“齐鲁”转运中心远程转运患者的临床特征

The clinical features of patients:transfered by"Qilu"interhospital transfer center

目的通过分析"齐鲁"转运中心转运患者的临床特征,探索院间转运新模式,为院间转运体系建设提供理论依据。方法2014年8月至2016年12月转入和转出山东大学齐鲁医院的成年患者258例。采集转运成功患者的性别、年龄、转运指标、改良早期预警评分及结局等临床指标。依据结局将转入患者分为好转组与非好转组,分析两组间上述指标的差异;数值变量分析应用成组t检验或Mann-Whitney非参数检验,分类变量应用χ^2检验,Logistic回归分析60例转入ICU的患者临床指标与结局的相关性。结果"齐鲁"院间转运中心总体转运成功率为98.5%。男性患者明显多于女性患者;前三位转入诊断为神经系统疾病、创伤、循环系统疾病,转出诊断为呼吸系统疾病、循环系统疾病、神经系统疾病;气管插管、气管切开、有创机械通气比例在11.9%~22.2%;转出患者应用血管活性药物比率、深静脉置管比例分别是转入患者的3倍、5倍;81.0%的转入患者、45.5%的转出患者为好转出院;转入好转组与非好转组间年龄、心率、MEWS、住院天数、ICU比例、机械通气比例、气管插管比例差异有统计学意义(P<0.05);转入ICU的患者中,住院时间与好转结局存在相关性(OR=1.213,95%CI=1.085-1.357)。结论"齐鲁"转运中心转运患者成功率和好转率均较高,或可作为院间转运体系建设的新模式。

Objective To explore new models for interhospital transfer and provide theoretical basis for the interhospital transfer system construction through analyzing the clinical features of the patients transfered by"Qilu"interhospital transfer center.MethodsTotally 258 patients aged over 18 years who were transferred to or from Qilu Hospital of Shandong University from August 2014 to December 2016 were analyzed.The data including sex,age,transport index,modified early warning score(MEWS)and outcome of patients with successful transport were collected.According to the results,the transferred patients were divided into the improved group and the non-improved group,and the differences of the above indicators between the two groups were analyzed.In the numerical variable analysis,Student’s t test or Mann-whitney non-parametric test was applied,and the categorical variable was applied with X^2 test.The correlation between clinical indicators and outcomes of the patients was analyzed by logistic regression analysis.ResultsThe total transfer success rate was 98.5%.The transported male patients were more than female patients.Patients transferred to Qilu Hospital were mainly diagnosed with nervous system disease,trauma and circulatory system disease,and patients transferred from QiLu Hospital were respiratory disease,circulatory system disease,and nervous system disease.Tracheal intubation,tracheotomy,and invasive mechanical ventilation rates were 11.9%-22.2%.The patients ratio of transferred from Qilu Hospital with vasoactive drugs and the ratio of patients with deep venous catheter were three times and five times than those transferred to Qilu Hospital.Eighty-one percent patients transferred to Qilu Hospital recovered,and 45.5%patients transferred from the hospital recovered.The age,heart rate,MEWS score,length of stay,ICU ratio,mechanical ventilation ratio and tracheal intubation ratio were significantly different between the improved group and the non-improved group(P<0.05).Among the critically patients transferred to ICU,the length of stay was correlated with the outcome of the improvement.(OR=1.213,95%CI:1.085-1.357).Conclusions"Qilu"Interhospital Transfer Center has a high success rate and high recovery rate of patients,and can be a new model for the construction of interhospital transfer system.