中国儿科重症监护室近10年发展情况调查分析

目的 了解2000至2009年我国重症监护室(ICU)的发展情况与现状。方法 对全国内地有中华医学会儿科学分会急救学组及急诊医学分会儿科学组成员的35家医院进行问卷调查,收集2009年1至11月资料并与2000年27家儿童医院调查数据（B组）进行比较。结果 33(94.3％)家医院作复,其中25家为儿童专科医院（A1组）,8家综合医院儿科（A2组）。ICU[儿科重症监护室( PICU)和新生儿重症监护室(NICU)]床位占医院儿科床位比例A1组较B组(6.9％vs.5.8％)增加1.1个百分点。ICU医生床位比A1组和B组分别为0.5：l和0.75:1,护士床位比分别为1.17:1和1.38:1。监护仪与床位比A1组为1.44:1,B组为0.74:1,有创呼吸机与床位比A1组为0.64:1,B组为0.46:1。拥有血气分析仪、可作床旁X-线摄片与超声检查的医院所占比例,A1组和B组分别为100％( 25/25):60％( 16/27),96％( 24/25):70％( 19/27)及88％ (22/25):30％( 8/27)。A1组和B组开展肺表面活性物质(Ps)治疗分别为96％ (24/25):48％ (13/27)、持续血液净化(CBP) 80％( 20/25)：22％ (6/27)、高频通气(HFV) 84％ (21/25):37％( 10/27)。A1组开展ECMO有20％(5/25),B组为0。在ICU（PICU和NICU）,A1组和B组有创机械通气治愈好转率分别为77.5％(6393/8245)：63.4％ (809/1276),B组低于A1组(P＜0.001)。A1组和B组1～1.5 kg早产儿治愈好转率分别为88％ (2183/2482)：75.1％( 531/707);＞1.5 ～2.5者分别为93.7％(6836/7296):84.1％(1890/2247),B组均较A1组低(P＜0.01)。A1组和A2组分别对12 659和1392例PICU患儿作了危重病例评分,其中非危重病例两组分别为3616例（占28.6％）和639例（占45.9％）,A1组低于A2组(P =0.000)。床位使用率PICU A1组和A2组分别为127.1（103.3～186.0）和90.91 (71.0～126.0),NICU两组分别为138.0(83.8～290.5)和108.9（90.7～128.0）。结论两次所调查的医院分布地域广、ICU成立较早,其前后10年状况大致可代表我国儿科ICU的发展与现状,特别是PICU。ICU的设备、技术、治疗结果均有显著提高,但专业医护人员匮乏,床位使用率及收治非危重患儿比例过高等问题,需受重视。

Development of pediatric and neonatal intensive care units: results of a national survey (2000 - 2009)

Objective To understand the current situation and development of intensive care units for neonates and children (ICUs) in China. Methods A form of survey was e-mailed to chief of each ICU who is one of the thirty five board members of Subspecialty group of Emergency Medicine Chinese Society of Pediatrics or Chinese Society of Emergency Medicine Pediatric Branch. The data from Jan. 1 to Nov. 30, 2009 were collected and compared with the first survey which was conducted during the year 2000( Group B). Results Thirty three of 35 (94. 3％ ) hospitals responded. Among them, 25 were children's hospitals ( Group A1 ), 8 were pediatric department of general hospitals ( Group B). The total number of ICU beds accounted for 6. 9％ and 5.8％ of total numbers of hospital beds in Group A1 and B respectively, increased 1. 1 percent. The doctor to bed ratio in Group A1 and B were 0. 5 : 1 and 0. 75 : 1, nurse to bed ratio in Group A1 and B was 1.17:1 and 1.38: 1. The monitor to bed ratio in Group A1 were 1.44: 1, Group B were 0. 74:1 and the ventilator to bed ratio in Group A1 were 0. 64: 1, Group B were 0. 46: 1. The percentage of blood gas analyzers, portable X-ray, bedside ultrasound which ICUs owned in Group A1 and B were 100％(25/25) vs. 60％ ( 16/27 ) ,96％ ( 24/25 ) vs. 70％ ( 19/27 ) and 88％ (22/25) vs. 30％ ( 8/27 ) separately . The percentage of surfactant therapy use, blood purification therapy, high frequency ventilation and ECMO in Group A1 and B were 96％ (24/25)vs. 48％ (13/27),80％ (20/25)vs. 22％(6/27) , 84％ (21/25)vs. 37％ (10/27) and 20％ (5/25) vs. 0％. The survival rate of ventilated patients in group A1 and B were 77.5％ (6393/8245)vs. 63.4％ (809/1276)separately, Group B was lower than Group A1 (P ＜ 0. 001 ).The survival rate of premature infants weighted 1-1.5 kg in Group A1 and B were 88％ (2183/2482)vs. 75. 1％ (531/707), weighted ＞ 1.5-2. 5 kg were 93. 7％ (6836/7296) vs. 84. 1％ (1890/2247), Group B were lower than group A1 ( P ＜ 0. 01 ). There were 12 659 and 1392 patients in Group A1 and A2 respectively for whom the Pediatric Critical Illness Scoring system (PCIS) was used to assess the severities of illness in PICU patients. Among them, the percentage of non critically ill (＞90) patients in group A1 and A2 were 3616 (28. 6％ ) and 639 (45. 9％ ) respectively, Group A1 was lower than A2 (P=0. 000). The mean bed occupation rate of PICU in Group A1 and A2 were 127. 1％ ( 103.3％-186. 0％ ) vs. 90. 91％(71.0％-126.0％) , NICU in the above Groups were 138.0(83.8-290.5) vs. 108.9 (90.7-128.0) .Conclusion The present study may roughly reflect the development of ICUs in the past ten years and current situation of neonatal and pediatric ICUs in tertiary hospitals in the mainland of China, especially development of PICUs. The percentage of ICU bed to hospital bed was increased. The equipments, new techniques and survival rates of patients treated in ICUs had been improved remarkably, but the occupation rate of bed was too high. A number of PICU beds were occupied by low risk patients and lack of human resource need to be urgently addressed.