儿科院前急救转运患儿病例分析

Analysis of pre-hospital first aid transfer in children's hospital

目的为提高危重症患儿转运救治能力,研究区域内院前转运患儿疾病构造,对转运团队进行有针对性的培训、加强转运团队建设提供依据。方法对本院2017全年接诊患儿的病例资料进行整理,对接诊患儿的年龄、疾病分布、转诊半径进行分析,并对近4年呼吸机转运患儿例数和我院接诊人员插管例数进行对比分析。结果 2017全年共接诊≤28 d新生儿1 947例(46. 45%),> 28 d～1岁1 206例(28. 76%),> 1～16岁1 039例(24. 79%)。疾病分布前5位分别为新生儿系统疾病1 827例(43. 58%),呼吸系统疾病721例(17. 20%),神经系统疾病652例(15. 55%),外科系统疾病461例(11. 00%),心血管系统疾病223例(5. 32%)。461例外科系统疾病中前5位为消化道畸形103例(22. 34%),肠梗阻79例(17. 14%),先天性膈疝71例(15. 40%),颅内出血和占位55例(11. 93%),气管异物47例(10. 20%)。转诊半径分布,<100 km 800例(19. 08%),100～200 km 926例(22. 09%),> 200 km 2 466例(58. 83%)。另外,需要呼吸机转运的患儿呈逐年增长趋势,我院出诊人员插管例数逐年降低。结论儿科院前急救转运中,新生儿占比较高,疾病构成主要包括新生儿系统疾病、呼吸系统疾病、神经系统疾病和外科系统疾病。转运半径> 200 km的长途转运比例较大。根据区域内转诊患儿疾病分布,加强急救转运队伍建设,完善车载设备技术,以提高转运水平。

OBJECTIVE To improve the ability of transfer and treatment of critical children,to study the pediatric disease composition of pre-hospital first aid transfer in the region,to carry out targeted training for the transfer team,and to strengthen the construction of the transfer team. METHODS The patients’ data of the hospital in 2017 were sorted out,then the age,disease distribution and referral radius of the children were analyzed. Furthermore,the number of children with ventilator during transport in the past 4 years and the number of intubation cases of the inpatients were compared and analyzed. RESULTS The age distribution of the children treated in the hospital in 2017 was the following: 1 947( 46. 45%) neonates,1 206( 28. 76%) from > 28 d to 1 year old,and 1 039( 24. 79%) from > 1 to 16 years old. The top 5 diseases of all the cases were 1 827 cases( 43. 58%) of neonatal system diseases,721 cases( 17. 20%) of respiratory diseases,652 cases( 15. 55%) of nervous system diseases,461 cases( 10. 99%) of surgical system diseases,and 223 cases( 5. 32%) of cardiovascular systemic disease. The top 5 diseases of 461 cases with surgical system diseases were 103 cases( 22. 34%) of gastrointestinal malformations,79 cases( 17. 14%) of intestinal obstruction,71 cases( 15. 40%) of congenital diaphragmatic hernia,55 cases( 11. 93%) of intracranial hemorrhage and 47 cases( 10. 20%) of tracheal foreign body. The distribution of referral radius was 800 cases( 19. 08%) < 100 km,926 cases( 22.09%) in 100-200 km,and 466 cases( 58. 83%) in > 200 km. In addition,the number of children requiring ventilator transport was increasing year by year,and the number of intubation cases in our hospital was decreasing year by year. CONCLUSIONS In the pre-hospital emergency transfer cases of children’s hospitals,the proportion of newborns is relatively high. The disease composition mainly includes neonatal system diseases,respiratory diseases,nervous system diseases and surgical system diseases.The proportion of long-distance transfer with a transit radius > 200 km is large. According to the distribution of disease in children in the region,it needs strengthen the construction of emergency transfer team and improve the technology of vehicle equipment to improve the level of emergency transfer.