目的 为提高云南省农村地区先天性心脏病早期诊断率,了解目前云南省基层医务人员先心病相关知识知晓度、筛查意识和能力,探讨提高基层医务人员相关知识技能的有效方法.方法 2015年9月至2017年4月期间,组建爱心流动学校,选择云南省昆明市西山区、昭通市地区等8个地区作为调查及培训地点,调查及培训共计1 022名县级及以下医疗卫生服务机构医护人员,内容涵盖先心病筛查意识、相关知识和筛查技术,并调查培训效果.结果 培训前、后共收回问卷2 044份,培训后,调查对象对先心病筛查的意愿、先心病发病情况、常见临床表现、艾森曼格综合征的概念、心脏听诊、血氧饱和度监测的认知和重症先心病的认知均较培训前提高,差异均有统计学意义(P＜0.01);培训后,共有563名调查对象参与先心筛查的实践技能检测,对听诊顺序、杂音时期、杂音性质的判断正确率为98.22%(553人)、30.55%(172人)、28.60%(161人),对室间隔缺损、房间格缺损、动脉导管未闭的杂音识别的正确率分别为45.47%(256人)、39.79%(224人)、50.80%(286人);94.81%(968人)的培训对象表示对培训评价优秀或良好.23.87%(244人)的培训对象建议做网络培训,63.80%(652人).结论 建议增加先心病筛查经济投入,进一步加强培训;云南省基层医务人员对先心筛查的意识;通过组建爱心流动学校,对县级及以下医务人员进行先心病理论及操作培训,提高云南省基层医务人员对先心筛查的意识、筛查知识、操作技能有效,进一步提高基层先心病早期诊断率.%Objective To improve the early diagnosis of congenital heart disease (CHD), investigate the awareness, screening knowledge and screening ability of CHD among health care providers in the rural areas of Yunnan province and discover an effective way to improve the related knowledge and skills of CHD screening. Methods From 2015 September to 2017 April, we set up charity mobile schools and chose eight areas as the investigating and training sites. We designed two questionnaires, and adopted the theoretical training as the main method combined with the training of clinical skills. We investigated and trained a total of 1022 medical staff. The training content include the awareness of CHD,the knowledge and skills of CHD screening. We also evaluated the outcomes of the training. Results A total of 2044 questionnaires were collected. After training, the number of objects which would screen CHD in future increased, and the cognition of the incidence and common clinical manifestations of CHD, Eisenmanger's syndrome,cardiac auscultation, pulse oximetry and the related knowledge of CHD were also improved; 563 took the test on practical skills of CHD detection. The correct rate of auscultation, period of murmurs and characteristics of murmurs was 98.22%(553),30.55%(172) and 28.60%(161). The correct rate of murmurs in ventricular septal defect,atrial septal defect and patent ductus arteriosus was 45.47%(256), 39.79 (224) and 50.80%(286) respectively. Online training was advised by 244 trainees. Increasing investment in congenital heart disease screening was suggested by 652 trainees. Conclusions The awareness of CHD screening in grassroots medical workers of Yunnan province is insufficient. It is an effective way to establish charity mobile school and to train the grassroots medical staff with the theory and practical knowledge to improve the awareness,screening knowledge and screening skills of CHD. The next step suggests that we can improve the early diagnosis of congenital heart disease (CHD).
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