规范化无创正压通气流程在危重患者长途转运中的应用

Standardized workflow of noninvasive positive pressure ventilation applied in long-distance transportation of critically ill patients

目的根据国内外指南及车载长途院际转运的特点，制定出无创正压通气（noninvasive positive pressure ventilation，NPPV）规范转运流程，通过分析63例使用转运流程长途转运患者的情况，评价该流程应用的可行性及安全性，并指导该流程质量的持续改进。方法通过前瞻性观察2012年3月至2013年3月我院启动规范化NPPV转运流程院际转入的危重病患者，记录患者转运前，到达医院时心率、平均动脉压、呼吸频率、血氧饱和度、PaO2、PaCO2、血乳酸水平的变化，同时记录转运途中并发症与紧急医疗处置情况。结果①63例患者人机协调性好，均成功转运，转运途中有1例行气管插管行有创通气治疗，3例出现呕吐，但无误吸发生，有4例出现躁动行镇静治疗；②63例患者转诊前后心率[（103．4±14．6）次／min vs（102．3±12．5）次／min）、平均动脉压[（78．4±11．4）mmHg vs（76．5±10．6）mmHg]、呼吸频率[（25．4±6．8）次／min vs（24．3±5．4）次／min]、血氧饱和度[（91．3±5．2）％vs（93．6±6．1）％]、氧分压变化[（61．8±3．6）mmHg vs（65．3±4．7）mmHg]、pH值（7．36±0．15VS7．38±0．12），以上差异均无统计学意义（P〉0．05），与转诊前比较，PaCO2[（58．4±2．4）mmHgVS（48．3±1．8）mmHg]、乳酸[（2．9±1．4）mmol／Lvs（1．5±1．2）mmol／L]水平下降，变化差异有统计学意义（P〈0．05）。结论使用规范化NPPV操作流程在院际长途转送危重患者是可行的、安全的，其中规范化培训及有经验的医护人员、患者的入选标准、转运前充分准备、途中动态严密监护是安全转送的关键。

Objective To set up a standardized workflow of noninvasive positive pressure ventilation based on clinical guide and extra requirement of long-distance transportation. Evaluate its feasibility and security through a 63 patients study and make continuous improvement the workflow. Methods Sixty-three patients transported to our hospital from March 2012 to March 2013 were admitted in this prospective study. Heart rate, mean arterial pressure, breathing rate, O2 saturation, O2 partial pressure, CO2 partial pressure,lactic acid level before and after transportation were recorded and analyzed. Results Sixty-three patients transported to our hospital from March 2012 to March 2013 were admitted in this prospective study. Heart rate, mean arterial pressure, breathing rate, Oz saturation, Oz partial pressure,CO2 partial pressure,lactic acid level before and after transportation were recorded and analyzed. Conclusions Standardized workflow of noninvasive positive pressure ventilation in long-distance transporting critically ill patients is feasible and safe. Standardized training, experienced staff and adequate preparation,continuous monitoring is necessary to the transportation.