Feasibility study of retinopathy of prematurity prevention mode based on lvevl-three hospitals

doi:10.3877/cma.j.issn.1673-5250.2015.05.009

Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Retinopathy of prematurity, Premature, Feasibility studies

表1 本研究分层抽样结果分布情况[例数(%)]

抽取地带	例数	省部级医院	市级医院	县(区)级医院
东部	122	8(6.6)	38(31.1)	76(62.3)
中部	81	5(6.2)	19(23.5)	57(70.4)
西部	81	10(12.3)	24(29.6)	47(58.0)
合计	284	23(80.9)	81(28.5)	180(63.4)

表1 本研究分层抽样结果分布情况[例数(%)]

抽取地带	例数	省部级医院	市级医院	县(区)级医院
东部	122	8(6.6)	38(31.1)	76(62.3)
中部	81	5(6.2)	19(23.5)	57(70.4)
西部	81	10(12.3)	24(29.6)	47(58.0)
合计	284	23(80.9)	81(28.5)	180(63.4)

表2 各地区各级医院中新生儿科及NICU设置情况比较[例数(%)]

地区		例数	新生儿科	NICU
三级医院
	东部	52	51(98.1)	49(94.2)
	中部	20	18(90.0)	14(70.0)
	西部	30	29(96.7)	27(90.0)
	χ²值		2.54	27.00
	P值		0.281	0.000
二级及以下医院
	东部	70	64(91.4)	47(67.1)
	中部	61	33(54.1)	12(19.7)
	西部	51	12(23.5)	6(11.7)
	χ²值		92.64	79.87
	P值		0.000	0.000

表2 各地区各级医院中新生儿科及NICU设置情况比较[例数(%)]

地区		例数	新生儿科	NICU
三级医院
	东部	52	51(98.1)	49(94.2)
	中部	20	18(90.0)	14(70.0)
	西部	30	29(96.7)	27(90.0)
	χ²值		2.54	27.00
	P值		0.281	0.000
二级及以下医院
	东部	70	64(91.4)	47(67.1)
	中部	61	33(54.1)	12(19.7)
	西部	51	12(23.5)	6(11.7)
	χ²值		92.64	79.87
	P值		0.000	0.000

表3 各地区各级医院用氧及其监测设备比较[例数(%)]

类别		例数	空氧混合仪	氧浓度测定仪	血气分析仪	血氧饱和度监测仪
三级医院
	东部	52	36(69.2)	42(80.8)	46(88.5)	51(98.1)
	中部	20	12(60.0)	12(60.0)	14(70.0)	20(100)
	西部	30	20(66.7)	21(70.0)	29(96.7)	30(100)
	χ²值		2.54	8.66	4.08	4.86
	P值		0.281	0.013	0.130	0.880
二级及以下医院
		70	26(37.1)	31(44.3)	51(72.9)	63(90.0)
	东部	61	12(19.7)	13(21.3)	24(39.3)	45(73.8)
	中部	51	4(7.8)	2(3.9)	5(9.8)	12(23.5)
	西部		13.57	25.51	23.64	42.53
	χ²值		0.001	0.000	0.000	0.000
	P值

表3 各地区各级医院用氧及其监测设备比较[例数(%)]

类别		例数	空氧混合仪	氧浓度测定仪	血气分析仪	血氧饱和度监测仪
三级医院
	东部	52	36(69.2)	42(80.8)	46(88.5)	51(98.1)
	中部	20	12(60.0)	12(60.0)	14(70.0)	20(100)
	西部	30	20(66.7)	21(70.0)	29(96.7)	30(100)
	χ²值		2.54	8.66	4.08	4.86
	P值		0.281	0.013	0.130	0.880
二级及以下医院
		70	26(37.1)	31(44.3)	51(72.9)	63(90.0)
	东部	61	12(19.7)	13(21.3)	24(39.3)	45(73.8)
	中部	51	4(7.8)	2(3.9)	5(9.8)	12(23.5)
	西部		13.57	25.51	23.64	42.53
	χ²值		0.001	0.000	0.000	0.000
	P值

表4 各地区各级医院间早产儿呼吸支持设备配置比较[例数(%)]

类别		例数	常频呼吸机	鼻塞CPAP呼吸机
三级医院
	东部	52	51(98.1)	51(98.1)
	中部	20	16(80.0)	18(90.0)
	西部	30	24(80.0)	29(96.7)
	χ²值		3.66	2.54
	P值		0.130	0.281
二级及以下医院
	东部	70	52(74.5)	53(75.7)
	中部	61	19(31.1)	27(44.3)
	西部	51	5(9.8)	5(9.8)
	χ²值		25.51	13.57
	P值		0.000	0.001

表4 各地区各级医院间早产儿呼吸支持设备配置比较[例数(%)]

类别		例数	常频呼吸机	鼻塞CPAP呼吸机
三级医院
	东部	52	51(98.1)	51(98.1)
	中部	20	16(80.0)	18(90.0)
	西部	30	24(80.0)	29(96.7)
	χ²值		3.66	2.54
	P值		0.130	0.281
二级及以下医院
	东部	70	52(74.5)	53(75.7)
	中部	61	19(31.1)	27(44.3)
	西部	51	5(9.8)	5(9.8)
	χ²值		25.51	13.57
	P值		0.000	0.001

表5 各地区各级医院间ROP筛查和治疗设备比较[例数(%)]

类别		例数	间接眼底镜	眼底激光治疗仪
三级医院
	东部	52	32(61.5)	12(23.1)
	中部	20	8(40.0)	4(20.0)
	西部	30	15(50.0)	10(33.3)
	χ²值		3.47	5.81
	P值		0.176	0.055
二级及以下医院
	东部	70	15(21.4)	5(7.1)
	中部	61	9(14.8)	1(1.5)
	西部	51	2(3.9)	1(1.9)
	χ²值		9.72	4.83
	P值		0.008	0.089

表5 各地区各级医院间ROP筛查和治疗设备比较[例数(%)]

类别		例数	间接眼底镜	眼底激光治疗仪
三级医院
	东部	52	32(61.5)	12(23.1)
	中部	20	8(40.0)	4(20.0)
	西部	30	15(50.0)	10(33.3)
	χ²值		3.47	5.81
	P值		0.176	0.055
二级及以下医院
	东部	70	15(21.4)	5(7.1)
	中部	61	9(14.8)	1(1.5)
	西部	51	2(3.9)	1(1.9)
	χ²值		9.72	4.83
	P值		0.008	0.089

图1 ROP防治管理模式

[1]	Bancalari E, Claure N. Too much or too little: how to handle oxygen saturation in the neonatal intensive care unit[J]. Early Hum Dev, 2012, 88(2):S78-S80.
[2]	Di Fiore JM, Bloom JN, Orge F, et al. A higher incidence of intermittent hypoxemic episodes is associated with severe retinopathy of prematurity[J]. J Pediatr, 2010, 157(1):69-73.
[3]	Wallace DK, Veness-Meehan KA, Miller WC. Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels[J]. J AAPOS, 2007, 11(2):170-174.
[4]	Wiwatwongwana A, Kersey JP, Gardiner JA. The effect of changing oxygen saturation protocols on the incidence of laser treatment for retinopathy of prematurity [J]. Can J Ophthalmol, 2010, 45(6):585-589.
[5]	杨文芳．我国卫生资源的省际分布与利用效率研究[J]．中国卫生资源，2010(1):8-10.
[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)2013[J]．中华实用儿科临床杂志，2013，28(23):1835-1836.
[7]	Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, et al. Screening examination of premature infants for retinopathy of prematurity [J]. Pediatrics, 2013, 131(1):189-195.
[8]	杨军，尹晓娟，李爱华，等．RetCam数字视网膜照像机检测早产儿视网膜病[J]．实用儿科临床杂志，2007，22(10):764-765.
[9]	贺买宏，王林，贺加，等．我国卫生资源配置状况及公平性研究[J]．中国卫生事业管理，2013，29(3):197-199.
[10]	李会，彭现美．我国卫生资源配置的现状分析以及对策构想[J]．卫生软科学，2009，23(1):33-36.
[11]	卫生部办公厅．卫生部关于印发《新生儿病室建设与管理指南(试行)》的通知[S].2009.
[12]	Ophthalmology AAO. Ophthalmologists warn of shortage in specialists who treat premature babies with blinding eye condition[EB/OL]. (2014-03-25)[2015-03-11]. URL
[13]	Wong RK, Ventura CV, Espiritu MJ, et al. Training fellows for retinopathy of prematurity care: a Web-based survey [J]. J AAPOS, 2012, 16(2):177-181.
[14]	罗先琼，聂川，张春一，等．广东省基层医院早产儿视网膜病筛查现状调查分析[J]．中国儿童保健杂志，2009，17(1):8-10.

[1]	Yiming Fei, Zhuo Liu, Lijuan Zhang. Current research status of omics analysis in the molecular mechanism of preterm birth[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 504-510.
[2]	Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[3]	Xia He, Rong Huang, Wenjin Qi. High-throughput sequencing study on the abundance of placenta and fetal membrane flora in pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 549-555.
[4]	Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[5]	Lizhen Guo, Tianqun Fan, Xinkai Zhang, Yunhong Jiang, Rong Jin, Dongyun Liu. Risk factors and prognosis analysis of bronchopulmonary dysplasia in preterm small for gestational age infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 209-215.
[6]	Quanxiu Tian, Aimin Han, Yan Xu. Correlation of patent ductus arteriosus with bronchopulmonary dysplasia in very low birth weight preterm infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 675-682.
[7]	Mengling Zhou, Zhiwei Xue, Shu Zhou. Changes in size of uterine myoma during pregnancy and its association with adverse pregnancy outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 611-615.
[8]	Zhengyun Hu, Jianwei Shi, Jianwei Shen, Bing Wang, Chunmiao Jiang, Chong Liu. Identification of hub genes associated with bronchopulmonary dysplasia in preterm infants based on machine learning[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 446-454.
[9]	Shengrong Zhang, Xiaodong Li, Wei Wang. Predictive value of group B Streptococcus infection typing for preterm premature rupture of membranes of pregnant women and its relationship with chorioamnionitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(03): 170-175.
[10]	Taojian You, Lin Ren, Yu Ma. Feasibility study on drainage of cT_1-2N₀ stage PTMC after endoscopic thyroidectomy via oral vestibular approach[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 311-314.
[11]	Lixuan Chen, Peining Dou, Yang Xiao. Progress and future prospects of stem cell therapy for premature ovarian insufficiency[J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2024, 14(04): 239-248.
[12]	Rui Su, Xuan Zhou, Shulin Yang, Chenyun Fang, Suhua Chen, Dongrui Deng, Wanjiang Zeng, Haiyi Liu, Xun Gong, Yuanyuan Wu, Yanyan Liu, Juan Xiao, Jun Yu, Mengzhou He, Shufang Li, Zizhuo Wang, Xingguang Lin, Jianli Wu, Shaoshuai Wang, Jing Yue, Lei Jin, Ling Feng, Wencheng Ding. Analysis of influencing factors of premature birth in pregnant patients with assisted reproductive technology.[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(03): 168-175.
[13]	Huiting Zhang, Ling Feng. In vitro fertilization-embryo transfer technology and preterm birth[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(02): 73-78.
[14]	Qianxue Yu, Xuemei Liao, Longlong Sun, Mengying Fan, Mingchao Jiang, Hui Meng, Ruiji Li. Research progress of mitochondrial dysfunction and premature ovarian failure[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(04): 283-288.
[15]	Yuxin Liu, Zihan Wang, Yixin Zhang, Yongjie Luan, Kai Meng. Research progress of Wilms' tumor gene 1 in the pathogenesis of ovarian diseases[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(03): 178-183.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export