广东省二级医院综合重症加强治疗病房现状调查和重症监护网的建设

目的 调查目前广东省二级医院综合重症加强治疗病房(ICU)的建设状况,并为省卫生厅建立省级重症监护网提供依据.方法 采用问卷调查形式采集广东省26家医院ICU的数据.结果 ①ICU床位数为(10.12±3.82)张,医生与床位数比及护士与床位数比分别是0.73±0.25和1.80±0.57,封闭式和半封闭式管理模式分别占69.2%和26.9%.②每张床用房面积是(17.57±7.58)m2,感应式洗手盆数与床位数比为0.47±0.33,正或负压病房、空气层流系统和营养准备室的配备率分别为15.4%、30.8%和23.1%.③人工气道建立与管理、机械通气技术、深静脉置管术、电复律与除颤术、肠外营养支持及镇静使用的开展率均达100.0%,96.2%的ICU能独立完成气管插管,53.8%的ICU开展血流动力学监测,持续血液净化开展率为73.1%.④床旁多功能持续心电监护仪装备率96.2%,其与床位数之比为0.89±0.29,复苏呼吸气囊或呼吸机与床位数之比分别为0.71±0.34和0.71±0.24,便携式呼吸机拥有率34.6%,40%的ICU未开展无创机械通气,纤维支气管镜装备率65.4%,92.3%的ICU能提供24 h血气分析.⑤26家综合ICU分布于珠江三角洲地区和粤东、粤北及粤西地区,构成了全省重症监护网的基石.结论 广东省二级医院综合ICU中大多数项目已达到或接近《关于广东省重症监护病房建设指导意见》和《中国重症加强治疗病房建设与管理指南》的要求,ICU的平均水平已接近Ⅱ级;重症监护网能有效整合现有资源而提升本地区危重病救治水平.

A survey of present situation of general intensive care unit in secondgrade hospitals and construction of intensive care network in Guangdong province

OBJECTIVE: To investigate the present situation of general intensive care unit (ICU) in secondgrade hospitals, and to establish intensive care network for the Department of Public Health of Guangdong province in Guangdong province. METHODS: Data from ICU of 26 hospitals in Guangdong were collected through questionnaire concerning different aspects of critical care medicine. RESULTS:(1) ICU size was (10.12+/-3.82) beds per unit, ratios of doctors to beds and nurses to beds were 0.73+/-0.25 and 1.80+/-0.57 respectively, and proportions of closed model or semi-closed model of ICU management were 69.2% and 26.9% respectively. (2) Area occupied by per bed was (17.57+/-7.58) m2, ratio of basins with infrared control faucet to beds was 0.47+/-0.33, proportions of ICU equipped with room equipped with positive or negative air pressure, laminar flow, or with room for preparing nutrition support were 15.4%, 30.8%, and 23.1% respectively. (3) All the ICU were capable of institution and management of artificial airway, mechanical ventilation, placement of deep vein line, cardiovertion and defibrillation, parenteral nutrition, and sedation. Ninety-six point two percent of the ICU could accomplish trachea intubation independently. Fifty-three point eight percent of the ICU could perform hemodynamic monitoring. Continuous blood purification could be done in 73.1 % of the ICU. (4) Ninety-six point two percent of the ICU were equipped with continuous bedside multifunctional electrocardiogram monitor and ratio of the monitors to beds was 0.89+/-0.29. Ratios of resuscitation air bags to beds and ventilators to beds were 0.71+/-0.34 and 0.71+/-0.24 respectively. Portable ventilator was equipped in 34.6 % of the ICU. Forty percent of the ICU could not perform non-invasive ventilation, 65.4 % of the ICU were equipped with fiberoptic bronchoscope, blood gas analysis could be done during 24 hours round in 92.3 % of the ICU. (5) Twenty-six ICU investigated were found to be distributed over the district of Zhujiang delta, and east, north and west regions of Guangdong, forming the footstone of intensive care network in Guangdong province. CONCLUSION: Most of the general ICU in secondgrade hospitals in Guangdong province have fulfilled the main requirement for ICU in accordance with the guidelines for construction of ICU in Guangdong province and of guidelines for construction and management of ICU in China. The average level of the ICU is close to level II. It is possible for the intensive care network to integrate, the present resources effectively and then enhance the level of treatment of critical illness in the said district.