摘要
目的探讨儿童危重症转运及协作网络的优势及对于危重症患儿救治的意义。方法回顾性分析2010年10月至2013年10月期间，我院重症医学科与上海市120跨省转运部合作，通过远距离院际转运收治的232例危重症患儿的临床资料。结果232例危重患儿转运自华东地区五省一市共31家单位，其中男141例，女91例；年龄29d～13岁（中位数12个月）；体重2．5～66蚝（中位数10垤）；小儿危重病例评分平均为（80．4±7．7）分，其中1个脏器功能障碍患儿155例（66．8％），2个或2个以上脏器功能障碍患儿55例（23．7％）；需要机械通气转运患儿有105例（45．3％）；转运半径50—1000km，其中87例（37．3％）转运半径〉200km，73例（36％）转运半径101—200km，62例（26．7％）转运半径≤100km；转运途中无一例患儿死亡，有3例（1．3％）患儿转运途中进行心肺复苏治疗，2例（0．9％）进行电复律治疗，2例（0．9％）途中更换气管插管；转运成功率100％；前4类疾病分别为呼吸系统疾病90例（38．8％）、神经系统疾病43例（18．5％）、循环系统疾病36例（15．5％）及儿童意外伤害28例（12．1％）。所有232例危重患儿均通过绿色通道收治于我院PICU，178例患儿（76．7％）经治疗好转出院，放弃治疗24例（10．3％），死亡32例（13．8％）；转运的危重患儿接受特殊脏器功能替代30例（1Z9％），其中4例（1．7％）进行体外膜肺治疗，26例（11．1％）进行血液净化治疗。结论儿童危重症院际转运体系的建立，有利于积极有效地救治危重症患儿；掌握好转运指征进行危重患儿的转运是安全的，值得推广。
Objective To investigate the value of the interhospital transportation and the advantage of the cooperative network to the critically ill children. Methods The clinical data of 232 critically ill chil- dren transported from other hospitals in long distances to PICU of Fudan University Affiliated Children Hos- pital cooperated with Shanghai 120 interprovincial transport Department, between Oct 2010 and Oct 2013, were analyzed retrospectively. Results A total of 232 critically ill children were transported from 31 hospi- tals of Eastern China region including five provinces and the city of Shanghai. Among these critically ill chil- dren 141 cases were male and 91 cases were female,with age from 29 days to 13 years（ median age was 12 months） and weight from 2. 5 to 66 kg（ median weight was 10 kg）. The average pediatric clinical illness score was 80.4 ~ 7.7,155 cases （ 66. 8 % ） were single organ dysfunction, 55 cases （ 23.7 % ） were multiple organs dysfunction, 105 cases（45.3% ） were mechanical ventilation required for transportation. Referral radi- us was 50-1 000 km （median）. Among these patients, 87 cases （37. 3 % ） were transported over 200 km radius and 73 cases（36% ） were transported 101-200 km,62 cases（26. 7% ） were transported 100 km or less. During the transportation,0 case died,3 cases（ 1.3% ） received cardiopulmonary resuscitation treatment,2 cases （0. 9 % ） received electrical conversion treatment, 2 cases （0. 9 % ） were replaced endotracheal intubation, the success rate of transportation was 100%. The top 4 diseases were respiratory diseases （90 cases, 38. 8% ）, neural diseases （ 43 cases, 18.5 % ）, cardiovascular diseases （ 36 cases, 15.5 % ） and acute pediatric trauma（ 28 cases, 12. 1% ）. All 232 critically ill children were admitted to our PICU for further treatment through the Green Channel. In the end, 178 cases （ 76.7% ） discharged, 24 cases （ 10. 3% ） gave up and 32 cases （ 13.8% ） died. Among these 232 critically ill children,30 cases（ 12. 9% ） received special organ replacement treatment,4 cases （1.7%） of whom were treated with extracorporeal membrane oxygenation, 26 cases （ 11.1% ） received blood purification therapy. Conclusion Establishing the system of transportation between PICU of hospitals will be propitious to treat the critically ill children energetically and effectively. It is worth pro- moting to master the transportation indication of children with critical illness,which is safe and reliable.
出处
《中国小儿急救医学》
CAS
2015年第5期295-299,共5页
Chinese Pediatric Emergency Medicine
关键词
危重症
院际转运
儿童
Critical ill
Inter-hospital transportation
Children
