探讨以三级医院为依托建立早产儿视网膜病(ROP)防治管理模式。

选取2013年1～12月，采用多阶段分层随机抽样法抽取的各级医疗机构284家及其管理人员为研究对象。将284家医院所属行政隶属关系分为3层：省部级医院、市级医院(包括省会所在地的市级医院和其他地级市所辖市级医院)、地级市所辖县(区)级医院，所涉及专业为新生儿科和眼科。《以三级医院为依托的ROP防治管理模式可行性问卷调查表》由本研究统一制定，内容包括：①收集各级医疗机构与ROP防治相关的医疗资源配置情况等，如设备、人员、科室设置等。②推广ROP防治管理模式的可行性问题，包括征询被访谈医疗机构对模式操作可行性评价、地区适用性评价、模式的评分、运行障碍等。同时也调查各级各地区ROP防治相关医疗设备。①用氧及其监测设备：空氧混合仪、氧浓度测定仪、血气分析仪、血氧饱和度监测仪；②早产儿呼吸支持设备：常频呼吸机、鼻塞持续呼吸道正压通气(CPAP)呼吸机；③筛查和治疗设备：间接眼底镜、眼底激光治疗仪。

①284家样本医院中，三级医院共计102家，二级及以下医院(基层医院)共计182家。本研究发放《问卷调查表》共计284份，回收合格问卷为284份，合格问卷有效回收率为100%。②284家医院中设置与ROP防治相关的新生科及NICU分别为207家(72.8%)、155家(54.5%)。102家三级医院中，各地区间新生儿科设置比较，差异无统计学意义(χ²＝2.54，P＝0.281)，但各地区间NICU设置比较，差异有统计学意义(χ²＝27.00，P＝0.000)。而182家二级及以下医院中，各地区间新生儿科及NICU设置比较，差异均有统计学意义(χ²＝92.64，79.87；P＝0.000)。③284家医院中从事ROP筛查的眼科医师共213名，其中174名(81.7%)眼科医师所在医院为三级医院，39名(18.3%)所在医院为二级及以下医院。④氧浓度测定仪的配置在各地区三级医院中比较，差异有统计学意义(χ²＝8.657，P＝0.013)；而空氧混合仪、血气分析仪及血氧饱和度监测仪的配置在各地区三级医院间比较，差异均无统计学意义(χ²＝2.540，4.081，4.861；P>0.05)。此外，空氧混合仪、氧浓度测定仪、血气分析仪和血氧饱和度监测仪在各地区二级及以下医院中比较，差异均有统计学意义(χ²＝13.57，25.51，23.64，42.53；P<0.05)。⑤常频呼吸机、鼻塞CPAP呼吸机在各地区二级及以下医院中的配置比较，差异有统计学意义(χ²＝25.51，13.57；P<0.05)。⑥间接眼底镜在各地区二级及以下医院中的配置比较，差异有统计学意义(χ²＝9.716，P<0.05)。⑦284家医院中，217家(76.4%)医院对推广以三级医院为依托的ROP防治管理模式的评价意见进行了反馈。

ROP防治是一项复杂的系统工程，有赖于卫生行政部门及各级医院的支持，建立以三级医院为依托的区域性ROP防治管理网络，让适宜技术下沉到基层，并进行资源共享，各层级各部门通力合作才能有效提高整体防控水平。

To explore the establishment of the retinopathy of prematurity (ROP) prevention management mode based on level-three hospitals.

Between January and December, 2013, a total of 284 hospitals and its administrators by stratified random sampling method were included in the study. By field survey, the information included: ①the medical resources distribution of ROP prevention related medical equipment, human resources, the department layout etc. were investigated within individual hospitals. ②Respondents' attitude on the promotion of ROP prevention management mode, e. g. the evaluation of feasibility on mode operation and regional applicability, the score of the mode, the obstacles were summarized.

①The sample of 284 hospitals included 102 Class 3, 182 Class 2 and below hospitals. ②there are 207(72.8%) hospitals have neonatal department, and 155(54.5%) hospitals have neonatal intensive care unit(NICU). There were significant differences among different area in NICU, whether Class 3 or Class 2 and below hospital(P<0.05). ③there were 213 oculist who engaged in ROP screening, of which 174(81.7%) oculist in Class 3, others in Class 2 and below hospitals. ④For Class 2 and below hospitals, there were significant differences among different area in O₂ monitoring system, air/oxygen blender, blood gas analyzer, oxygen saturation monitor, ventilator support system, CPAP system, indirect ophthalmoscope(P<0.05). ⑤A total of 217(76.4%) hospitals evaluated the feasibility of spreading retinopathy of prematurity prevention mode based on Class 3 hospitals.

ROP prevention is a complicated systematic project, depending on the support from health administrative departments as well as all levels of the hospitals. As long as a regional prevention network based on Class 3 hospitals is established and cooperated by all the related departments, sharing resources and conveying practicable technology to lower level hospitals, which would the general level of ROP prevention improve effectively.