【摘要】：目的探討如何提升危重孕產(chǎn)婦及時(shí)有效救治力,進(jìn)一步降低孕產(chǎn)婦死亡率。方法根據(jù)重慶市沙坪壩區(qū)(沙區(qū))13家接產(chǎn)單位產(chǎn)科質(zhì)量調(diào)查結(jié)果,分析在2015年1月起實(shí)施重慶市危重孕產(chǎn)婦風(fēng)險(xiǎn)預(yù)警體系運(yùn)行前后3年的產(chǎn)科質(zhì)量相關(guān)指標(biāo)變化情況(孕產(chǎn)婦總數(shù)、危重孕產(chǎn)婦發(fā)生率、孕產(chǎn)婦死亡率、剖宮產(chǎn)率、產(chǎn)后出血發(fā)生率和新生兒死亡率)以及危重孕產(chǎn)婦病因和孕產(chǎn)婦死亡原因。調(diào)查預(yù)警體系運(yùn)行2年中存在問(wèn)題。結(jié)果 2014、2015、2016年重慶市沙區(qū)孕產(chǎn)婦總數(shù)逐年上升(16 359、17 311、19 014人)。危重孕產(chǎn)婦發(fā)生率逐年上升(27.72%、38.29%、39.05%),差異有統(tǒng)計(jì)學(xué)意義(χ~2=3.819,P=0.031);孕產(chǎn)婦死亡率逐年下降(42.79/10萬(wàn)、28.88/10萬(wàn)、5.26/10萬(wàn)),差異有統(tǒng)計(jì)學(xué)意義(χ~2=5.104,P=0.018);剖宮產(chǎn)率(48.30%、47.84%、47.21%)及產(chǎn)后出血發(fā)生率(2.22%、2.14%、2.05%)有下降趨勢(shì),差異無(wú)統(tǒng)計(jì)學(xué)意義(χ~2=0.643,P=0.575;χ~2=1.446,P=0.228);新生兒死亡率逐年下降(1.58%、0.90%、0.69%),差異有統(tǒng)計(jì)學(xué)意義(χ~2=4.761,P=0.023)。妊娠合并內(nèi)外科疾病是危重孕產(chǎn)婦的第1位病因及孕產(chǎn)婦死亡的第1位原因。預(yù)警體系運(yùn)行2年中存在風(fēng)險(xiǎn)預(yù)警認(rèn)識(shí)、動(dòng)態(tài)評(píng)估不夠,轉(zhuǎn)診不及時(shí)、轉(zhuǎn)診不規(guī)范等問(wèn)題。結(jié)論危重孕產(chǎn)婦風(fēng)險(xiǎn)預(yù)警體系在重慶市沙區(qū)運(yùn)行成效明顯,在提高危重孕產(chǎn)婦救治成功率和降低孕產(chǎn)婦死亡率方面起著重要作用,值得不斷完善和推廣。
[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.
【作者單位】： 第三軍醫(yī)大學(xué)第一附屬醫(yī)院;重慶市沙坪壩區(qū)婦幼保健院;重慶醫(yī)科大學(xué)附屬第二醫(yī)院;重慶市婦幼保健院;
【基金】：重慶市衛(wèi)生計(jì)生重點(diǎn)項(xiàng)目(20141006)
【分類(lèi)號(hào)】：R714.2

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