中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2015年
5期
295-299
,共5页
陈伟明%陆国平%马健%程晔%闫钢风
陳偉明%陸國平%馬健%程曄%閆鋼風
진위명%륙국평%마건%정엽%염강풍
危重症%院际转运%儿童
危重癥%院際轉運%兒童
위중증%원제전운%인동
Critical ill%Inter-hospital transportation%Children
目的：探讨儿童危重症转运及协作网络的优势及对于危重症患儿救治的意义。方法回顾性分析2010年10月至2013年10月期间，我院重症医学科与上海市120跨省转运部合作，通过远距离院际转运收治的232例危重症患儿的临床资料。结果232例危重患儿转运自华东地区五省一市共31家单位，其中男141例，女91例；年龄29 d～13岁（中位数12个月）；体重2.5～66 kg （中位数10 kg）；小儿危重病例评分平均为（80.4±7.7）分，其中1个脏器功能障碍患儿155例（66.8％），2个或2个以上脏器功能障碍患儿55例（23.7％）；需要机械通气转运患儿有105例（45.3％）；转运半径50～1000 km，其中87例（37.3％）转运半径＞200 km，73例（36％）转运半径101～200 km，62例（26.7％）转运半径≤100 km；转运途中无一例患儿死亡，有3例（1.3％）患儿转运途中进行心肺复苏治疗，2例（0.9％）进行电复律治疗，2例（0.9％）途中更换气管插管；转运成功率100％；前4类疾病分别为呼吸系统疾病90例（38.8％）、神经系统疾病43例（18.5％）、循环系统疾病36例（15.5％）及儿童意外伤害28例（12.1％）。所有232例危重患儿均通过绿色通道收治于我院PICU，178例患儿（76.7％）经治疗好转出院，放弃治疗24例（10.3％），死亡32例（13.8％）；转运的危重患儿接受特殊脏器功能替代30例（12.9％），其中4例（1.7％）进行体外膜肺治疗，26例（11.1％）进行血液净化治疗。结论儿童危重症院际转运体系的建立，有利于积极有效地救治危重症患儿；掌握好转运指征进行危重患儿的转运是安全的，值得推广。
目的：探討兒童危重癥轉運及協作網絡的優勢及對于危重癥患兒救治的意義。方法迴顧性分析2010年10月至2013年10月期間，我院重癥醫學科與上海市120跨省轉運部閤作，通過遠距離院際轉運收治的232例危重癥患兒的臨床資料。結果232例危重患兒轉運自華東地區五省一市共31傢單位，其中男141例，女91例；年齡29 d～13歲（中位數12箇月）；體重2.5～66 kg （中位數10 kg）；小兒危重病例評分平均為（80.4±7.7）分，其中1箇髒器功能障礙患兒155例（66.8％），2箇或2箇以上髒器功能障礙患兒55例（23.7％）；需要機械通氣轉運患兒有105例（45.3％）；轉運半徑50～1000 km，其中87例（37.3％）轉運半徑＞200 km，73例（36％）轉運半徑101～200 km，62例（26.7％）轉運半徑≤100 km；轉運途中無一例患兒死亡，有3例（1.3％）患兒轉運途中進行心肺複囌治療，2例（0.9％）進行電複律治療，2例（0.9％）途中更換氣管插管；轉運成功率100％；前4類疾病分彆為呼吸繫統疾病90例（38.8％）、神經繫統疾病43例（18.5％）、循環繫統疾病36例（15.5％）及兒童意外傷害28例（12.1％）。所有232例危重患兒均通過綠色通道收治于我院PICU，178例患兒（76.7％）經治療好轉齣院，放棄治療24例（10.3％），死亡32例（13.8％）；轉運的危重患兒接受特殊髒器功能替代30例（12.9％），其中4例（1.7％）進行體外膜肺治療，26例（11.1％）進行血液淨化治療。結論兒童危重癥院際轉運體繫的建立，有利于積極有效地救治危重癥患兒；掌握好轉運指徵進行危重患兒的轉運是安全的，值得推廣。
목적：탐토인동위중증전운급협작망락적우세급대우위중증환인구치적의의。방법회고성분석2010년10월지2013년10월기간，아원중증의학과여상해시120과성전운부합작，통과원거리원제전운수치적232례위중증환인적림상자료。결과232례위중환인전운자화동지구오성일시공31가단위，기중남141례，녀91례；년령29 d～13세（중위수12개월）；체중2.5～66 kg （중위수10 kg）；소인위중병례평분평균위（80.4±7.7）분，기중1개장기공능장애환인155례（66.8％），2개혹2개이상장기공능장애환인55례（23.7％）；수요궤계통기전운환인유105례（45.3％）；전운반경50～1000 km，기중87례（37.3％）전운반경＞200 km，73례（36％）전운반경101～200 km，62례（26.7％）전운반경≤100 km；전운도중무일례환인사망，유3례（1.3％）환인전운도중진행심폐복소치료，2례（0.9％）진행전복률치료，2례（0.9％）도중경환기관삽관；전운성공솔100％；전4류질병분별위호흡계통질병90례（38.8％）、신경계통질병43례（18.5％）、순배계통질병36례（15.5％）급인동의외상해28례（12.1％）。소유232례위중환인균통과록색통도수치우아원PICU，178례환인（76.7％）경치료호전출원，방기치료24례（10.3％），사망32례（13.8％）；전운적위중환인접수특수장기공능체대30례（12.9％），기중4례（1.7％）진행체외막폐치료，26례（11.1％）진행혈액정화치료。결론인동위중증원제전운체계적건립，유리우적겁유효지구치위중증환인；장악호전운지정진행위중환인적전운시안전적，치득추엄。
Objective To investigate the value of the interhospital transportation and the advantage of the cooperative network to the critically ill children.Methods The clinical data of 232 critically ill chil-dren transported from other hospitals in long distances to PICU of Fudan University Affiliated Children Hos-pital cooperated with Shanghai 120 interprovincial transport Department,between Oct 2010 and Oct 2013, were analyzed retrospectively.Results At otal of 232 critically ill childrne were transported from 31 hospi-tals of Eastern China region including five provinces and the city of Shanghai.Among thse e critically ill chil-dren 141 casse were male and 91 cases were femla e,with age from 29 days ot 13 years( median age was 12 months) and weight from 2.5 to 66 kg ( median weight was 10 kg ) .The average pediatric clinical illness score was 80.4 ±7.7,155 cases(66.8%) were single organ dysfunction,55 cases(23.7%) were multiple organs dysfunction,105 cases(45.3%) were mechanical ventilation required fort ransportait on.Referral radi-us was 50-1 000 km(median).Among these patients,87 cases(37.3%) weret ransported over 200 km radius and73 cases(36%) were transop rted 101-200 km,62 cases(26.7%) were transported 100 km or less.D ur-ing the transportation,0 case died,3 cases(1.3%) received cardiopulmonary resuscitation treatment,2 cases (0.9%) received electrical conversion treatment,2 cases(0.9%) were replaced endotracheal intuab tion,the success rate of transportation was 100%.The top 4 disae ses were respiratro y id seases(90 cases,38.8%), neural diseases(43 cases,18.5%) ,cardiovascular diseases(36 cases,15.5%) and acute pediatric trauma(28 cases,12.1%) .Al l 232 cir tically ill children were admitted to our PICU for further treatment through the Green Channel.In the end, 178 cases ( 76.7%) discharged, 24 cases ( 10.3%) gave up and 32 cases (13.8%) died.Among thse e 232 rc itically ill children,30 cases(12.9%) received special organ replacement treatment,4 casse ( 1.7%) of whom were treated with extracorporeal membrane oxyg enation, 26 cases (11.1%) received blood purification therapy.Conclusion Establishing the system of transportation between PICU of hospitals will be propitious to treat the critically ill children energetically and effectively.It is worth pro-moting to master the transportation indication of children with critical illness,which is safe and reliable.
