西北地区体外膜肺氧合辅助患者院际转运模式的探索  

Exploration of Interhospital Transport Mode of Patients With Extracorporeal Membrane Oxygenation in Northwest China

作　　者：瓦永凌 卢安东 高涵翔[1] 赵晶[1] 乙成成 白明[1] WA Yongling;LU Andong;GAO Hanxiang;ZHAO Jing;YI Chengcheng;BAI Ming(The First Clinical Medical College of Lanzhou University,Heart Center,The First Hospital of Lanzhou University,Cardiovascular Disease Clinical Medical Research Center of Gansu Province,Lanzhou(730000),Gansu,China)

机构地区：[1]兰州大学第一临床医学院兰州大学第一医院心脏中心甘肃省心血管病临床医学研究中心甘肃省心血管疾病重点实验室,甘肃省兰州市730000

出　　处：《中国循环杂志》2022年第5期519-525,共7页Chinese Circulation Journal

基　　金：冠心病诊疗甘肃省国际科技合作基地(甘科外{2018}3号)。

摘　　要：目的:总结西北地区体外膜肺氧合(ECMO)救治团队在“EFFECT(E:efficient,高效;F:fast,快速;F:flexible,灵活;E:equipment,设备;C:cooperation,合作;T:timely,及时)原则”指导下进行远程救治和院际转运的效果。方法:回顾性分析2019年3月至2021年7月兰州大学第一医院ECMO团队在“EFFECT原则”指导下转运的46例患者的临床资料,记录并分析患者的一般情况、ECMO适应证、ECMO置管模式、转运方式、院际转运距离、转运期间并发症以及结局。结果:46例转运患者的平均年龄为(49±18)岁,其中男性30例(65.2%);ECMO适应证包括心原性休克35例(76.1%)、严重呼吸衰竭6例(13.0%)、其他原因导致的循环衰竭5例(10.9%);ECMO采用静脉-动脉模式40例(87.0%),采用静脉-静脉模式6例(13.0%)。所有患者在“EFFECT原则”指导下均成功转运,均经救护车转运至我院,转运最远距离1095 km,平均距离为(267.87±271.05)km。转运过程中无死亡事件发生,转运期间最常见的并发症为发热(9例,19.6%)和置管处渗血(7例,15.2%),均未造成严重后果。患者的平均住院时间为(16±7)d,ECMO平均辅助时间为(6±2)d;29例(63.0%)患者存活出院。结论:ECMO辅助患者在“EFFECT原则”指导下,转运更加快速、高效,这种方法有利于西北地区医疗资源的合理利用。Objectives:To sum up the experience of ECMO treatment team in Northwest China based on the"EFFECT"principle(E:efficient;F:fast;F:flexible;E:equipment;C:cooperation;T:timely),and explored the effect of“EFFECT”principle on remote therapy and inter-hospital transfer.Methods:The clinical data of 46 patients who were transported based on the"EFFECT principle"by the ECMO team of the First Hospital of Lanzhou University from March 2019 to July 2021 were retrospectively analyzed.Results:The mean age of the 46 transported patients was(49±18)years;30(65.2%)patients were male.The indications for ECMO included cardiogenic shock in 35 cases(76.1%),severe respiratory failure in 6 cases(13.0%)and circulatory failure due to other causes in 5 cases(10.9%).ECMO mode was as follows:40 patients(87.0%)were treated with veno-arterial mode,and 6 patients(13.0%)were treated with veno-venous mode.All patients were successfully transported to our hospital by ambulance under the guidance of“EFFECT”principle,with the longest distance of 1095 km and the average distance of(267.87±271.05)km.No death occurred during transportation.The most common complications during transportation were fever(9 cases,19.6%)and bleeding at the place of catheterization(7 cases,15.2%),which did not cause serious consequences The mean time of hospital stay was(16±7)d,and the mean treatment time of ECMO was(6±2)d.Twenty-nine patients(63.0%)were discharged alive.Conclusions:Patient transportation is faster and more efficient based on the"EFFECT"principle.This principle could improve the rational utilization of medical resources in Northwest China.

关 键 词：体外膜肺氧合 院际转运 呼吸衰竭 循环衰竭 

分 类 号：R54[医药卫生—心血管疾病]