镇痛镇静在机械通气危重症患儿院际转运应用的安全性研究  

The study of safety of analgesia and sedation for critical pediatric patients with mechanical ventilation in inter-hospital transport

作　　者：莫武桂[1] 韦蓉[1] 唐育鹏[1] 谢友军 卢功志 傅君[1] MO Wu-gui WEI rong TANG Yu-peng XIE You-jun LU Gong-zhi FU Jun(Intensive Care Unit, the Guangxi Maternal and Children＇ s Hospital, Nanning 530003, Chin)

机构地区：[1]广西壮族自治区妇幼保健院重症医学科,南宁530003

出　　处：《中国急救复苏与灾害医学杂志》2017年第5期420-423,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：广西卫生厅自筹经费课题：重症患儿院外急救转运集成技术应用研究（Z2012213）

摘　　要：目的研究应用程序化镇痛镇静及强化儿童重症监护病房（pediatricintensivecareunit，PICU）工作背景或PICU培训医护人员组成转运小组对呼吸机辅助通气危重症患儿院际转运中不良事件的发生、安全性、成功率及转归的效果。方法取2009年6月-2010年5月广西壮族自治区妇幼保健院未开展序化镇痛镇静及优化转运院际转运机械通气危重症患儿117例作为Ⅰ组，2010年6月-2011年6月开展序化镇痛镇静及优化转运后院际转运机械通气危重症患儿184作为Ⅱ组，分别对两组患儿病例的临床资料进行对照分析，对应用程序化镇痛镇静危重症患儿转运前后两组病例转运中不良事件发生（气管插管脱管、动脉、静脉留置针脱出）情况、转运达到后危重症评分、转运成功率及转归进行对比、分析。结果Ⅰ组、Ⅱ组气管插管脱管不良事件发生率分别为5．13％及0．54％（P〈0．05）；动脉、静脉留置针脱出率分别为13．60％及2．72％（P〈0．01）；转运达到后危重症评分分别为80．33分和83．94分（P〈0．05），转运成功率分别为82．05％和90．22％（P〈0．05），治愈好转率分别为76．07％和85．87％（P〈0．05），Ⅱ组效果均明显优于Ⅰ组。结论应用程序化镇痛镇静及强化儿PICU工作背景或PICU培训医护人员组成转运小组对呼吸机辅助通气危重症患儿的院际转运取得较好效果，可降低转运过程中不良事件的发生率，提高转运安全性、成功率及治疗效果，降低患儿的病死率。Objective The purpose of the study is to assess sequenced analgesia and sedation on the occurrence of adverse events, safety, success rate and prognosis of disease in the course of inter-hospital transport of critical pediatric ventilated patients transferred with well-trained and richly experienced medical personnel in PICU. Method 117 cases selected as Group I without sequenced sedation, analgesia and optimized inter-hospital transport was admitted from Jun. 2009 to May. 2010, 184 cases registered as Group II with sequenced sedation and analgesia and optimized inter-hospital transport admitted from Jun. 2010 to Jun. 2011.Clinical data ,adverse events （tracheal tube withdrawal, and the prolepsis of arterial and venous indwelling needles）, critical illness scores on arrival of transport, success rates of transfer and prognosis were compared between two groups. Results Group II has significantly better effects than Group I, with incidence of tracheal tube withdrawal in group I and group II was respectively 5.13% and 0.54% （P 〈0.05）; the prolapsis rate of arterial and venous indwelling needle was 13.60% and 2.72% （P 〈0.01）; the critical illness scores on arrival of transport, was 80.33 and 83.94 （P 〈0.05）; success rate of transfer was 82.05% and 90.33% （P 〈0.05 ）, recoverary and improvement rates was 76.07% and 85.87% （P 〈0.05）. Conclusion The application of sequenced analgesia and sedation, intensively trained and richly experienced medical personnel for the purpose of transfer in PICU has better effects on inter-hospital transport critical pediatric patients, with adverse events and fatality rates reduced; safety, success rate and treatment effect improved.

关 键 词：镇痛镇静 危重症 儿童 机械通气 院际转运 安全性 

分 类 号：R459.7[医药卫生—急诊医学]