浙江省急诊科开展体外膜肺氧合技术情况的调查研究  

Cross-sectional study on the application of extracorporeal membrane pulmonary oxygenation in emergency departments of Zhejiang province

作　　者：张斌[1] 金文扬 刘宏[1,3] 王弋[4] 吴德军[5] 贺鹤群[6] 曹伟中[7] 林华 陈玉熹 黄明伟 嵇朝晖[11] 丁国娟 张茂 调查协作组[13] Zhang Bin;Jin Wen-yang;Liu Hong;Wang Yi;Wu De-jun;He He-qun;Cao Wei-zhong;Lin Hua;Chen Yu-xi;Huang Ming-wei;Ji Zhao-hui;Ding Guo-juan;Zhang Mao;Investigation Cooperation Group(Department of Emergency Medicine,the Second Affiliated Hospital of Zhejiang University School of Medicine,Institute of Emergency Medicine,Zhejiang University,Research Center of Zhejiang Emergency of Critical Clinical Medicine,Zhejiang Key Laboratory for Diagnosis and Treatment of Severe Trauma and Burn,Hangzhou 310009,China;不详)

机构地区：[1]浙江大学医学院附属第二医院急诊医学科,浙江大学急救医学研究所,浙江省急危重症临床医学研究中心,浙江省严重创伤与烧伤诊治重点实验室,浙江杭州310009 [2]台州医院急诊科,浙江台州317000 [3]丽水市人民医院急诊医学科,浙江丽水323000 [4]杭州市第一人民医院急诊科,浙江杭州310006 [5]衢州市人民医院急诊科,浙江衢州324000 [6]宁波市第一医院急诊科,浙江宁波315010 [7]嘉兴市第一医院急诊科,浙江嘉兴314000 [8]舟山医院急诊科,浙江舟江316021 [9]温州市中心医院急救科,浙江温州325000 [10]金华市中心医院磐安分院急诊重症医学中心,浙江金华322300 [11]绍兴市人民医院急诊科,浙江绍兴312000 [12]湖州市第一人民医院急诊科,浙江湖州313000 [13]不详

出　　处：《中国急救医学》2021年第12期1045-1050,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的调查浙江省县区级及以上的综合性医院急诊科开展体外膜肺氧合(ECMO)技术的情况。方法采用横断面调查性研究,由浙江省急诊医学质量控制中心发起,组织专家制定调查表,纳入浙江省县区级第一人民医院及以上的综合性公立医院,调查内容包含医院的概况、ECMO配置情况、全院及急诊科ECMO开展情况,以及在开展ECMO时遇到的困难及对质控、培训的态度和要求。通过省、地市、县区三级急诊质控网络落实调查表的发放与回收、核对。结果(1)最终纳入全省11个地市的114家医院,占目标医院总数的94.2%;54家医院(47.4%)开展ECMO,其中34家(29.8%)能独立开展;25家医院的急诊科(21.9%)开展ECMO,其中17家(14.9%)能独立开展。(2)2019年全省急诊科开展128例ECMO(占全省总数669例的19.1%),其中省级医院为53例(占41.4%),其次为台州市(30例,23.4%)、嘉兴市(12例,9.4%)。静脉-静脉体外膜肺氧合(V-V ECMO)26例(20.3%),静脉-动脉体外膜肺氧合(V-A ECMO)102例(79.7%),含体外心肺复苏(ECPR)65例(50.8%),V-A ECMO及ECPR的比例高于全省(79.7%vs.68.5%,P=0.011;50.8%vs.19.1%,P<0.05)。(3)急诊科开展ECMO的成功撤机率为51.6%,患者存活率为38.3%,与2020年世界总体的ECMO标化撤机率(51.5%,P=1.000)、患者存活率(39.4%,P=0.898)差异无统计学意义(P>0.05)。(4)93.8%和95.5%的调查对象认为ECMO对医院、学科发展和危重患者救治的作用大或很大;83.9%和83.0%的医院对ECMO的培训、质控有需求。结论ECMO技术在浙江省县区级及以上医院的急诊科有一定的开展,但地区间的差异较大;ECMO在急诊主要用于循环支持和心肺复苏(CPR);需要进一步加强急诊ECMO的培训与质控。Objective To investigate the implementation of extracorporeal membrane pulmonary oxygenation(ECMO)technology in the emergency departments of general hospitals at the county and district levels and above in Zhejiang province.Methods A cross-sectional survey study was conducted,initiated by the Quality Control Center of Emergency Medicine of Zhejiang province,and the experts were organized to develop a questionnaire about general public hospitals of the first people′s hospital(excluding Chinese medicine hospitals)and above at the county and district levels in Zhejiang province.The survey included hospital overview,the configuration of ECMO,the development of ECMO in the emergency department and the whole hospital,and the difficulties encountered in the development of ECMO,and attitudes and requirements for quality control and training.The questionnaires were distributed,collected and verified through the three-level emergency care quality control network of the province,local cities and counties.Results(1)114 hospitals in 11 localities and cities in the province were finally included,accounting for 94.2%of the total number of target hospitals;54 hospitals(47.4%)carried out ECMO,of which 34 hospitals(29.8%)could do so independently;25 hospitals′emergency departments(21.9%)carried out ECMO,of which 17(14.9%)could do so independently.(2)In 2019,ECMO were carried out for 128 cases in emergency departments in the province(19.1%of the total 669 cases in the province),including 53 cases(41.4%)in provincial hospitals,followed by Taizhou region(30 cases,23.4%)and Jiaxing region(12 cases,9.4%).26 cases(20.3%)accepted veno-venous extracorporeal membrane pulmonary oxygenation(V-V ECMO),102 cases(79.7%)veno-arterial extracorporeal membrane pulmonary oxygenation(V-A ECMO),including 65 cases(50.8%)extracorporeal cardiopulmonary resuscitation(ECPR),and the proportions of V-A ECMO and ECPR were higher than those of the province(79.7%vs.68.5%,P=0.011;50.8%vs.19.1%,P<0.05).(3)The successful weaning rate of ECMO performed in the e

关 键 词：体外膜肺氧合(ECMO) 应用 急诊科 调查 浙江省 

分 类 号：R459.7[医药卫生—急诊医学]