优化危重症患儿院前急救转运系统的安全性研究

Safety of optimized pre-hospital emergency transfer system for critically ill children

目的：研究优化院前危重症患儿专科急救转运系统对院际转运安全性、成功率及患儿转归的影响。方法选择我院2007年1月至2009年12月未开展优化院前危重症患儿专科急救转运系统前及2010年6月至2012年12月开展优化院前危重症患儿专科急救转运系统后出诊转运危重患儿分别作为Ⅰ组（n＝1015）、Ⅱ组（n＝1431）,进行对照分析。对Ⅰ、Ⅱ两组病例的出车准备时间、转运到达后危重症评分、转运成功率及转归进行对比分析。结果转运前危重症评分Ⅰ组为（81.73±18.11）分,Ⅱ组为（78.45±20.96）分,Ⅱ组明显低于Ⅰ组（t＝4.154,P〈0.001）,病情较重。Ⅱ组较Ⅰ组转运途中需要使用呼吸机支持及血管活性药物的病例明显增多（50.5％vs.30.2％；60.8％ vs.51.6％）,差异均有统计学意义（P〈0.01）。Ⅰ组、Ⅱ组出车准备时间分别为（19.34±6.45）min、（16.19±5.89） min,Ⅱ组接到求助电话到实际出车时间较Ⅰ组缩短,差异有统计学意义（P〈0.001）。成功转运到达后危重症评分Ⅰ组（83.01±16.73）分,Ⅱ组（83.97±17.50）分,Ⅱ组患儿危重症评分改善情况比Ⅰ组好,差异有统计学意义（ P〈0.05）。Ⅰ组、Ⅱ组转运成功率分别为94.8％和97.6％,治愈好转率分别为91.0％和94.5％,Ⅱ组较Ⅰ组转运成功率、治愈及好转率高（P〈0.01）。结论优化危重症患儿院前急救系统的应用,可提高患儿的转运效率、安全性、成功率及治疗效果,降低患儿的病死率。

Objective To study the influence of the optimized pre-hospital emergency transfer sys-tem on the safety, success rate and prognosis of pediatric patients. Methods A clinical data analysis was made of 1 015 cases of critically ill children delivered with the not-optimized pre-hospital emergency transfer system as group Ⅰ（ Jan. 2007-Dec. 2009 ） and those of 1 431 with the optimized pre-hospital emergency transfer system as group Ⅱ（Jun. 2010-Dec. 2012）. The preparation time for dispatch,critical illness scores before and after transport,transfer success rates and outcomes were compared between the two groups. Re-sults Before transfer,the critical illness score for group Ⅰ was 81. 73 ± 18. 11,for group Ⅱ78. 45 ± 20. 96, with groupⅡ being more critical（t=4. 154,P〈0. 001） and needing respirator supporting and more vasoac-tive agents（50. 5%vs. 30. 2%;60. 8% vs. 51. 6%;P〈0. 01）. The dispatch delay for groupⅠand groupⅡwere（19. 34 ± 6. 45）min and （16. 19 ± 5. 89）min,respectively,actual time out for groupⅡwas shorter than that for groupⅠ（P〈0. 001）. The critical illness scores on arrival of ward were 83. 01 ± 16. 73 in groupⅠ, 83. 97 ± 17. 50 in group Ⅱ,the score for group Ⅱ being more improved than that for group Ⅰ（ P〈0. 05 ） . The transfer success rates, cure and improvement rates were higher in group Ⅱ compared with group Ⅰ（97. 6% vs. 94. 8%;94. 5% vs. 91. 0%;P〈0. 01）. Conclusion The application of the optimized pre-hos-pital emergency care system can improve the transfer efficiency and success rate,safety and treatment effect, reduce the mortality rate of pediatric patients.