第四次四川省中医医院重症医学科质控工作现状调查及分析  

Fourth investigation and analysis of the quality control situation in the critical care medicine of traditional Chinese medicine hospitals in Sichuan province

作　　者：陈骏[1,2,3] 陈星月 龙坤兰 袁睿 张松 李晓斌[5] 钟兴美 张楷晨 丁鹏[1] 高培阳 Chen Jun;Chen Xingyue;Long Kunlan;Yuan Rui;Zhang Song;Li Xiaobin;Zhong Xingmei;Zhang Kaichen;Ding Peng;Gao Peiyang(Department of Critical Care Medicine,Hospial of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,Sichuan,China;Sichuan Provincial Critical Care Medicine Quality Control Center of Traditional Chinese Medicine,Chengdu 610072,Sichuan,China;Department of Critical Care Medicine,Deyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine,Deyang 618000,Sichuan,China;Graduate School,Chengdu University of Traditional Chinese Medicine,Chengdu 610072,Sichuan,China;Department of Critical Care Medicine,Southwest Medical University Affiliated Hospital of Traditional Chinese Medicine,Luhou 646699,Sichuan,China;Department of Critical Care Medicine,Chengdu Traditional Chinese Medicine and Western Medicine Hospital,Chengdu 610095,Sichuan,China)

机构地区：[1]成都中医药大学附属医院重症医学科,四川成都610072 [2]四川省中医重症医学质量控制中心,四川成都610072 [3]成都中医药大学附属德阳医院重症医学科,四川德阳618000 [4]成都中医药大学研究生院,四川成都610072 [5]西南医科大学附属中医医院重症医学科,四川泸州646699 [6]成都市中西医结合医院重症医学科,四川成都610095

出　　处：《中国中西医结合急救杂志》2024年第4期459-464,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：四川省中医药管理局科学技术研究专项(2021MS414);四川省中医医院成都中医药大学附属医院科研专项(22XG01)。

摘　　要：目的调查和分析四川省中医医院重症监护病房(ICU)质量控制(质控)工作现状,旨在增强省内中医医院ICU的医疗服务质量.方法2023年11月,四川省中医重症医学质控中心推出《中医重症医学质控督导项目评分标准》,对设有独立ICU的全部中医医院进行质控评估和业务指导.调查内容涵盖结构指标、控制指标、中医参与情况、新技术开展情况以及优势病种诊疗方案等.结果结构指标方面:全省共有110家中医医院拥有独立ICU,相比2019年增长了1.12倍.质控指标显示,ICU患者收治率较2017年全国ICU收治率有所提升,并且急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分≥15分患者的收治率有所增加,不过,ICU的病死率却超过了全国平均水平.核心指标完成率显著改进,但结局指标如ICU呼吸机相关性肺炎(VAP)、ICU血管内导管相关血流感染(CRBSI)和ICU导尿管相关泌尿系感染(CAUTI)的发生率自2019年以来均有所上升,主要集中在二级医院;新技术开展数量平均(5.5±3.4)项,中医参与率下降,优势病种较2019年上升,以脓毒症、呼吸衰竭、出血性中风为主.结论四川省各级中医医院ICU数量有了快速增长,各项核心指标完成率较前也有所提高,但VAP、CRBSI、CAUTI发生率的预防仍需加强,医疗资源配置不足,区域医疗资源、人才培养的不平衡性仍亟待解决,同时中医参与率及优势病种诊治仍需进一步加强.Objective To enhance the quality of medical services in the intensive care unit(ICU)of provincial traditional Chinese medicine(TCM)hospitals.Methods In November 2023,Sichuan Provincial Critical Care Medicine Quality Control Center of TCM launched the"quality control supervision project scoring standard for critical care medicine of TCM"to conduct quality control evaluation and business guidance for all TCM hospitals with independent ICU.The survey covered structural indicators,control indicators,participation of TCM,development of new technologies,and diagnosis and treatment programs for dominant diseases.Results In terms of structural indicators:a total of 110 TCM hospitals in the province have independent ICU,an increase of 1.12 times compared with 2019.The control indicators showed that the ICU patients admission rate was higher than that of the national ICU admission rate in 2017,and the admission rate of patients with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score≥15 points increased.However,the mortality of ICU exceeded the national average.The implementation of core indicators had been significantly improved,but the incidence of outcome indicators such as ICU ventilator-associated pneumonia(VAP),ICU intravascular catheter-related bloodstream infection(CRBSI),and ICU catheter-related urinary tract infection(CAUTI)had increased since 2019,mainly in secondary hospitals.The average number of new technologies was about(5.5±3.4),the participation rate of TCM decreased,and the dominant diseases increased compared with 2019,mainly sepsis,respiratory failure and hemorrhagic stroke.Conclusions The number of ICU units in TCM hospitals at all levels in Sichuan province has grown rapidly,and key performance indicators have also improved compared to previous periods.However,greater efforts are still needed in preventing the occurrence rates of VAP,CRBSI,and CAUTI.There is a shortage of medical resources allocation,and the imbalance in regional medical resources and professional training remains an

关 键 词：四川 口中医医院 重症监护病房 质量控制 现状 

分 类 号：R19[医药卫生—卫生事业管理]