目的 了解国内三甲医院新生儿重症监护病房(NICU)早产儿用氧及早产儿视网膜病变(ROP)防治现状,为进一步规范早产儿用氧及提高ROP防治水平提供参考依据.方法 2010年10月采取专家现场突击检查形式对国内不同地区共16家三甲医院NICU早产儿用氧及ROP筛查和治疗情况进行调查并进行汇总分析.结果 16家医院平均新生儿床位(113.0±67.0)张,2009年平均收治新生儿(3596.6±1609.8)例,其中早产儿(1030.5±580.2)例,胎龄34周以下早产儿(397.8±237.1)例.绝大部分医院对早产儿用氧进行了告知,其中11家告知率100％,但最低用氧告知率仅22.06％.9家NICU用氧指征符合率达到100％,但最低符合率仅20％.所有医院均为中心供氧,但有8家无空氧混合仪,2家无氧浓度测定仪.9家医院用氧记录不完善,6家医院经皮血氧饱和度高于95％比例超过10％,3家医院血气分析高氧分压比例超过10％.所有NICU均已开展ROP筛查,其中3家在外院进行,1家仍为直接眼底镜检查.16家医院共抽查病历1023份,其中612例(59.8％)曾行眼底检查,检出ROP69例,检出率为11.27％,其中阈值ROP 7例,检出率为1.14％.有4家可开展ROP治疗,其中3家为激光治疗,1家为冷凝治疗,8家医院早产儿出院后ROP随访率不足5成.结论 自2004年卫生部早产儿用氧及ROP防治指南颁布以来,我国三级甲等医院NICU在早产儿用氧及ROP防治方面已取得相当成绩,绝大部分对指南执行情况较好,抽检未发现致盲病例,但部分医院仍存在用氧无告知、用氧指征执行不严、氧疗设施不齐、氧浓度监测不力、记录不详、筛查率和随访率低、治疗开展不普遍等问题,有待改进.%Objective To investigate the present status of oxygen therapy and retinopathy of prematurity (ROP) management in premature infants in tertiary class-one hospitals of the mainland of China.Methods A non-informed inspection on oxygen therapy and ROP management in premature infants was carried out by experts in neonatal intensive care units (NICU) of 16 tertiary class-one hospitals in different areas of the mainland of China in Oct.2010,and data were collected and analyzed.Result In 16 tertiary firstclass hospitals,NICU had (113.0± 67.0) beds for newborn per unit,with hospital admission of (3596.6 ±1609.8) newborns in 2009,among them (1030.5 ± 580.2)cases were premature infants,and (397.8 ±237.1 ) cases had gestational age less than 34 weeks.Most hospitals obtained written informed consents before using oxygen for premature infants and 11 of them informed parents of all patients,while the lowest inform rate was only 22.06％.Indication for oxygen administration was abided strictly in all patients in 9 hospitals,but the lowest accordance rate to the indication was only 20％.All of the hospitals were equipped with central oxygen supply system,but only 8 hospitals were equipped with air-oxygen mixers,and 14 hospitals were equipped with oxygen concentration detectors. Incomplete records of oxygen therapy were found in 9 hospitals,and high oxygen saturation ( ＞ 95％ ) was found in more than 10％ of infants who received oxygen therapy in 6hospitals.High PaO2 ( ＞ 80 mm Hg,1 mm Hg =0.133 kPa) was found in more than 10％ infants who received oxygen therapy in additional 3 hospitals.All of the NICUs had carried out ROP screening,but only 13 of them conducted it by themselves,and one still conducted it by direct ophthalmoscope.Of the 1023 medical records inspected randomly in 16 hospital,612(59.8％ )had retinal examination records,and 69 were found to suffer from ROP,with the incidence rate of 11.27％,of them 7 threshold ROP cases were found with the incidence rate of 1.14％.Only 4 hospitals had carried out ROP treatment,of them 3 used laser therapy,and one used cryotherapy.The follow-up rates of ROP in premature infants after discharge were less than 50％ in 8hospitals.Conclusion Since the first guidance on oxygen therapy and ROP management was promulgated by the Ministry of Health in 2004,the situation of oxygen therapy and ROP management in tertiary first-class hospitals of China had made considerable improvement,most of hospitals could abide the guidance well without blindness were found during the inspection,but some hospitals still have problems to be solved,including oxygen therapy without informing,loose implementation of oxygen indication, insufficient oxygen therapy facilities,inadequate oxygen concentration monitoring,incomplete records,low screening rate and follow-up rate,as well as under-treatment.
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