重症患者转运中不良事件原因分析  

Cause analysis of adverse events in the transport of critically ill patients

作　　者：宁波[1] 张莉莉[2] 张晓慧[1] 马宇洁[1] 

机构地区：[1]空军总医院重症医学科,北京100142 [2]解放军第205医院心内科,辽宁锦州121000

出　　处：《空军医学杂志》2014年第3期152-154,共3页Medical Journal of Air Force

摘　　要：目的分析重症患者转运时不良事件发生情况,为重症患者安全转运提供依据。方法收集我院2010年1月—2013年12月急性生理学及慢性健康状况评分系统(acute physiology and ch ronic health evaluation,A PACHE)Ⅱ评分≥15分转运患者369例,其中重症医学科参与转运158例。确定转运不良事件标准为到达目的地时:心率变化≥30%;收缩压<90 mm Hg,调整治疗5 min后血压仍不能恢复者;出现严重缺氧并经皮氧饱和度≤80%者;需要紧急气管插管及心肺复苏者;入科30 min内死亡者。计算不良事件发生率。结果不良事件出现13例,发生率为3.5%。主要为缺氧、循环不稳定、不适宜搬动状态下转运等因素导致转运不良事件的发生。而重症医学科参与转运未发生不良事件,其中包括空中转运3例(飞行时间>2 h)、长途转运(路程10 h以上)3例。结论转运前必须经过认真评估,做好充分转运准备,对可能的突发事件要有处理预案。经过转运培训,有经验的医护人员参与转运可减少不良事件的发生。Objective We aimed to analyze the incidence of adverse events in the transport of critically ill patients, and to facilitate the safe transport. Method 369 patients transported with APACHE≥15 from January 2010 to December 2013 were included, among which the department of Intensive Care Unit （ICU） participated in 158 cases. The criteria of adverse events in the transport is： the change of heart rate ≥30%; systolic blood pressure 〈90 mmHg, and not restore after the 5-minutes-treatment; severe hypoxia, the value of transcutaneous oxygen saturation ≤80%; requiring emergency intubation and cardiopulmonary resuscitation; died within 30 minutes into the department. The incidence of adverse events was calculated. Results The incidence of adverse events was 3.5%, mainly caused by hypoxia, hemodynamic instability, and not suitable for transport. However, there was no incidence of adverse events when the ICU participated in, including 3 cases of air-plane transport with more than 2 hours of flying, and 2 cases of long distance transport with longer than 10 hours of journey. Conclusion Before transport, careful assessment, full preparation, and necessary contingency plan are very necessary. After transport training, the adverse events in the transport can be reduced when the experienced medical staff is involved.

关 键 词：重症患者 转运 不良事件 

分 类 号：R459.7[医药卫生—急诊医学] R473.52[医药卫生—治疗学]