目的:为了调查德国围产期专科单位和基础产科护理单位对国家指南的依从性,我们比较了全国范围内关于维持分娩治疗实践的调查数据,早产胎膜早破和宫颈环扎术的围手术期治疗,根据当前德国指南015/025“早产的预防和治疗”的建议,在分娩期间和之后进行卧床休息。
方法:对德国总共632个产科诊所进行了调查,并收到了一个在线问卷的链接。通过执行频率测量对数据进行描述性分析。为了比较两个或更多个组,使用Fisher精确检验。
结果:反应率为19%;23(19.2%)的受访者没有进行维持分娩,97例(80.8%)进行了维持保胎治疗;30例(25.0%)产科进行了宫颈环扎术而未进行保胎治疗,90例(75.0%)宫颈环扎术合并保胎治疗;11例(9.2%)受访者未在早产胎膜早破患者中使用保胎剂,而109(90.8%)在这些患者中进行了分娩;69(57.5%)产科单位不建议在分娩期间卧床休息,而51人(42.5%)喜欢卧床休息。基础产科护理的围产期护理中心建议在分娩治疗期间对其患者的卧床比对围产期护理水平较高的患者更有统计学意义(53.6vs.32.8%,p=0.0269)。
结论:我们的调查结果与来自不同国家的其他调查结果一致,并揭示了循证指南建议与日常临床实践之间的巨大差异。
OBJECTIVE: To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national
guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German
Guideline 015/025 \"Prevention and Treatment of Preterm Birth\".
METHODS: A total of 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisher\'s exact test was used.
RESULTS: The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11 (9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269).
CONCLUSIONS: The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based
guideline recommendations and daily clinical practice.