危重患儿院内转运血氧饱和度降低的危险因素分析及预防策略  

Screening of risk factors and prevention strategies for the decrease of oxygen saturation during the intra-hospital transport of critically ill children

作　　者：张敏[1] 沈国莲 钱飞阳 ZHANG Min;SHEN Guo-lian;QIAN Fei-yang(Department of Pediatrics,Hangzhou First Peoples Hospital Afiliated to Medical School Zhejiang University,Hangzhou,Zhejiang 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院儿科,浙江杭州310006

出　　处：《中华全科医学》2020年第11期1864-1868,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2020KY691)。

摘　　要：目的采用前瞻性横断面调查法分析儿科危重患儿院内转运期间血氧饱和度(SpO2)下降发生情况及影响因素,为临床优化危重患儿院内转运方案提供参考依据。方法纳入2019年9--11月期间浙江大学医学院附属杭州市第--人民医院危重患儿共计204例次。按照患儿转运过程是否发生SpO2下降将其分为观察组和对照组。制定可能影响患儿转运过程中发生SpO2下降的各项因素调查方案。转运全程跟踪记录各项可能影响因素并进统计分析。结果①危重患儿院内转运过程中SpO2下降率为60.29%,转运过程中发生SpO2降低时间以转运开始5min内为主;②可能影响危重患儿院内转运SpO2下降相关因素有:年龄、BMI、基础疾病、PEWS评分、血压、呼吸频率、转运护士年资转运过程有无主治医生协助转运路径、转运距离、转运过程意外事件、转运时间(P<0.05);③患儿年龄在0~6岁、呼吸系统和(或)神经系统疾病、PEWS评分为出现3分项目、转运护士年资<3年、转运路径、转运过程意外事件为危重患儿院内转运SpO2降低的高危因素。结论危重患儿院内转运期间SpO2下降发生率高,危险因素以患儿病情严重及转运过程效率低及防护措施不当为主,通过转运流程改造强化转运人员培训及谨慎评估危重患儿院内转运风险等各项措施,提高转运效率及加强防护效果,提升患儿安全。Objective To analyze the incidence of blood oxygen saturation(SpO2) decrease influencing factors during the intra-hospital transport of pediatric critically ill children by using a prospective cross-sectional survey, and provide a reference for clinical optimization of the intra-hospital transport plan for critically ill children. Methods Two hundred and four critically ill children who met the research conditions in Hangzhou First People’s Hospital Affiliated to Medical School of Zhejiang University from September 2019 to November 2019 were selected as the study subjects. They were divided into observation group and control group. An investigation scheme was developed for various factors that may affect SpO2 reduction during the transportation of children. All possible influencing factors were recorded and analyzed statistically. Results(1) The incidence of SpO2 decrease was 60.29% in the process of intra-hospital transport of critical children, and the time of SpO2 decrease was mainly within 5 minutes of the beginning of the transfer;(2) The factors that may affect the decrease of SpO2 during the transport in critically ill children were: age, body mass index(BMI), basic disease, pediatric early warning score(PEWS), blood pressure, respiratory rate, age of transfer nurse, assistance of attending doctor in the process of transfer, transfer path, transfer distance, accident in the process of transfer, transfer time(P<0.05);(3) Risk factors of SpO2 decrease during the intra-hospital transportation of critically ill children: multivariate logistic analysis showed that the risk factors of SpO2 reduction decrease during the intra-hospital transportation of critically ill children were the low age( 0-6 years old), respiratory and/or nervous system diseases, one or more items in PEWS score is 3 points, the experience of the transfer nurse was less than 3 years, transportation path, transportation process accidents the high risk factors of SpO2 reduction intra-hospital transport of critically ill children. Conclusion

关 键 词：危重患儿 院内转运 血氧饱和度 影响因素 危险因素 预防策略 

分 类 号：R473.72[医药卫生—护理学]