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目的:初步调查湛江市近3年肾病医疗服务资源和医疗队伍发展状况。方法:连续三年对湛江地区五县四区各家医院肾脏病专科的建设和专科服务开展情况开展实地调查,调查内容包括专科病床数、血透床数、门诊量、出入院量、以及血液透析各种专科业务开展情况等;同时对全市各肾病中心专科医师的配备情况以及人员基本素质进行调查;最后与我市肾脏疾病防治需求情况进行对比分析。结果:1、目前全市共有14家医院开展肾脏病专科服务,其中7家医院设立独立肾病专科;全市开放肾病专科病床从2010年的229张,增至2012年的289张,其中县区医院肾病专科病床由2010年的73张增加至现在101张,增长38.4%:全市血透床位由2010年的174张扩增至目前的232张,增长33.3%。近3年本市全市肾病专科住院患者从2010年5 023人次增至2012年的5 926人次,但80%集中在5间市级医院;专科门诊量2010年的51 674人次,与2012年的51 828人次基本持平,市区外医院专科门诊量仅为市区医院的1/16左右。全市近3年每年血液透例次均以20 000例次递增,分别73 796、97 937、124 737例次,其中区、县级医院血透业务量约占1/3;肾病专科技术主要集中在市区开展,如肾活检每年约550例以上,而市区医院占的比例就超过90%:相比2010年,临时血透通路置管术、内瘘手术,其它血液净化技术,如腹膜透析、血滤、血液灌流等技术近两年例数都呈缓慢增加的趋势,区、县医院增加例数大于市区医院,而CRRT目前仅在市级医院开展,县级医院尚未开展。2、近两年肾专科医师由2011年的62名增至2012年的78名,专科护士由103名增至169名;在学历方面,专科医师主要以本科学历为主,约占70%;而专科护士主要以大专、中专学历为主,约占80%。在职称方面,近两年专科医师主要以高级和初级为主,中级职称均在25%以下,呈两头大,中间窄的现象;专职护士主要以初级为主,高级职称所占比例偏低;全市专职肾科科研技术人员由2011年的6名增至2012年的10名,结论:近年湛江市肾病专科医疗服务资源和专科服务能力正在稳步发展,但发展速度相对缓慢,而且存在城乡分布不均衡问题,相对于785万人口来说,目前湛江市肾病专科服务资源仍明显不足,肾病专科医疗队伍总体专科素质仍有待提高。
Objective: To investigate the development of medical service resources and medical team of nephropathy in Zhanjiang city in recent 3 years. Methods: The field investigation was carried out for the construction of kidney disease specialist and the development of specialist services in hospitals of four districts of five counties in Zhanjiang for three consecutive years. The investigation included the number of special beds, the number of beds, the outpatient visits, Dialysis all kinds of specialist business development, etc .; the same time, the city’s kidney disease center specialist physicians equipped with the situation and the basic quality of staff to investigate; and finally the city’s kidney disease prevention and control needs of the situation comparative analysis. At present, there are 14 hospitals in the city which have specialized renal disease specialist services. Among them, 7 hospitals set up independent kidney disease specialist departments. The number of open specialist nephrology beds in the city increased from 229 in 2010 to 289 in 2012, of which kidney disease The number of specialist beds increased from 73 in 2010 to 101 now, an increase of 38.4%. The city’s hemodialysis beds expanded from 174 in 2010 to the current 232, an increase of 33.3%. In the past three years, the number of inpatients with nephrology in the city increased from 5,023 in 2010 to 5,926 in 2012, but 80% were concentrated in 5 municipal hospitals. The number of specialist outpatient visits in 2010 was 51,674, 51 828 people basically the same, outside the city outpatient specialist hospital only about 1/16 city hospital. In the recent 3 years, the number of hemodialysis cases in every city in the past 3 years increased by 20 000 cases, accounting for 73 796, 97 937 and 124 737 cases respectively, of which the hemodialysis volume in the district and county hospitals was about 1/3; and the nephrology specialist mainly concentrated In urban areas, such as renal biopsy of about 550 cases each year, while the proportion of urban hospitals accounted for more than 90%: compared to 2010, temporary hemodialysis catheterization, fistula surgery, other blood purification techniques, such as the peritoneum The dialysis, hemofiltration, hemoperfusion and other techniques have shown a slow increase in the number of cases in recent years. District and county hospitals have increased the number of cases than urban hospitals, while CRRT is currently only implemented in municipal hospitals and county hospitals have not yet been implemented. 2. In the past two years, the number of kidney specialists increased from 62 in 2011 to 78 in 2012, and the number of specialist nurses has increased from 103 to 169. Among academic qualifications, specialist physicians mainly hold a bachelor’s degree, accounting for about 70% of the total; The specialist nurses mainly college, secondary education, accounting for about 80%. In terms of professional titles, in the recent two years, the chief physicians are mostly senior and junior ones, while those with mid-level professional titles are below 25%. They are two large and narrow ones. The full-time nurses are primarily junior and the senior professional titles account for a relatively low proportion. The number of full-time nephrology research technicians in the city increased from 6 in 2011 to 10 in 2012. Conclusion: In recent years, Zhanjiang City, kidney nephropathy specialist medical service resources and specialist services capabilities are steadily developing, but the development speed is relatively slow, and there is not the urban-rural distribution Equilibrium, relative to the population of 7.85 million, Zhanjiang City, renal disease specialist service resources are still clearly insufficient, the overall specialist Nephropathy medical team still needs to improve the quality of specialist.