than that in phase 1, but the total cure rates of these two diseases had no significant changes between the two phases. The most important finding was that the improvement of outcome of premature infants and those with asphyxia and aspiration syndrome was noted following the tevelopment of ANTN. Conclusion Establishing regional ANTN for a tertiary hospital is very important to elevate the total level in management of critically ill newborn infants. It plays a very important role in reducing mortality and i

关 键 词：婴儿 新生 病人转送 重症监护病房 新生儿 

分 类 号：R722.1[医药卫生—儿科]