CAJ | 학술논문

目的：分析重症患者转运时不良事件发生情况，为重症患者安全转运提供依据。方法收集我院2010年1月-2013年12月急性生理学及慢性健康状况评分系统（acute physiology and chronic health evaluation，APACHE）Ⅱ评分≥15分转运患者369例，其中重症医学科参与转运158例。确定转运不良事件标准为到达目的地时：心率变化≥30%；收缩压＜90 mmHg，调整治疗5 min后血压仍不能恢复者；出现严重缺氧并经皮氧饱和度≤80%者；需要紧急气管插管及心肺复苏者；入科30 min内死亡者。计算不良事件发生率。结果不良事件出现13例，发生率为3.5%。主要为缺氧、循环不稳定、不适宜搬动状态下转运等因素导致转运不良事件的发生。而重症医学科参与转运未发生不良事件，其中包括空中转运3例（飞行时间＞2 h）、长途转运（路程10 h以上）3例。结论转运前必须经过认真评估，做好充分转运准备，对可能的突发事件要有处理预案。经过转运培训，有经验的医护人员参与转运可减少不良事件的发生。
목적：분석중증환자전운시불량사건발생정황，위중증환자안전전운제공의거。방법수집아원2010년1월-2013년12월급성생이학급만성건강상황평분계통（acute physiology and chronic health evaluation，APACHE）Ⅱ평분≥15분전운환자369례，기중중증의학과삼여전운158례。학정전운불량사건표준위도체목적지시：심솔변화≥30%；수축압＜90 mmHg，조정치료5 min후혈압잉불능회복자；출현엄중결양병경피양포화도≤80%자；수요긴급기관삽관급심폐복소자；입과30 min내사망자。계산불량사건발생솔。결과불량사건출현13례，발생솔위3.5%。주요위결양、순배불은정、불괄의반동상태하전운등인소도치전운불량사건적발생。이중증의학과삼여전운미발생불량사건，기중포괄공중전운3례（비행시간＞2 h）、장도전운（로정10 h이상）3례。결론전운전필수경과인진평고，주호충분전운준비，대가능적돌발사건요유처리예안。경과전운배훈，유경험적의호인원삼여전운가감소불량사건적발생。
Objective We aimed to analyze the incidence of adverse events in the transport of critically ill patients, and to facilitate the safe transport. Method 369 patients transported with APACHE≥15 from January 2010 to December 2013 were included, among which the department of Intensive Care Unit (ICU) participated in 158 cases. The criteria of adverse events in the transport is: the change of heart rate ≥30%; systolic blood pressure <90 mmHg, and not restore after the 5-minutes-treatment; severe hypoxia, the value of transcutaneous oxygen saturation ≤80%; requiring emergency intubation and cardiopulmonary resuscitation; died within 30 minutes into the department. The incidence of adverse events was calculated. Results The incidence of adverse events was 3.5%, mainly caused by hypoxia, hemodynamic instability, and not suitable for transport. However, there was no incidence of adverse events when the ICU participated in, including 3 cases of air-plane transport with more than 2 hours of flying, and 2 cases of long distance transport with longer than 10 hours of journey. Conclusion Before transport, careful assessment, full preparation, and necessary contingency plan are very necessary. After transport training, the adverse events in the transport can be reduced when the experienced medical staff is involved.