救护型直升机院间转运重症患者36例报告

Thirty-six critical cases of emergency helicopter transferring between hospitals

目的总结直升机院间转运重症病例的经验,提高重症救护质量及安全性。方法检索广西航空医学救援培训基地2017年9月至2020年9月出诊任务记录单,汇总并分析任务受理及实施情况、疾病谱构成、转运前准备、机上医疗干预等情况。结果①一般资料:共登记直升机院间转运请求168例,实际转运36例,成功35例,1例在飞机降落阶段发生心搏骤停,持续复苏至入院数小时后死亡。36例患者中,男性30例,女性6例;中位年龄50.5(29.8,66.0)岁;平均转运时间(54.95±17.89)min,平均转运距离(205.74±74.68)km。②疾病谱:脑卒中11例(30.55%),创伤7例(19.45%),重症肺炎5例(13.89%),心脏及大血管疾病5例(13.89%),腹部急症5例(13.89%),其他疾病3例(8.33%)。③疾病严重程度:根据急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),31例(占86.11%)为重症患者(≥15分);根据Hamilton早期预警评分(HEWS),19例(占52.78%)为急诊转运高风险(≥6分);根据创伤严重度评分(ISS),6例(占创伤患者的85.71%)为严重创伤(≥16分)。④转运前准备:开通远程会诊,以掌握患者最新病情状态,特别是呼吸循环情况,必要时复查有关项目,实施必要的紧急救治,并对转运途中可能出现的意外进行针对性准备,如心电图(94.44%)、血气分析(94.44%)、颅脑CT(36.11%)等辅助检查,气管插管或气管切开(72.22%)、深静脉置管(91.67%),胃管(86.11%)、尿管(88.89%)置入,镇静药物(38.89%)、血管活性药物(58.33%)和脱水降颅压药物(33.33%)的调整,骨折固定是否牢靠(11.11%)等。⑤机上医疗干预:所有患者均全程实施心电、血压、呼吸和血氧监测,使用呼吸机者及时调整参数(66.67%),使用微泵给药者及时调整用量(91.67%),其他还包括必要的镇静/镇痛药物使用(38.89%)、吸痰护理(75.00%),各类置入管道护理(气管插管或切开护理72.22%,留置尿管护理88.89%),心搏骤停患者实施心肺复苏(2.78%)等。结论直升机转运服务对象以危重症患者为主,对机载医疗设备与救护技术要求高,亟待建立技术规范和人才培养标准。

Objective To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care.Methods The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved.The mission acceptance,implementation results,disease spectrum composition,pre-transfer preparation and medical intervention on board were summarized.Results①General information:a total of 168 patients of helicopter transfer requests were registered,of which 36 patients were transferred,35 patients were successful,1 patient had cardiac arrest during the landing phase,and died several hours after continuous resuscitation.Of the 36 patients 30 were males and 6 were females,with median age of 50.5(29.8,66.0)years old,the average transfer time was(54.95±17.89)minutes,and the average transfer distance was(205.74±74.68)km.②Disease spectrum included 11 cases of stroke(30.55%),7 cases of trauma(19.45%),5 cases of severe pneumonia(13.89%),5 cases of heart and macro-vascular diseases(13.89%),5 cases of abdominal emergency(13.89%),and 3 other conditions(8.33%).③Severity:31 patients(86.11%)were severe(≥15)according to acute physiology and chronic health evaluationⅡ(APACHEⅡ)score;19 patients(52.78%)were high-risk emergency transport(≥6)according to Hamilton early warning score(HEWS);6 patients(85.71%of trauma patients)were severe trauma(≥16)according to injury severity score(ISS).④Preparation before transfer:remote consultation was carried out to evaluate the latest state of the patient's condition,especially the respiratory and circulatory conditions.Relevant items were reviewed and emergency treatments were implemented when necessary.Targeted preparation was made for accidents that might occur during transfer,such as electrocardiogram(94.44%),blood gas analysis(94.44%),brain CT(36.11%)and other auxiliary examinations,endotracheal intubation or tracheotomy(72.22%),deep vein catheterization(91.67%),placement of gastric tube(86.11%)and urinary tube(88.89%),adjustment of sedative(38.89%),vasoactive drugs(58.33%)and drugs for dehydration and lowering intracranial pressure(33.33%),and fixation of fracture(11.11%),etc.⑤On-board medical intervention:cardiac monitoring,blood pressure,respiration and blood oxygen monitoring were carried out in all patients.The parameters of patients using ventilator were adjusted in time(66.67%).The dosage of patients using micropump was adjusted in time(91.67%).Other aspects included the use of sedative and analgesics(38.89%),sputum suction nursing(75.00%),all kinds of catheter nursing(endotracheal intubation/incision nursing of 72.22%,indwelling catheter nursing of 88.89%),and cardiopulmonary resuscitation for patient with cardiac arrest(2.78%).Conclusion As the patients transferred by helicopter are mainly those of critically ill at this stage,the requirements for airborne medical equipment and rescue technology are high,and there is an urgent need to establish technical specifications and personnel training standards.