新型转运模式在急性重度颅脑外伤院内转运中的应用  

Application of new transport mode in intra-hospital transport of patients with severe acute traumatic brain injury

作　　者：冯静 崔继祯 杨广盈 胡本玲 张允忠 张华锋 曹元江 Feng Jing;Cui Jizhen;Yang Guangying;Hu Benling;Zhang Yunzhong;Zhang Huafeng;Cao Yuanjiang(Department of Gynaecology,Qingzhou Hospital Affiliated to Shandong First Medical University(Qingzhou People's Hospital),Qingzhou 262500,Shandong,China;Department of Intensive Care Unit,Qingzhou Hospital Affiliated to Shandong First Medical University(Qingzhou People's Hospital),Qingzhou 262500,Shandong,China;Department of Emergency,Qingzhou Hospital Affiliated to Shandong First Medical University(Qingzhou People's Hospital),Qingzhou 262500,Shandong,China;Department of Neurosurgery,Qingzhou Hospital Affiliated to Shandong First Medical University(Qingzhou People's Hospital),Qingzhou 262500,Shandong,China)

机构地区：[1]山东第一医科大学附属青州医院(青州市人民医院)妇科,青州262500 [2]山东第一医科大学附属青州医院(青州市人民医院)重症医学科,青州262500 [3]山东第一医科大学附属青州医院(青州市人民医院)急诊科,青州262500 [4]山东第一医科大学附属青州医院(青州市人民医院)神经外科,青州262500

出　　处：《中国中西医结合急救杂志》2022年第4期426-429,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：山东省临床重点专科(SD2020-29);潍坊市卫健委科研计划项目(WFWSJK2021-064)。

摘　　要：目的研究急诊科新型转运模式对急性重度颅脑外伤安全转运的作用。方法以2020年1月至2021年10月采用速度与安全的急诊科新型转运模式的120例急性重度颅脑外伤患者为观察组,以2018年1月至2019年12月采用传统以速度为主要目标的快速院内转运模式的100例急性重度颅脑外伤患者为对照组。观察两组间转运途中管道、治疗设备、坠床、呼吸系统、循环系统意外等意外情况,计算意外总体发生率。比较两组的转出交接问题发生率、交接所耗时间、转运时间、机械通气时间、重症监护病房(ICU)住院时间、总住院时间、住院14 d格拉斯哥昏迷评分(GCS)、抢救成功率及出院好转率。结果观察组患者的意外情况总体发生率、交接问题发生率均显著低于对照组〔意外情况发生率:10.8%(13/120)比27.0%(27/100),交接问题发生率:6.6%(8/120)比13.0%(13/100),P<0.05〕;交接所耗时间明显短于对照组(min:3.7±2.1比5.7±2.4,P<0.01);转运时间略高于对照组(36.5±2.7比32.1±2.1),但差异无统计学意义(P>0.05)。观察组患者的机械通气时间、ICU住院时间、总住院时间均明显短于对照组〔机械通气时间(d):6.1±1.1比9.1±1.2,ICU住院时间(d):9.1±3.1比14.2±2.3,总住院时间(d):20.5±6.8比27.8±5.5,均P<0.05〕;住院14 d GCS评分、抢救成功率及出院好转率较对照组均显著提高〔GCS评分(分):10.5±2.8比8.02±3.4,抢救成功率:98.3%(118/120)比91.0%(91/100),出院好转率:95.8%(115/120)比87.0%(87/100),均P<0.05〕。结论急诊科新型转运模式能明显降低急性重度颅脑外伤转运不良事件的发生、缩短院内住院时间,提高抢救成功率及出院好转率。Objective To study the effect of new transport mode in department of emergency on the safe transport of patients with severe acute traumatic brain injury.Methods A totol of 120 patients with severe acute traumatic brain injury rescued in the department of emergency were transported by a new model of transit with speediness and safety from January 2020 to October 2021 were selected to be in an observation group.Another 100 patients with severe acute traumatic brain injury rescued from January 2018 to December 2019 by previous intra-hospital rapid transport mode with speediness as the main target of transport were assigned in a control group.The accidents during transit in the two groups:accidents happened in pipeline,treatment equipment,bed falling,respiratory system,circulatory system and overall accident rate were observed and calculated in the two groups.The occurrence rate of transfer problems,the time spent on transfer,the patients'transport time,duration of mechanical ventilation,length of intensive care unit(ICU)stay,total length of hospitalization,Glasgow coma score(GCS)in 14-day hospitalization,successful rate of rescue and discharge recovery rate were compared between the two groups.Results The overall rate of accidents,incidence of transfer problems in observation group were significantly lower than those in control group[overall rate of accidents:10.8%(13/120)vs.27.0%(27/100),incidence of transfer problems:6.6%(8/120)vs.13.0%(13/100),both P<0.05],the time spent on transfer was obviously shorter than that in control group[(minutes):3.7±2.1 vs.5.7±2.4,P<0.01];the transport time of patients in the observation group was a little bit higher than that in control group(36.5±2.7 vs.32.1±2.1),but in the comparison between the two groups,there is no statistical significant difference(P>0.05).The duration of mechanical ventilation,length of ICU stay and total length of hospitalization in observation group were obviously shorter than those in control group[duration of mechanical ventilation(days):6.1±1.1 vs.9

关 键 词：急性重度颅脑外伤 院内转运 早期干预 双风险评估 新型模式 

分 类 号：R651.15[医药卫生—外科学]