湖南省三甲医院早产儿视网膜病变防治现状
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摘要
目的:探讨湖南省三甲医院早产儿视网膜病变(ROP)防治现状及其制约因素。方法:采取分层随机抽样的方法,从湖南省13个地级市和1个自治州中抽取设立新生儿重症监护病房的三甲医院20家。对医院新生儿科负责人派发《医院ROP防治情况调查表》,以此了解三甲医院新生儿氧疗监测情况、ROP筛查和治疗情况、医院开展ROP培训和管理情况、卫生行政部门督导情况及开展ROP防治工作的制约因素。结果:本研究有效回收调查表20份。20家(100%)医院均开展了氧疗监测,12家(60%)医院开展了ROP筛查,3家(15%)医院开展了ROP治疗,2家(10%)医院同时开展了ROP筛查和治疗,5家(25%)医院进行了ROP防治专项培训,4家(20%)医院所属地卫生行政部门开展了ROP防治督导工作。省部级三甲医院开展ROP治疗、专项培训及督导情况均好于地市级三甲医院。ROP防治的主要制约因素包括缺乏专业技术人才、防治设备、规范化培训及重症患儿治疗风险大。结论:湖南省三甲医院新生儿氧疗监测情况较好,但ROP的筛查及治疗现状不容乐观,应加强开展ROP防治专项技能培训及督导工作,进一步提高ROP整体防治水平。
AIM: To investigate the present situation and restrictive factors about the prevention and control of retinopathy of prematurity in Grade Ⅲ A hospitals of Hunan Province. METHODS: A total of 20 hospitals with neonatal intensive care unit were selected from 13 prefecture level cities and 1 autonomous prefectures in Hunan Province by stratified random sampling method. The questionnaires for prevention and treatment of retinopathy of prematurity in hospital were distributed to the hospital officers in order to survey the condition of oxygen monitoring,ROP screening and treatment,ROP training in hospitals and the supervision of health administration departments and the restrictive factors for prevention and treatment of ROP. RESULTS: Totally 20 questionnaires were collected.There were 20( 100%) hospitals carried out oxygen monitoring, 12( 60%) hospitals conducted ROP screening,3( 15%) hospitals conducted ROP treatment,2( 10%) hospitals conducted ROP screening and treatment,5( 25%) hospitals conducted special training for prevention and treatment of ROP and 4( 20%) local health administration conducted supervision for prevention and control of ROP. The situation of treatment, special training and supervision for ROP in provincial Grade Ⅲ A hospitals were better than ministerial Grade Ⅲ A hospitals. The main restrictive factors of ROP were lack of professional and technical talents, equipment for prevention and treatment,standardized training and the great risk of treatment in children with severe disease.CONCLUSION: The oxygen monitoring for newborns in Grade Ⅲ A hospitals were good,but the present situation of screening and treatment about ROP is not optimistic.The training of special skills and supervision for prevention and treatment of ROP should be strengthened to further improve the overall level of ROP prevention and control.
AIM: To investigate the present situation and restrictive factors about the prevention and control of retinopathy of prematurity in Grade Ⅲ A hospitals of Hunan Province. METHODS: A total of 20 hospitals with neonatal intensive care unit were selected from 13 prefecture level cities and 1 autonomous prefectures in Hunan Province by stratified random sampling method. The questionnaires for prevention and treatment of retinopathy of prematurity in hospital were distributed to the hospital officers in order to survey the condition of oxygen monitoring,ROP screening and treatment,ROP training in hospitals and the supervision of health administration departments and the restrictive factors for prevention and treatment of ROP. RESULTS: Totally 20 questionnaires were collected.There were 20( 100%) hospitals carried out oxygen monitoring, 12( 60%) hospitals conducted ROP screening,3( 15%) hospitals conducted ROP treatment,2( 10%) hospitals conducted ROP screening and treatment,5( 25%) hospitals conducted special training for prevention and treatment of ROP and 4( 20%) local health administration conducted supervision for prevention and control of ROP. The situation of treatment, special training and supervision for ROP in provincial Grade Ⅲ A hospitals were better than ministerial Grade Ⅲ A hospitals. The main restrictive factors of ROP were lack of professional and technical talents, equipment for prevention and treatment,standardized training and the great risk of treatment in children with severe disease.CONCLUSION: The oxygen monitoring for newborns in Grade Ⅲ A hospitals were good,but the present situation of screening and treatment about ROP is not optimistic.The training of special skills and supervision for prevention and treatment of ROP should be strengthened to further improve the overall level of ROP prevention and control.
引文
1 Freitas AM,Morschbacher R,Thorell MR, et al. Incidence and risk factors for retinopathy of prematurity:a retrospective cohort study. Int J Retina Vitreous 2018; 4(1):20
2 Yau GS,Lee JW,Tam VT, et al. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants. IntOphthalmol 2015;35(3):365-373
3 Reyes ZS, A1-Mulaabed SW, Bataclan F, et al. Retinopathy of prematurity:Revisiting incidence and risk factors from Oman compared to other countries. Oman J Ophthalmol 2017; 10(1):26-32
4 Ahuja AA, V Reddy YC, Adenuga OO,et al. Risk factors for retinopathy of prematurity in a district in South India:A prospective cohort study.Oman J Ophthalmol 2018; 11(1):33-37
5早产儿视网膜病变多中心调查协作组.中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查.中国循证儿科杂志2015;10(3):161-165
6中国医师协会新生儿科医师分会.早产儿治疗用氧和视网膜病变防治指南(修订版).中华实用儿科临床杂志2013;28(23):1835-1836
7 Martinelli S,Gatelli I, Proto A. SpO2 and retinopathy of prematurity:state of the art. J Matern Fetal Neonatal Med 2012;25:108-110
8 NICU早产儿用氧及ROP防治现状调查组.16家三甲医院新生儿重症监护病房早产儿用氧及早产儿视网膜病变防治现状调查.中华儿科杂志2012;50(3):167-171
9谭光明,杨洋,杜天明,等.早产儿视网膜病防治现状的探讨.中华疾病控制杂志2015; 19(9):955-956,965
10贺美华,罗先琼,杨洋,等.广东省早产儿视网膜病防治现状.中华实用儿科临床杂志2016;31(2):105-107
11李秋平,周细中,章晨,等.2185例早产儿视网膜病变筛查结果及其高危因素.中华围产医学杂志2013;16(2):71-75
12中国内地新生儿专业发展现状调查协助组.国内109家医院早产儿视网膜病防治现状调查.中华实用儿科临床杂志2013;28(2):86-88
13 Fijalkowski N,Zheng LL, Henderson M T, et al. Stanford University Network for Diagnosis of Retinopathy of Prematurity(SUNDROP):five years of screening with telemedicine. Ophthalmic Surg Lasers Imaging Retina 2014;45(2):106-113
14 Quinn GE,Ying GS,Pan W,et al. Detection of Potentially Severe Retinopathy of Prematurity by Remote Image Grading. JAMA Ophthalmol2017;135(9):982-986
15王雨生,李蓉.重视我国早产儿视网膜病的防治工作.中华眼科杂志2011;47(6):483-486
16 Hariharan,Gilbert CE, Quinn GE, et al. Reducing Blindness from Retinopathy of Prematurity(ROP)in Argentina Through Collaboration,Advocacy and Policy Implementation. Health Policy Plan 2018; 33(5):654-665
17 Arnesen L, Duran P, Silva J,et al. A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean. Rev Panam Salud Publica 2016; 9(6):322-329
2 Yau GS,Lee JW,Tam VT, et al. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants. IntOphthalmol 2015;35(3):365-373
3 Reyes ZS, A1-Mulaabed SW, Bataclan F, et al. Retinopathy of prematurity:Revisiting incidence and risk factors from Oman compared to other countries. Oman J Ophthalmol 2017; 10(1):26-32
4 Ahuja AA, V Reddy YC, Adenuga OO,et al. Risk factors for retinopathy of prematurity in a district in South India:A prospective cohort study.Oman J Ophthalmol 2018; 11(1):33-37
5早产儿视网膜病变多中心调查协作组.中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查.中国循证儿科杂志2015;10(3):161-165
6中国医师协会新生儿科医师分会.早产儿治疗用氧和视网膜病变防治指南(修订版).中华实用儿科临床杂志2013;28(23):1835-1836
7 Martinelli S,Gatelli I, Proto A. SpO2 and retinopathy of prematurity:state of the art. J Matern Fetal Neonatal Med 2012;25:108-110
8 NICU早产儿用氧及ROP防治现状调查组.16家三甲医院新生儿重症监护病房早产儿用氧及早产儿视网膜病变防治现状调查.中华儿科杂志2012;50(3):167-171
9谭光明,杨洋,杜天明,等.早产儿视网膜病防治现状的探讨.中华疾病控制杂志2015; 19(9):955-956,965
10贺美华,罗先琼,杨洋,等.广东省早产儿视网膜病防治现状.中华实用儿科临床杂志2016;31(2):105-107
11李秋平,周细中,章晨,等.2185例早产儿视网膜病变筛查结果及其高危因素.中华围产医学杂志2013;16(2):71-75
12中国内地新生儿专业发展现状调查协助组.国内109家医院早产儿视网膜病防治现状调查.中华实用儿科临床杂志2013;28(2):86-88
13 Fijalkowski N,Zheng LL, Henderson M T, et al. Stanford University Network for Diagnosis of Retinopathy of Prematurity(SUNDROP):five years of screening with telemedicine. Ophthalmic Surg Lasers Imaging Retina 2014;45(2):106-113
14 Quinn GE,Ying GS,Pan W,et al. Detection of Potentially Severe Retinopathy of Prematurity by Remote Image Grading. JAMA Ophthalmol2017;135(9):982-986
15王雨生,李蓉.重视我国早产儿视网膜病的防治工作.中华眼科杂志2011;47(6):483-486
16 Hariharan,Gilbert CE, Quinn GE, et al. Reducing Blindness from Retinopathy of Prematurity(ROP)in Argentina Through Collaboration,Advocacy and Policy Implementation. Health Policy Plan 2018; 33(5):654-665
17 Arnesen L, Duran P, Silva J,et al. A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean. Rev Panam Salud Publica 2016; 9(6):322-329