区域性新生儿转运网络的改进策略与早期成效  

Improved Outcomes of Transported Newborns:Effects of Strategic Changes in Establishment of Regional Active Neonatal Transport Network

作　　者：孔祥永[1] 洪小杨[1] 董建英[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医学中心,北京100700

出　　处：《中国医刊》2010年第12期38-41,共4页Chinese Journal of Medicine

基　　金：首都医学发展科研基金资助项目(2005-3044)

摘　　要：目的探讨建立和改进北京区域性综合主动型新生儿转运网络(ANTN)组织的措施,评估其改善转运新生儿预后的短期效果。方法用回顾性分析的方法,分析在建设ANTN过程中有关转运网络建设效果的新生儿资料。主要改进措施为转运中心建立规范现代化NICU、扩大转运队伍和建立PSS系统。分2个阶段对比研究:初级阶段和成熟阶段。结果前后两阶段相比,转运新生儿总数由567例增加到2903例,由23.6例/月增加到121例/月;新生儿转运成功率明显增高;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。转运早产儿病死率明显降低,使相应转运新生儿病死率明显降低;转运早产儿的比例,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明显增多,新生儿窒息及RDS的发生率明显降低,提高了早产儿、新生儿窒息、RDS以及吸入综合征的治愈率。结论这些改进措施促进了ANTN的稳定和发展,对降低新生儿发病率和死亡率至关重要,其中三级NICU(转运中心)建设在ANTN中起主导作用。Objective The aim of this study was to examine the effects on the outcomes of transported infants and the development of ANTN especially after the major strategic changes in operating to optimize the ANTN in Beijing, China. Methods Information on transported newborns from July 2004-June 2008 was retrospectively collected. The interventions included establishment standardized NICU, increased number of dedicated neonatal transported teams and the Perinatal Support Service （PSS）. Data from stage 1 were compared with those of stage 2. Results 567 infants were transferred in the first 2 year period （ stage 1 ） and 2903 infants in stage 2. The number of transported newborns increased. Significantly fewer transported newborns in the stage 2 group had hypothermia, acidosis and hypo/hyperglycemia than those in the stage 1 group. There were no deaths during retrieval in both groups. The transport achievement rate was significantly higher in stage 2. There was a significant decrease in overall NICU mortality in stage 2, especially for preterm infants. More preterm infants and low birth weight infants were transferred in stage 2. Transported neonates had a lower incidence of low 5 minutes Apgar scores（ 〈7）, RDS and Nosocomial sepsis in stage 2. The incidence of asphyxia and respiratory distress syndrome were lower in stage 2 than that in stage 1. The most important is that the improvement of short-term outcome in premature infants, asphyxia infants, RDS and aspiration syndrome was noted after the strategy changes. Conclusion Our findings demonstrate a significant improvement in sbort-term neonatal outcomes in transported newborn infants following introduction of the ANTN system and the strategic changes.

关 键 词：新生儿转运网络 效果 病死率 

分 类 号：R722.1[医药卫生—儿科]