| 摘要: |
| 目的:探索互联网+远程胎心监护在医院临床使用的可行性及孕期管理服务模式。方法:2016年6月至2017年6月在我院招募孕32周及以上孕妇300例,随机分为3组,G1组为院内医生操作远程胎心监护和传统胎心监护设备且同时进行,G2组为院内医生操作传统胎心监测设备与孕妇操作远程胎心监测设备且同时进行,G3组为院外孕妇操作远程胎心监护设备,之后到医院由医师操作传统胎心监护设备。评价两种监测设备监测结果的一致性,同时自行设计问卷对受试对象对远程胎心监护的接受度和需求进行调查。结果:3组远程胎心监护和传统胎心监护无应激实验(NST)结果总一致率为91.3%,院内组(G1组+G2组)两种胎心监护NST结果总一致率为95.0%,两种仪器监测NST结局一致性较好(κ值分别为0.806与0.828),两种监测方法对基线、基线变异和加速等胎监图基本要素的判读结果一致性较好(κ>0.75);院外组(G3组)所有孕妇均能在家正常判读,孕妇在家操作远程设备进行胎心监护和在医院用传统胎心仪进行监护的效果差异无统计学意义(μ0.05=1.96,P>0.05)。问卷调查96.3%孕妇认为胎心监护很重要,59.3%(178/300)孕妇每次到医院路费花费至少20元以上;71.3%的孕妇每次去医院做胎心监护需要时间1小时以上。96.0%的孕妇认为远程胎心监护容易掌握,98.3%的试用者表示愿意或在医生推荐下使用远程胎心监护设备。56.0%希望与传统胎心监护相同价格,44.0%的可接受40元/次以上的价格。对于支付方式的调查,47.7%接受手机远程支付,37.0%接受单次刷卡或电子支付方式。结论:应用远程设备不影响胎心监护结果,远程胎监设备由孕妇自己在家操作后上传数据的服务模式在临床应用具有可行性,同时缩减了孕妇来院做胎心监护的时间成本和经济成本,接受度高,也减轻了医护资源压力。 |
| 关键词: 互联网+ 远程胎心监护 传统胎心监护 无应激实验 一致性 |
| DOI： |
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| 基金项目:中国疾病预防控制中心妇幼保健中心课题(编号:2016 FY001) |
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| Feasibility Study on Clinical Application of Rem ote Fetal Heart Monitoring Based on Internet |
| PU Jie;ZHANG Gang;JIANG Qingyuan |
| (Sichuan Maternity and Child Health Care Hospital,Sichuan Provincial Hospital for Women and Children) |
| Abstract: |
| Objective:Explore the feasibility of Internet + remote fetal heart monitoring in hospital and the management mode of pregnancy service.Methods:In June 2016 to June 2017,we recruited 300 cases of pregnancy women whose gestational weeks were 32 and above,and these pregnancy women were randomly divided into 3 groups,G1 group:doctors operate the remoted monitoring and the traditional monitoring equipment at the same time;G2 group:doctors operate the traditional monitoring equipment and the pregnancy woman operate the remote monitoring equipment at the same time;G3 group:the pregnancy women operate the remote monitoring equipment at home,then go to the hospital monitored by the doctors using the traditional monitoring equipment.We evaluated the consistency of the results between the two monitoring equipment,and designed a questionnaire to investigate acceptance and demand of the remote fetal heart monitoring equipment.Results:The total consensus rate of the three groups of remote fetal monitoring and traditional fetal monitoring for NST was 91. 3%.The total consensus rate of G1 group +G2 group( in-hospital group) using two fetal heart monitoring NST was 95. 0%.The total consensus rate of NST operating by pregnancy women in hospital group and by doctor group,NST using two kinds of instruments monitor have a good consistency( κ = 0. 806,0. 828),The two methods of monitoring were also consistent with the result of baseline,variation and acceleration(κ > 0. 75). The pregnancy women in the G3 group were able to read the NST chart correctly,and there were no difference between operate of the remote fetal heart monitoring by pregnant women at home and operate traditional fetal heart monitoring by doctors in the hospital.( μ0. 05 = 1. 96,P > 0. 05). Questionnaire survey showed that 96. 3% of pregnancy women think fetal heart monitoring was very important.71. 3% of pregnancy women need more than 1 h,59. 3%(178/300) of pregnancy women cost more than 20 yuan per time,96. 0% pregnancy women thought remote fetal monitoring was easy to operate.98. 3% of pregnancy women were willing to use the equipment under doctor’s recommendation.56. 0%of pregnancy women hope the price of the remote fetal heart monitor was the same with the traditional fetal heart monitor,and 44. 0% could accept the price of 40 yuan or more.There was no clear trend on the payment method,and the mobile phone has a high acceptance rate for remote payment,accounting for 47. 7%.37. 0% of pregnancy women could accept swipe card or electronic payment. Conclusions:The application of the remote device does not affect the monitoring result,by training pregnancy women can correctly grasp and apply the remote fetal heart monitoring equipment at home and the monitoring data is reliable,and the results have a good consistency with the traditional device in hospital.Using remote fetal monitoring equipment and then upload the data at home is feasible clinical application.At the same time,it has a higher acceptance degree,furthermore,remote fetal monitoring equipment can reduce the stress of health care resources. |
| Key words: Internet+ Remotefetalheartmonitoring Traditionalfetalheartmonitoring Non-stressstest Consistency |
