【摘要】 目的提高项目地区县级医疗机构产儿科人员新生儿窒息复苏能力,在试点地区建立包括政策、规章、人员和资金支持在内的医疗机构新生儿窒息复苏工作的长效机制。方法在中澳卫生与艾滋病项目确定的4个项目县开展项目活动。为实现项目目标,项目组计划实施了省级师资培训班、县级定期复训,建立院内新生儿窒息复苏领导小组制度,开展国家级和省级督导与评估,举办专家研讨会及经验交流会等22项子活动。项目结束后,采用随机对照的研究方法,选择4个对照县进行调查并与干预县进行比较。结果①政策影响方面:干预县新生儿科医生参加高危分娩术前讨论、分娩现场等待分娩、参加新生儿窒息病例评审等制度建立率均在90%以上,对照县均低于55%。项目省将中澳项目所引进的知识、管理制度和经验扩展到全省范围,产生深远的影响。②能力建设方面:干预县和对照县医务人员新生儿复苏知识平均得分分别为(9.19±1.18)分和(8.40±1.52)分(t=3.922,P<0.001),自信心平均得分分别为(57.33±2.50)分和(54.09±8.19)分(t=3.541,P=0.001);对照县医务人员"快速评估的四项内容"、"羊水污染且无活力是否需要立即气管内吸引胎粪"等核心知识的回答,正确率均低于70%,且均显著低于干预县。③临床效果方面:干预县新生儿窒息发生率由8.83%降至5.99%(χ2=11.300,P=0.001),因窒息死于分娩现场率由27.60/10万降至5.03/10万(χ2=3.142,P=0.076);对照县这两个率的变化均无统计学意义。结论中澳项目在政策影响、能力建设和临床效果等方面取得了显著成绩,不仅提高了医务人员新生儿窒息复苏的技术能力和自信心水平,降低新生儿窒息发生率和死亡率,而且促成项目省出台了一系列降低新生儿死亡的政策、规章和制度,以项目为契机促进妇幼卫生工作的全面发展和提高。更多还原

【Abstract】 Objective Neonatal mortality is one of the leading causes of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. Under the funds support of CAHHF, the National Centre for Women and Children’s Health of China CDC, the Department of Maternal and Child Health Care and Community Health of MOH, the Nossal Institute for Global Health of the University of Melbourne, the Shandong Provincial Health Bureau and the Heilongjiang Provincial Health Bureau cooperated to launch the pilot program exploring effective mechanism of neonatal resuscitation training in rural China. The program was laungched in Februay 2009 and completed in February 2012, lasting for 37 months. Objectives To improve the neonatal resuscitation practical skills of health providers at county levels. Sustainable supportive systems of regulations, policies, human resources and funding to implement neonatal resuscitation training in county level health care institutions in pilot provinces implemented. Methods The program activities were implemented in 4 counties identified by the CAHHF. In order to achieve the objectives, 22 sub-activities including experts meeting &seminar, training and retraining, policy advocacy, investigation/supervision/evaluation and experience exchanging were implemented. Upon completing the program activities, a random control survey was conducted in the intervention counties and 4 randomly selected control counties to evaluate the impact of intervention. Results ① Policy impact: Over 90% of intervention hospitals had carried out neonatal resuscitation related regulations requiring that trained paediatricians participate in case discussion of high-risk delivery and onsite resuscitation, while in control hospitals less than 55% had such requirements. ②Capacity building: The average knowledge score of health providers in the intervention and control counties were 9.19±1.18 and 8.40±1.52 respectively (t=3.922, P<0.001). The average self-confidence score in the two groups were 57.33±2.50 and 54.09±8.19 respectively (t=3.541, P=0.001). For some core questions, such as "what are the four indicators of rapid assessment", "cases with fluid contained meconium that were judged as not vigorous infant should conduct endotracheal intubation for meconium suction", the correct answer rates were less than 70% in the control group and was significantly lower than that in the intervention group. ③Clinical effect: The incidence of birth asphyxia (defined as Apgar score≤7) decreased from 8.83% to 5.99% (χ2=11.300, P=0.001) in the intervention counties, and the intrapartum-related deaths in the delivery room decreased from 27.60 to 5.03 per 100,000 (χ2=3.142,P=0.076).No significantly changes of asphyxia incidence and mortality were found in the control counties. Conclusions China-Australian neonatal resuscitation pilot program has made achievements in policy influence, capacity building, and clinical impact. It not only improved the skill of health staff, decreased the mortality and mobility of birth asphyxia, but also helped to bring out the sustainable policies and regulations. The program functions as a turning point to promote the work of women and children health care.更多还原