优化导管管理策略在体外膜肺氧合患者院际转运中的应用

Application of optimized catheter management strategy in interhospital patients transition with extracorporeal membrane oxygenation

目的探讨应用优化导管管理策略对减少体外膜肺氧合(ECMO)患者院际转运过程中导管相关不良事件发生的效果。方法采用历史对照研究设计,选择2018年1月至2020年12月ECMO院际转运至南昌大学第二附属医院的患者。将2019年1月至2020年12月采用优化导管管理策略转运的38例患者作为观察组;2018年1月至12月采用常规导管管理方法转运的30例患者作为对照组。比较两组患者转运过程中导管相关不良事件的发生率。结果观察组与对照组患者年龄、带管数、转运时间、转运距离、ECMO运转时间等临床资料比较差异均无统计学意义〔年龄(岁):58.26±10.38比54.00±16.61,带管数(根):6.03±1.32比5.51±1.37,转运时间(h):2.48±0.30比2.51±0.39,转运距离(km):155.27±20.45比165.56±25.62,ECMO运转时间(d):8.47±1.28比9.11±1.99,均P>0.05〕,具有可比性。对照组导管相关不良事件发生率为26.67%(8/30),其中2例患者过床后出现ECMO导管打折,导致流量监测报警;1例患者中心静脉导管(CVC)未呈"U"型摆放,导致导管扭曲,血管活性药物未及时输入体内,造成患者低血压;3例患者导管穿刺点渗血较多,贴膜卷边;2例患者上车后尿管夹闭,未及时开放。而观察组实施优化导管管理策略后,ECMO患者转运途中均未发生导管相关不良事件。两组导管相关不良事件发生率比较差异有统计学意义(χ^(2)=7.814,P<0.05)。结论对ECMO患者院际转运途中实施优化导管管理策略,很大程度减少了导管相关不良事件的发生,为ECMO患者院际转运提供了有效的安全保障。

Objective To discuss the effect of optimized catheter management strategy on reducing the incidence of catheter-related adverse events in interhospital patients transition with extracorporeal membrane oxygenation(ECMO).Methods A historical control trial was conducted.The patients transferred with ECMO to the Second Affiliated Hospital of Nanchang University from January 2018 to December 2020 were enrolled.From January 2019 to December 2020,38 patients with interhospital transport using optimized catheter management strategy were as observation group;from January to December in 2018,30 patients with routine catheter management method were selected as the control group.The incidence of catheter-related adverse events during transition was compared between the two groups.Results There were no significant differences in clinical data such as age,number of catheters,transit time,transit distance,ECMO operation time between the observation group and the control group[age(years old):58.26±10.38 vs.54.00±16.61,number of catheters(roots):6.03±1.32 vs.5.51±1.37,transit time(hours):2.48±0.30 vs.2.51±0.39,transfer distance(kilometers):155.27±20.45 vs.165.56±25.62,ECMO operating time(days):8.47±1.28 vs.9.11±1.99,all P>0.05].The incidence of catheter-related adverse events in the control group was 26.67%(8/30),among them,2 patients had ECMO catheter discount after getting over the bed,causing the flow alarm;1 patient's central venous catheter(CVC)was not placed with U-shape and twisted,the vasopressors were not entered in time,which caused hypotension;3 patients had more bleeding at the puncture points and film crimping;the urinary catheters were clamped in 2 patients and not opened in time.In the observation group,the patients did not have catheter-related adverse events during transition.There was statistically significant difference in the incidence of catheter-related adverse events between the two groups(χ^(2)=7.814,P<0.05).Conclusion The implementation of optimized catheter management strategy can greatly reduce the incidence of catheter-related adverse events and provide an effective safety guarantee for the interhospital transit of ECMO patients.