重庆市沙坪坝区危重孕产妇风险预警体系运行评估研究

发布时间：2018-12-19 13:25

【摘要】：目的探讨如何提升危重孕产妇及时有效救治力,进一步降低孕产妇死亡率。方法根据重庆市沙坪坝区(沙区)13家接产单位产科质量调查结果,分析在2015年1月起实施重庆市危重孕产妇风险预警体系运行前后3年的产科质量相关指标变化情况(孕产妇总数、危重孕产妇发生率、孕产妇死亡率、剖宫产率、产后出血发生率和新生儿死亡率)以及危重孕产妇病因和孕产妇死亡原因。调查预警体系运行2年中存在问题。结果 2014、2015、2016年重庆市沙区孕产妇总数逐年上升(16 359、17 311、19 014人)。危重孕产妇发生率逐年上升(27.72%、38.29%、39.05%),差异有统计学意义(χ~2=3.819,P=0.031);孕产妇死亡率逐年下降(42.79/10万、28.88/10万、5.26/10万),差异有统计学意义(χ~2=5.104,P=0.018);剖宫产率(48.30%、47.84%、47.21%)及产后出血发生率(2.22%、2.14%、2.05%)有下降趋势,差异无统计学意义(χ~2=0.643,P=0.575;χ~2=1.446,P=0.228);新生儿死亡率逐年下降(1.58%、0.90%、0.69%),差异有统计学意义(χ~2=4.761,P=0.023)。妊娠合并内外科疾病是危重孕产妇的第1位病因及孕产妇死亡的第1位原因。预警体系运行2年中存在风险预警认识、动态评估不够,转诊不及时、转诊不规范等问题。结论危重孕产妇风险预警体系在重庆市沙区运行成效明显,在提高危重孕产妇救治成功率和降低孕产妇死亡率方面起着重要作用,值得不断完善和推广。
[Abstract]:Objective to explore how to improve the timely and effective treatment ability of critical pregnant women and further reduce the maternal mortality rate. Methods according to the investigation results of obstetrical quality of 13 parturient units in Shapingba district of Chongqing, To analyze the changes of obstetrical quality related indexes (total number of pregnant women, incidence rate of critical pregnant women, maternal mortality rate, cesarean section rate) before and after the implementation of Chongqing critical Maternal risk warning system in January 2015. Incidence of postpartum hemorrhage and neonatal mortality) as well as critical maternal causes and causes of maternal mortality. There are problems in the investigation and early warning system for 2 years. Results the total number of pregnant and lying-in women increased year by year in the sand area of Chongqing in 2016 (16 359 / 17 3111,19 014). The incidence rate of critical pregnant and parturient increased year by year (27.72% 38.29%), the difference was statistically significant (蠂 ~ 2 = 3.819). The maternal mortality rate decreased year by year (427.9 / 100,28.88 / 100,5.26 / 100 thousand), and the difference was statistically significant (蠂 ~ (2) 5.104% P ~ (0.018). The rate of cesarean section (48.30%, 47.84%) and the incidence of postpartum hemorrhage (2.222.14%, 2.05%) showed a downward trend, and the difference was not statistically significant (蠂 ~ 2 ~ 2, 0.643, P ~ (0.575); 蠂 ~ (2) ~ (1.446) P ~ (0.228); The neonatal mortality rate decreased year by year (1.58 / 0.90 / 0.69%), and the difference was statistically significant (蠂 ~ 2 ~ (4.761) P ~ (0.023). Pregnancy combined with internal and surgical diseases is the first etiology and the first cause of maternal mortality. During the two years of operation of the early warning system, there are some problems, such as early warning awareness, insufficient dynamic evaluation, untimely referral and non-standard referral, etc. Conclusion the risk early warning system of critical pregnant and lying-in women is effective in the sand area of Chongqing and plays an important role in improving the success rate of treatment and reducing the mortality rate of pregnant and lying-in women. It is worth perfecting and popularizing.
【作者单位】：第三军医大学第一附属医院;重庆市沙坪坝区妇幼保健院;重庆医科大学附属第二医院;重庆市妇幼保健院;
【基金】：重庆市卫生计生重点项目(20141006)
【分类号】：R714.2

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