小儿外科危重创伤患者院际转运的临床研究

Clinical study on interhospital transport of pediatric patients with critical surgical injuries

目的分析院际转运的小儿外科危重创伤患者临床资料,为其安全有效转运提供参考建议。方法回顾性分析2015年1月至2022年1月湖南省儿童医院转运中心主动院际转运的232例小儿危重创伤患者临床资料。根据小儿创伤评分(pediatric trauma score,PTS)是否≥8分,分为非重伤组(即PTS≥8分组,108例)和重伤组(即PTS<8分组,124例),对两组患儿一般情况、创伤病因及部位、转运过程中的处理和不良事件发生情况进行对比分析,并对不同创伤病因患儿的处理及转归情况进行比较分析。结果232例转运患儿中,男160例(69.0%),女72例(31.0%)。平均年龄4岁6个月。3~6岁为接诊人数最多年龄段(96例,41.3%)。转运距离中位数为72 km,总转运时间为(2.68±1.06)h。非重伤组与重伤组患儿性别(男/女:76/32比84/40)、年龄[<1岁/1~3岁(含3岁)/3~6岁(含6岁)/>6岁:11/20/42/35比13/26/54/31]、转运距离[0~100 km(含100 km)/100~200 km(含200 km)/>200 km:62/30/16比66/41/27]构成比差异无统计学意义(P>0.05),但在转运时间(<1 h/1~2 h/>2 h:40/45/23比22/64/38)的构成比上,差异有统计学意义(P<0.05)。转运患儿病因以碰撞伤最常见,部位以颅脑损伤最常见,两组患儿在创伤病因(碰撞伤/高处坠落伤/交通意外伤/其他:77/12/10/9比12/52/43/17)和创伤部位(颅脑损伤/肢体骨折/多发伤/其他:34/38/11/25比38/26/39/21)构成比比较,差异均有统计学意义(P<0.001)。患儿在转运过程中均未出现呼吸、心跳骤停等严重不良事件,两组患儿的途中处理(机械通气/镇痛镇静药/血管活性药/液体复苏:3/6/2/2比14/16/6/6)和不良事件(气道导管脱出/留置针脱出/发绀/心跳呼吸骤停:1/1/1/0比3/2/2/0)构成比差异无统计学意义(P>0.05)。住院后处理:经手术处理223例(96.1%)、非手术处理9例(3.9%);两组患儿在手术处理构成比上比较,差异有统计学意义(P<0.001)。患儿转归:好转/治愈221例(95.3%),出现伤残/后遗症6例(2.6%),死亡5例(2.2%);两组患儿在转归构成比上比较,差异有统计学意义(P<0.001)。结论配备专业的转运团队和转运设备,在转运前做好准确的病情评估和沟通,转运途中密切监护病情变化并能及时处置,转运后能通过优化的流程使患儿得到及时有效手术等治疗,有助于提高创伤危重患儿院际转运的安全性,并改善其预后。

Objective To review the clinical data of critical pediatric surgical trauma patients transported from hospital to hospital and provide suggestions for safe and effective transport.Methods Clinical data were retrospectively reviewed for 232 critically injured children actively transported between hospitals from January 2015 to January 2022 analyzed.According to whether or not pediatric trauma score(PTS)was≥8,they were assigned into two groups of non-serious injury(PTS≥8,n=108)and serious injury(PTS<8,n=124).General profiles,causes and sites of trauma,treatment during transport and adverse events of two groups were compared and treatment and outcomes of children with different causes of trauma examined.Results There were 160 boys(69.0%)and 72 girls(31.0%)with an average age of 54 months.The age group of(3-6)years was the largest number of children(n=96,41.3%).The median transport distance was 72 km and the total transport time(2.68±1.06)hour.Gender(boy/girl:76/32 vs.84/40),age[<1 year/1-3 years(including 3 years)/3-6 years/>6 years:11/20/42/35 vs.13/26/54/31],transport distance(0~100 km/100~200 km/>200 km):62/30/16 vs.66/41/27)had no statistical significance(P>0.05).However,statistical significance(P<0.05)existed in transit time(<1 h/1-2 h/>2 h:40/45/23 vs.22/64/38).In terms of causes,collision injury was the most common;as for site,craniocerebral injury was the most common.In terms of causes(collision/height fall/traffic accident/others:77/12/10/9 vs.12/52/43/17)and site(craniocerebral injury/limb fracture/multiple injuries/other:34/38/11/25 vs.38/26/39/21),the differences were statistically significant(P<0.001).No serious adverse events such as respiratory&cardiac arrest occurred during transport.Both groups were treated en route(mechanical ventilation/sedative analgesics/vasoactive agents/fluid resuscitation:(3/6/2/2 vs.14/16/6/6)and adverse events(airway catheter withdrawal/retention needle withdrawal/cyanosis/cardiac&respiratory arrest:no significant difference between 1/1/1/0 and 3/2/2/0)(P>0.05).After hospitalization:223 children(96.1%)were operated and 9(3.9%)received non-surgical treatment.The inter-group difference in composition ratio of surgical treatment was statistically significant(P<0.001).Outcome:221 cases improved/cured(95.3%),6 disabled/sequelae(2.6%)and 5(2.2%)died.The inter-group difference in outcome composition ratio was statistically significant(P<0.001).Conclusion Equipped with professional transport team and transport equipment,accurate assessment and communication of condition before transport,close monitoring of the changes of condition during transport and timely treatment after transport,children may undergo timely and effective surgery and receive optimal interventions.Thus it is feasible to improve the safety and prognosis of inter-hospital transport of critically injured children.