移动ICU远距离院际转运危重症患儿的应用价值

Application of mobile intensive care unit in long distance inter-hospital transportation of critically illchildren

目的探讨移动ICU远距离院际转运在危重症患儿救治中的临床应用价值。方法回顾性分析2011年1月至2013年12月我院重症医学科移动ICU模式远距离院际转运收治的467例危重症患儿的临床资料。结果467例危重症患儿转运自南宁周边县市共27家医疗单位，其中男295例，女172例；年龄29d～11岁（中位数10个月）；体重2．5—40．0kg（中位数8．3kg）；转运距离68～436km（中位数157km）；转运时间1．5～13．0h（中位数5．3h）；小儿危重病例评分平均为（83-t-10）分；转运前急救107例（22．9％，107／467），其中气管插管63例（58．9％），抗休克治疗26例（24．3％）；转运途中所有467例患儿均给予持续心电、血压、血氧饱和度监测及静脉补液维持内环境稳定等对症支持治疗，其中镇静／镇痛341例（73．0％），机械通气185例（39．6％），大剂量血管活性药物维持15例（3．2％）；467例患儿均成功到达我院，通过绿色通道收住重症医学科，监测生命体征与转运前比较明显好转[心率：（143±19）次／min比（165±24）次／min；平均动脉压：（76±5）mmHg比（71±4）mmHg，1mmHg=0．133kPa；经皮氧饱和度：（95±2）％比（92±2）％；pH：7．37±0．04比7．34±0．03；乳酸：（2．5±0．2）mmol／L比（2．8±0．3）mmol／L]，差异均有统计学意义（P均〈0．01）。结论移动ICU模式远距离院际转运有利于积极有效救治危重症患儿，提高转运过程的安全系数，值得推广。

Objective To investigate the clinical application of mobile ICU in long distance inter- hospital transportation of critically ill children. Methods The clinical data of 467 critically ill children admit- ted in the mobile ICU for long distance inter-hospital transportation during Jan 2011 to Dec 2013 were studied retrospectively. Results A total of 467 critically ill children were transported from 27 hospitals of the coun- ties and cities around Nanning. Of these 467 cases,295 cases were male and 172 female,with ages from 29 days to 11 years（median age was 10 months） and weights from 2. 5 to 40.0 kg（median weight was 8.3 kg）. The transport distances were from 68 to 436 kin（ median distance was 157 km） ; the transport durations ranged from 1.5 to 13.0 h（ median duration was 5.3 h） ,and the average pediatric clinical illness score was 83 ± 10. Of these 107 cases （22. 9 %, 107/467 ） who required first aid before transfer, 63 cases （58.9 % ） were treated with endotracheal intubation while 26 cases （24. 3% ） with anti-shock therapy. All the 467 cases received sustained electrocardiographic, blood pressure, blood oxygen saturation monitoring and rehydration therapy for maintaining stable internal environment during the transportation, with 341 cases （73.0%） of them received sedative or analgesic treatment, 185 cases（39.6% ） received mechanical ventilation, 15 cases （ 3.2% ） received high doses of vascular active drugs. All the critically ill children were admitted to our Criti- cal Care Department through the green channel. The vital signs improved significantly than those before trans- portation [ heart rate： （ 143 ± 19） times/min vs. （ 165 ± 24） times/min; mean arterial pressure ： （ 76 ± 5 ） mmHg vs. （71±4）mmHg,lmmHg=0.133 kPa; SPO2：（95±2）% vs. （92 ±2）%; pH：7.37±0.04 vs. 7.34± 0. 03 ; lactate （ 2. 5 ± 0. 2 ） mmol/L vs. （ 2. 8± 0. 3 ） mmol/L]. There were significant differences between before and after the transportation （P 〈 0. 01, respectively）. Conclusion Mobile ICU is propitious to treat the critically ill children energetically and effectively in long distance inter-hospital transportation and ensures the safety. It is worth promoting.