综合医院开展新生儿复苏院内培训的实践及存在问题分析

目的：探讨综合医院开展新生儿复苏院内培训及复训模式，评价其培训效果。方法建立院内新生儿复苏领导小组，落实产、儿科合作制度的建立和运作，对新生儿窒息病例进行讨论，对院内培训后医护人员现场操作情况进行分析，比较新疆开展新生儿复苏培训项目（ NRP）及院内培训后新生儿窒息的发生及死亡情况。结果①受训人员操作情况：实施院内培训前，初步复苏操作率为93％，其中65％的患儿初步复苏步骤不全面。正压人工通气、胸外按压及应当给予气管插管的患儿的操作正确率偏低。院内培训后，初步复苏操作率为90％，其中82％的患儿实施了完整的初步复苏操作。正压人工通气的操作率较院内培训前有明显上升。②新生儿窒息情况比较：新疆自治区人民医院新生儿窒息发生率从2000年的5．75％降至2013年的3．2％，现场死亡率由2000年的2．5‰降至2013年的1．18‰。2004年底开展新生儿复苏培训项目（ NRP）后新生儿窒息发生率及重度窒息发生率与培训前比较，差异均具有统计学意义异（χ2值分别为75．96、4．75，均P＜0．05），但现场死亡率差异无统计学差意义（χ2＝2．39，P＞0．05）。接受院内培训后新生儿窒息发生率、重度窒息的发生率比较，差异均具有统计学意义（χ2值分别为11．83、3．68，均P＜0．05），但现场死亡率差异无统计学差意义（Fisher P＞0．05）。培训周期延长至1年，窒息的发生率及重度窒息的发生率比较，差异均无统计学意义差异（χ2值分别为1．07、0．51，均P＞0．05），现场死亡率亦无统计学差异（χ2＝0．81，P＞0．05）。结论通过建立院内新生儿复苏培训，可促进综合医院科室间的协调，提高了受训人员的操作水平，提高了Apgar评分为0～1分患儿的抢救水平，降低了新生儿窒息发生率。

Analysis of the practice and existing problems of hospital-based neonatal resuscitation training in general hospitals

Objective To investigate the mode of neonatal resuscitation hospital-based training and re-training in general hospitals and evaluate the effectiveness of the training.Methods A leading group concerning neonatal resuscitation was set up, the cooperation between the Department of Obstetrics and Department of Pediatrics was implemented, and the cases of neonatal asphyxia were discussed.Besides, situations concerning medical personnel's spot operations after training were analyzed so as to compare the situation of incidence and death of asphyxia after neonatal resuscitation training program ( NRP) and hospital training.Results Operating conditions by trainees showed that before hospital-based neonatal resuscitation training, the rate of initial resuscitation was 93% with about 65% of initial recovery steps finished incompletely.The rates of correct operation of positive pressure artificial ventilation, chest compressions and endotracheal intubation were low.After hospital-based training, the rate of initial resuscitation was 90% with about 82% of initial recovery steps finished completely.The rate of correct operation of positive pressure artificial ventilation increased apparently.Comparison of neonatal asphyxia revealed that in People's Hospital of Xinjiang Uygur Autonomous Region, the incidence rate of neonatal asphyxia decreased from 5.75%in 2000 to 3.2%in 2013, and the rate of death on spot decreased from 2.5‰in 2000 to 1.18‰in 2013.When comparing the incidence rate of neonatal asphyxia and severe asphyxia after medical personnel's receiving new born resuscitation program ( NRP) at the end of 2004 to that before the training, statistically significant differences were identified (χ2 value was 75.96 and 4.75, respectively, both P<0.05).However, there was no statistically significant difference in the rate of death on spot (χ2 =2.39,P>0.05).After medical personnel’ s receiving of hospital-based training, the incidence rate of asphyxia and severe asphyxia showed statistical differences before and after training (χ2 value was 11.83 and 3.68, respectively, both P<0.05), but no statistical difference was noted in the rate of death on spot ( Fisher P>0.05) .After extending the cycle of training to 1 year, no statistical difference was identified in the incidence rate of asphyxia and severe asphyxia (χ2 value was 1.07 and 0.51, respectively, both P>0.05).In addition, there was no statistical difference in mortality rate (χ2 =0.81, P>0.05).Conclusion Neonatal resuscitation training can promote cooperation between departments and improve trainee’ s ability to rescue neonates whose Apgar score ranges from 0 to 1.Besides, it reduces the incidence rate of neonatal asphyxia.