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目的:了解重庆市地方医院综合性ICU的管理模式、人力资源及设备配置等现状及存在问题。方法:对我市二级及二级以上地方医院(不含军队医院及专科医院)的重症医学科(即综合性ICU或执行综合性ICU功能的专科ICU)采用网络问卷调查。结果:本次调查为普查,共76家医院,其中二级医院55家,三级医院21家。(1)53家综合性ICU采用封闭式管理,21家采用半封闭式,2家为开放式管理。(2)全市综合性ICU总床位与全市医院床位总数比为1.74%,ICU医生总数与ICU床位总数比为0.6∶1,ICU护士总数与ICU床位总数比为1.7∶1,三级医院综合ICU床位比例为(1.56±0.48)%,较二级医院(2.09±0.81)%低,但医护人员配置与床位数比例[医生:(0.75±0.36)∶1,护士:(1.83±0.78)∶1]较二级医院[医生:(0.55±0.35):1,护士:(1.50±0.60)∶1]高(P<0.05)。(3)综合性ICU男性医生比例较女性医生高,在二级医院(218∶138)及三级医院(127∶93)中没有明显差别(P>0.05),二级医院医生中职称及学历以初级及本科为主,而三甲医院中高级职称及中级职称比例明显增高,其中硕士研究生及博士研究生比例亦较二级医院高。(4)各级医院综合性ICU均有较为齐全的基础设备及仪器,能够开展大部分常规技术操作。(5)各级医院综合性ICU在院感防控、入室急性生理学及慢性健康状况(acute physiology and chroni health evaluation,APACHEⅡ)评分等质控方面较为重视,部分有专人负责,并能遵从相关指南要求。结论:重庆市重症医学较前明显进步,但仍存在人员配置不足、结构欠合理、部分常规技术开展不理想及新技术掌握不够等问题,且地区间发展不平衡。
OBJECTIVE: To understand the status quo and existing problems of comprehensive ICU management mode, human resources and equipment allocation in Chongqing local hospitals. Methods: We conducted a questionnaire survey on the major medical departments (ie comprehensive ICU or specialized ICU performing general ICU functions) in the local hospitals (excluding military hospitals and specialty hospitals) at the second and the same level in our city. Results: This survey is a census, a total of 76 hospitals, including 55 secondary hospitals, 21 tertiary hospitals. (1) The 53 integrated ICUs are closed-end management, 21 are semi-closed and two are open-ended. (2) the city’s comprehensive ICU beds in total, and the total number of hospital beds in the city’s ratio of 1.74%, ICU doctors and the total number of ICU beds total ratio 0.6:1, ICU nurses and the total number of ICU beds total ratio of 1.7, a comprehensive tertiary hospital ICU (1.56 ± 0.48)%, which is lower than 2.09 ± 0.81% in secondary hospital, but the ratio of medical staff to the number of beds is significantly lower than that of second-level hospital [Physician: 0.75 ± 0.36: 1, Nurse: 1.83 ± 0.78) ] Than the second-class hospital [doctor: (0.55 ± 0.35): 1, nurse: (1.50 ± 0.60): 1] (P <0.05). (3) There was no significant difference (P> 0.05) in the proportion of male doctors in general ICU between female doctors and secondary doctors (218:138) and tertiary hospitals (127:93) The primary and undergraduate-based, and the top three senior titles and intermediate grade ratio was significantly higher, of which the proportion of master’s and doctoral students is also higher than the two hospitals. (4) Comprehensive ICU hospitals at all levels have a more complete set of basic equipment and instruments, to carry out most of the conventional technical operations. (5) integrated at all levels of hospital ICU in hospital infection prevention and control, burglary Acute Physiology and Chronic Health (acute physiology and chroni health evaluation, APACHEⅡ) more emphasis on quality control and other aspects of scoring, some have the person responsible, and to comply with guidelines Claim. Conclusion: Chongqing has significantly improved its critical medicine, but there are still some problems such as insufficient staffing, unstructured structure, unsatisfactory development of some conventional techniques and insufficient mastery of new technologies, and the unbalanced development among regions.