急诊危重患者院内转运过程中临床恶化的危险因素分析及护理

Risk factors and nursing countermeasures for clinical deterioration during intrahospital transport of critically ill patients in the emergency department

目的探讨急诊危重患者院内转运过程中临床恶化的危险因素及护理对策。方法采用回顾性研究方法,选取2023年3—12月急诊科收治且因诊断治疗需在院内转运的危重患者,收集转运前风险评分、患者临床资料、转运护士资质、准备时间、最终护理时间以及转运过程中表征临床恶化的国家早期预警评分系统(NEWS)评分。对危重患者院内转运过程中的危险因素进行多因素Logistic回归分析。结果839例急诊危重患者院内转运过程中临床恶化率为28.37%。多因素Logistic回归分析发现,21~25 min转运时间与临床恶化显著相关(β=0.133,P=0.027)。以下患者症状与临床恶化的可能性相关性较高:身体部位受伤/头部受伤/烧伤/中毒(β=0.670,P=0.030)、呼吸困难/痉挛(β=0.919,P<0.001)、休克/心律失常/胸痛/出血(β=1.134,P<0.001)、昏迷/意识改变/晕厥(β=1.343,P<0.001)和心脏骤停(β=2.251,P<0.001)。病情不稳定(β=1.689,P<0.001)、转移前风险评分为8分或更高(β=0.625,P<0.001)以及由非专职转运护士转运(β=0.495,P<0.008)的患者临床恶化率较高。结论急诊危重患者院内转运过程中临床恶化率较高。涉及循环、呼吸和神经系统的疾病,病情不稳定,转运前风险评分高,21~25 min转运时间以及由无急诊转运专职资质护士转运均与较高的临床恶化率相关。

Objective To investigate the risk factors and nursing strategies for clinical deterioration during intrahospital transport of critically ill patients in the emergency department.Methods A retrospective study was conducted in critically ill patients admitted to the emergency department from March to December 2023 who required intrahospital transport for diagnostic and therapeutic purposes.Data were collected including risk scores prior to transport,patients′clinical information,qualification of the transporting nurses,preparation time,final care time,and the National Early Warning Scoring(NEWS)score indicating clinical deterioration during transport.Multivariate Logistic regression analysis was performed to identify the risk factors influencing clinical deterioration during intrahospital transport of critically ill patients.Results Among 839 critically ill patients transported within the hospital,the clinical deterioration rate was 28.37%.Multivariate Logistic regression analysis revealed that transport duration ranging from 21 to 25 minutes were significantly associated with clinical deterioration(β=0.133,P=0.027).Patients′symptoms including body part injury,head injury,burns,poisoning(β=0.670,P=0.030),respiratory distress/spasm(β=0.919,P<0.001),shock/arrhythmia/chest pain/hemorrhage(β=1.134,P<0.001),coma/changes in mental status/fainting(β=1.343,P<0.001),and cardiac arrest(β=2.251,P<0.001)were highly correlated with clinical deterioration.Patients with unstable conditions(β=1.689,P<0.001),those with pre-transport risk scores of 8 or higher(β=0.625,P<0.001),and those transported by non-dedicated transport nurses(β=0.495,P<0.008)were significantly related to increased risk of clinical deterioration.Conclusion The incidence of clinical deterioration during intrahospital transport of critically ill patients is relatively high.Diseases involving the circulatory,respiratory,and nervous systems,unstable clinical conditions,high pre-transport risk scores,transport duration of 21 to 25 minutes,and presence of transport by non-specialized nurses are all associated with higher rates of clinical deterioration.