急诊患者院内转运的风险与影响因素研究

The risk and related factors of intra-hospital transport in emergency patients

目的 :分析急诊患者院内转运的风险及其影响因素。方法 :选择2017年4-5月急诊收住入院的成人患者1 025例,记录每位患者诊断、血管活性药物使用、机械通气、转运时间、收住去向等,观察转运前后病情变化。并以转运后国家早期预警评分系统风险级别增加或单项得分增加至3分为转运后病情有变化的评价标准,对所有患者进行转运风险的分层。结果:共有15.0%的患者转运后发生危重度分级变化,其中以呼吸与血氧饱和度变化明显。收住去向为监护室的危重患者转运风险更高;呼吸系统疾病、多脏器功能衰竭患者的转运风险最高;使用一种与两种血管活性药物患者的转运风险分别是未使用血管活性药物患者的1.587倍与4.343倍(P<0.05)。结论 :急诊患者转运存在一定风险,其中呼吸与血氧饱和度最易发生变化。疾病危重度、血管活性药物使用与疾病种类与急诊患者院内转运风险密切相关。

Objective： To study the risk of intra-hospital transport in emergency patients and its related factors. Methods： A total of 1 025 adult patients admitted to the emergency room from April 2017 to May 2017 were enrolled. We recorded patients＇ diagnosis, vasoactive medication use, mechanical ventilation status, transit time, and specialty destinations. Meanwhile, we observed the changes of vital signs and consciousness before and after transport. NEWS risk level increased or single item score increased to 3 points after transport was defined as the criteria of patients＇ condition change, then we stratified the transport risk for all patients. Results： There were 15.0% of patients who experienced changes in the conditions severity after transport. Changes in respiration and oxygen saturation were obvious. Patients transferring to ICU have higher risk of condition change than others. Those with respiratory disorders and multiple organ failure had the highest risk of transports. The transport risks in patients with one and two kinds of vasoactive drugs were 1.587 times and 4.343 times of that in patients without vasoactive drugs. Conclusion： Transport risk does exist in the emergency patients＇ transit, in which the respiration and oxygen saturation are most likely to change. The severity of the disease, the use ofvasoactive drugs and the type of disease are closely related to the risk of transit in emergency patients.