Roemer V M, Heger-Römermann G
Frauenklinik des Klinikums Lippe-Detmold.
Z Geburtshilfe Perinatol. 1993 Jul-Aug;197(4):153-61.
This retrospective clinical study was performed to analyze the relationship between the time course of an emergency Cesarean Section and the structural, logistic and circadian aspects of the clinical environment.
Statistical analysis was based on architectural and structural data from 132 Departments of Obstetrics in the region of Northrhine-Westfalia, Germany. Hospitals were compared in four groups of equal size defined by the number of deliveries per year. Data were available on 207 emergency C-Sections from 66 participating hospitals. The time of the day of each delivery was rounded to full hours.
The size of the hospital was a highly significant predictor (p < 0.001) of the time elapsing between decision making and delivery (DD-interval) and of the preparation time required prior to the start of the operation: With increasing number of yearly deliveries the DD interval decreased from 31 minutes (SD = 15) to 19 minutes (SD = 7) with respective set-up times of 26 minutes (SD = 15) and 15 minutes (SD = 7) respectively. The time of the day had a significant influence on both variables (p < 0.05) with emergency C-Sections being slowest between 1:00 a.m. and 7:00 a.m. The mean time intervals observed may serve as a reference for the individual hospital situation: A preparation time of 15 minutes, time from start of surgery until delivery of 4 minutes and a DD interval of 19 minutes.
The data presented in this study underline the importance of the immediate availability of a complete emergency team consisting of midwife, obstetrician, anesthesiologist, OR nursing staff and pediatrician. While not necessarily arguing in favor of a concentration of obstetrical practice in specialized centers, the following recommendations might be worth considering for any given clinical setting: 1. Immediate availability of a complete team is essential, especially during the night. 2. Well defined steps of urgency in agreement between all disciplines involved improve communication and save time. 3. The emergency C-Section in the delivery room may be a worthwhile alternative in the individual case. 4. Flexibility in the decision making process may increase efficiency. 5. Practice drills may help to identify weaknesses in the interaction and coordination of the team. 6. A functional hospital architecture is important to avoid unnecessary and uncontrollable delays. 7. Adequate training programs for the obstetrical team are essential with special emphasis on the early diagnosis of fetal distress and maternal complications.
本回顾性临床研究旨在分析急诊剖宫产的时间进程与临床环境的结构、后勤及昼夜节律方面之间的关系。
统计分析基于德国北莱茵 - 威斯特法伦州132个产科部门的建筑和结构数据。根据每年分娩数量将医院分为四组，每组规模相等。数据来自66家参与研究的医院的207例急诊剖宫产。每次分娩的时间精确到整点。
医院规模是决策至分娩时间间隔（DD间隔）以及手术开始前所需准备时间的高度显著预测因素（p < 0.001）：随着年分娩数量增加，DD间隔从31分钟（标准差 = 15）降至19分钟（标准差 = 7），相应的准备时间分别为26分钟（标准差 = 15）和15分钟（标准差 = 7）。一天中的时间对这两个变量均有显著影响（p < 0.05），凌晨1点至7点之间的急诊剖宫产速度最慢。观察到的平均时间间隔可为各医院情况提供参考：准备时间15分钟、手术开始至分娩时间4分钟以及DD间隔19分钟。
本研究呈现的数据强调了由助产士、产科医生、麻醉师、手术室护理人员和儿科医生组成的完整应急团队随时待命的重要性。虽然不一定主张将产科业务集中在专科中心，但对于任何给定的临床环境，以下建议可能值得考虑：1. 完整团队随时待命至关重要，尤其是在夜间。2. 所有相关学科达成明确的紧急程度步骤，可改善沟通并节省时间。3. 在个别情况下，产房内的急诊剖宫产可能是一个值得考虑的选择。4. 决策过程中的灵活性可能提高效率。5. 演练有助于发现团队互动与协调中的薄弱环节。6. 功能性的医院建筑对于避免不必要和无法控制的延误很重要。7. 为产科团队提供充分的培训计划至关重要，特别强调胎儿窘迫和产妇并发症的早期诊断。
