Zhonghua Er Ke Za Zhi. 2011 Sep;49(9):669-74.
To understand the current situation and development of intensive care units for neonates and children (ICUs) in China.
A form of survey was e-mailed to chief of each ICU who is one of the thirty five board members of Subspecialty group of Emergency Medicine Chinese Society of Pediatrics or Chinese Society of Emergency Medicine Pediatric Branch. The data from Jan. 1 to Nov. 30, 2009 were collected and compared with the first survey which was conducted during the year 2000(Group B).
Thirty three of 35 (94.3%) hospitals responded. Among them, 25 were children's hospitals (Group A1), 8 were pediatric department of general hospitals (Group B). The total number of ICU beds accounted for 6.9% and 5.8% of total numbers of hospital beds in Group A1 and B respectively, increased 1.1 percent. The doctor to bed ratio in Group A1 and B were 0.5:1 and 0.75:1, nurse to bed ratio in Group A1 and B was 1.17:1 and 1.38:1. The monitor to bed ratio in Group A1 were 1.44:1, Group B were 0.74:1 and the ventilator to bed ratio in Group A1 were 0.64:1, Group B were 0.46:1. The percentage of blood gas analyzers, portable X-ray, bedside ultrasound which ICUs owned in Group A1 and B were 100% (25/25) vs. 60% (16/27), 96% (24/25) vs. 70% (19/27) and 88% (22/25) vs. 30% (8/27) separately. The percentage of surfactant therapy use, blood purification therapy, high frequency ventilation and ECMO in Group A1 and B were 96% (24/25) vs. 48% (13/27), 80% (20/25) vs. 22% (6/27), 84% (21/25) vs. 37% (10/27) and 20% (5/25) vs. 0%. The survival rate of ventilated patients in group A1 and B were 77.5% (6393/8245) vs. 63.4% (809/1276) separately, Group B was lower than Group A1 (P < 0.001). The survival rate of premature infants weighted 1 - 1.5 kg in Group A1 and B were 88% (2183/2482) vs.75.1% (531/707), weighted > 1.5 - 2.5 kg were 93.7% (6836/7296) vs.84.1% (1890/2247), Group B were lower than group A1(P < 0.01). There were 12 659 and 1392 patients in Group A1 and A2 respectively for whom the Pediatric Critical Illness Scoring system (PCIS) was used to assess the severities of illness in PICU patients. Among them, the percentage of non critically ill (> 90) patients in group A1 and A2 were 3616 (28.6%) and 639 (45.9%) respectively, Group A1 was lower than A2 (P = 0.000). The mean bed occupation rate of PICU in Group A1 and A2 were 127.1% (103.3% - 186.0%) vs. 90.91% (71.0% - 126.0%), NICU in the above Groups were 138.0 (83.8 - 290.5) vs.108.9 (90.7 - 128.0).
The present study may roughly reflect the development of ICUs in the past ten years and current situation of neonatal and pediatric ICUs in tertiary hospitals in the mainland of China, especially development of PICUs. The percentage of ICU bed to hospital bed was increased. The equipments, new techniques and survival rates of patients treated in ICUs had been improved remarkably, but the occupation rate of bed was too high. A number of PICU beds were occupied by low risk patients and lack of human resource need to be urgently addressed.
了解我国新生儿及儿童重症监护病房（ICU）的现状与发展。
通过电子邮件向中国医师协会儿科分会急救医学专业组或中华医学会急诊医学分会儿科学组35名委员所在各ICU的主任发送调查问卷。收集2009年1月1日至11月30日的数据，并与2000年进行的首次调查（B组）进行比较。
35家医院中有33家（94.3%）回复。其中，儿童医院25家（A1组），综合医院儿科8家（B组）。A1组和B组ICU床位总数分别占医院总床位数的6.9%和5.8%，增加了1.1个百分点。A1组和B组的医生与床位比分别为0.5:1和0.75:1，护士与床位比分别为1.17:1和1.38:1。A1组的监护仪与床位比为1.44:1，B组为0.74:1；A1组的呼吸机与床位比为0.64:1，B组为0.46:1。A1组和B组ICU拥有血气分析仪、便携式X线机、床边超声的比例分别为100%（25/25）对60%（16/27）、96%（24/25）对70%（19/27）、88%（22/25）对30%（8/27）。A1组和B组使用表面活性剂治疗、血液净化治疗、高频通气和体外膜肺氧合（ECMO）的比例分别为96%（24/25）对48%（13/27）、80%（20/25）对22%（6/27）、84%（21/25）对37%（10/27）、20%（5/25）对0%。A1组和B组机械通气患者的生存率分别为77.5%（6393/8245）和63.4%（809/1276），B组低于A1组（P<0.001）。A1组和B组体重11.5 kg早产儿的生存率分别为88%（2183/2482）和75.1%（531/707），体重>1.52.5 kg者分别为93.7%（6836/7296）和84.1%（1890/2247），B组低于A1组（P<0.01）。A1组和A2组分别有12659例和1392例PICU患者使用儿科危重病评分系统（PCIS）评估病情严重程度。其中，A1组和A2组非危重病（>90分）患者的比例分别为3616例（28.6%）和639例（45.9%），A1组低于A2组（P=0.000）。A1组和A2组PICU的平均床位占用率分别为127.1%（103.3%186.0%）和90.91%（71.0%126.0%），上述两组NICU分别为138.0（83.8290.5）和108.9（90.7128.0）。
本研究大致反映了过去十年我国ICU的发展以及中国大陆三级医院新生儿及儿科ICU的现状，尤其是PICU的发展。ICU床位占医院床位的比例有所增加。ICU的设备、新技术及患者生存率有显著提高，但床位占用率过高。大量PICU床位被低风险患者占用，人力资源短缺问题亟待解决。
