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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (04) : 236 -241. doi: 10.3877/cma.j.issn.2095-3259.2021.04.010

论著

阶梯式亚专科培训模式在重症孕产妇救治中的效果评估
余琳1, 刘静2, 陈桂娴1, 李叶2, 李进3, 张苏玉1, 魏宋荃1, 罗敏2, 陈敦金1, 杨宁1,†()   
  1. 1. 广州医科大学附属第三医院妇产科　广州重症孕产妇救治中心　广州妇产科重大疾病实验室　510150
    2. 贵州省，毕节市妇幼保健院产科　551603
    3. 毕节市卫生健康局　551603
  • 收稿日期:2021-07-06 出版日期:2021-11-18
  • 通信作者: 杨宁

Effect evaluation of a stepped sub-specialist training model on the treatment of severely ill pregnant women

Lin Yu1, Jing Liu2, Guixian Chen1, Ye Li2, Jin Li3, Suyu Zhang1, Songquan Wei1, Min Luo2, Dunjin Chen1, Ning Yang1,†()   

  1. 1. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou Medical Center for Critical Pregnant Women, Guangzhou 510150, China
    2. Obstetrical Department of Maternity & Child Healthcare Hospital of Bijie, Bijie 551603, China
    3. Health Bureau of Bijie, Bijie 551603, China
  • Received:2021-07-06 Published:2021-11-18
  • Corresponding author: Ning Yang
  • About author:
    *Yu Lin and Liu Jing are the first authors who contributed equally to the article. Yu Lin，Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou Medical Center for Critical Pregnant Women，Guangzhou 510150, China; Liu Jing, Obstetrical Department of Maternity & Child Healthcare Hospital of Bijie, Bijie 551603, China
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余琳, 刘静, 陈桂娴, 李叶, 李进, 张苏玉, 魏宋荃, 罗敏, 陈敦金, 杨宁. 阶梯式亚专科培训模式在重症孕产妇救治中的效果评估[J]. 中华产科急救电子杂志, 2021, 10(04): 236-241.

Lin Yu, Jing Liu, Guixian Chen, Ye Li, Jin Li, Suyu Zhang, Songquan Wei, Min Luo, Dunjin Chen, Ning Yang. Effect evaluation of a stepped sub-specialist training model on the treatment of severely ill pregnant women[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(04): 236-241.

目的

借助国家脱贫攻坚政策，在毕节示范区实施重症孕产妇救治阶梯式亚专科培训模式，评估该模式对当地重症孕产妇救治的临床效果。

方法

2020年6月，以广州医科大学附属第三医院为依托，在贵州省毕节市开展重症孕产妇救治阶梯式亚专科培训，培养市级产科重症救治骨干，并持续深入到各县各乡镇的所有助产机构。观察和了解该培训模式前后受训人员考核成绩与孕产妇临床相关质控指标及各项产科质控指标的变化。

结果

(1)培训前学员的平均理论成绩为(62.9±3.2)分，培训后的理论成绩为(81.8±4.0)分，差异有统计学意义(t＝-15.748，P<0.001)；培训前技能成绩为(57.5±3.8)分，培训后的平均技能成绩为(75.1±2.7)分，差异具有统计学意义(t＝-16.292，P<0.001)。(2)毕节市2020年上半年的产后出血率、严重产后出血率、子痫发生率、羊水栓塞率、孕产妇死亡率分别为：34.66‰、8.39‰、8.58/万、7.22/万、1.455/10万；下半年对应数据分别为：31.92‰、4.65‰、5.55/万、0.61/万、1.069/10万，毕节全市2020年下半年的产后出血率、严重产后出血率、子痫发生率、羊水栓塞率、孕产妇死亡率明显低于上半年；下半年的危重症孕产妇发生率较上半年无明显降低。

结论

采用重症孕产妇救治阶梯式亚专科培训模式对改善危重症孕产妇的妊娠结局可能有积极影响。

关键词: 模拟培训, 产妇死亡率, 孕产妇健康, 导师制
Objective

With the help of the national poverty alleviation policy, a stepped sub-specialist training model for the treatment of severely ill pregnant women was implemented in the Bijie Demonstration Area, and the clinical effect of this model on the treatment of local severely ill pregnant women was evaluated.

Methods

In June 2020, with the support of the Third Affiliated Hospital of Guangzhou Medical University, a stepped sub-specialist training model for the treatment of severe pregnant and lying-in women was carried out in Bijie City, Guizhou Province. The backbone of the municipal obstetrics for severe treatment was cultivated. This model was continued to carried out at all midwifery institutions in all counties and towns. The changes of trainees′ assessment scores, clinical quality control indicators and obstetrical quality control indicators were compared before and after the training.

Results

The average theoretical score of the trainees before the training was (62.9±3.2) points, and the theoretical score after the training was (81.8±4.0) points. The difference was statistically significant (t=-15.748, P<0.001). The skills scores before the training was (57.5±3.8) points, and the average skill score after training was (75.1±2.7) points. The difference was statistically significant (t=-16.292, P<0.001). The postpartum hemorrhage rate, severe postpartum hemorrhage rate, eclampsia rate, amniotic fluid embolism rate, and maternal mortality rate in Bijie City in the first half of 2020 were 34.66‰, 8.39‰, 8.58?, 7.22?, 1.455, respectively. In the second half of the year of training, the data was: 31.92‰, 4.65‰, 5.55?, 0.61?, 1.069, respectively. The postpartum hemorrhage rate, severe postpartum hemorrhage rate, eclampsia rate, amniotic fluid embolism rate, and maternal mortality rate in the second half of 2020 in Bijie City were significantly lower than in the first half of the year. The incidence of critically ill pregnant women in the second half of the year was not significantly lower than in of the first half.

Conclusions

The stepped sub-specialty training model for the treatment of severely ill pregnant women may have a positive effect on improving the pregnancy outcome of severely ill pregnant women.

Key words: Simulation training, Maternal mortality, Maternal health, Preceptorship
图1 阶梯式亚专科培训模式图
图2 2020年1~12月毕节市阴道分娩和剖宫产产后出血、严重产后出血和危重症孕产妇发生率
图3 2020年1~12月毕节市子痫和羊水栓塞发生率
图4 2020年毕节市孕产妇死亡率
[1]
Cantwell R, Clutton-Brock T, Cooper G，et al. Saving mothers′ lives: reviewing maternal deaths to make motherhood safer: 2006-2008.The eighth report of the confidential enquiries into maternal deaths in the United Kingdom[J]. BJOG，2011，118(Suppl 1):1-203.
[2]
孟煜，夏人青．美国专科医师培训制度体系探析及启示[J]．复旦教育论坛，2020，18(2):99-105.
[3]
Hopkins L, Hampton BS, Abbott JF, et al. To the point: medical education, technology and the millennial learner[J]. Am J Obstet Gynecal, 2018，218(2):188-192.
[4]
杨英，郑丽云，汪偌宁，等．专科医师规范化培训体系建立的探索[J]．中华医学教育杂志，2020，40(6):471-475.
[5]
詹宏，阮恒超，林俊．妇产科后住培教育精英化培养的思考与实践[J]．中国毕业后医学教育，2020，4(1):64-67.
[6]
田爽，刘忠宇．新型综合培养模式在产科进修医生临床带教中的应用[J]．现代医药卫生，2018，34(22):3566-3567.
[7]
王燕，袁佳艳，张菲菲．我国教学医院进修医生管理存在的问题及对策[J]．医学与社会，2019，32(1):127-129.
[8]
巴丽聪，宋明刚． "互联网+教育"模式下的继续医学教育现状与思考[J]．包头医学，2019，43(4):64+69.
[9]
Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers' lives: reviewing maternal deaths to make mother hood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the united kingdom[J]. BJOG，2011，118(Suppl 1):1-203.
[10]
段涛．开展模拟实训，提高产科抢救能力[J]．中国实用妇科与产科杂志，2016，32(8):713-715.
[11]
Ameh CA, White S, Dickinson F, et al. Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study[J]．PLoS One, 2018, 13(10): 1-12.
[12]
孟煜．中美专科医师培养模式比较研究 [D]．上海师范大学，2018.
[13]
Joint Commission on Accreditation of Health care organizations, USA. Preventing maternal death[J]. Sentinel Event Alert，2010(26):1-4.
[14]
Gonzalves A, Verhaeghe C, Bouet PE, et al. Effect of the use of a video tutorial in addition to simulation in learning the maneuvers for shoulder dystocia[J] J Gynecol Obstet Hum Reprod, 2018, 47(4): 151-155.
[15]
Copson S, Calvert K, Raman P, et al. The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse-A retrospective cohort study [J] .Aust N Z J Obstet Gynaecol, 2017, 57(3): 327-333.
[16]
何泓，黄美娟，陈敦金．情景模拟演练对提高严重产后出血患者救治能力的分析[J/CD]．中华产科急救电子杂志，2021，10(3):174-178.
[17]
陈奕，范玲，韩翠存，等．产科危急重症模拟培训探讨[J]．中华医学教育探索杂志，2016，15(9):969-972.
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