意外伤害危重患儿229例院际转运的临床分析  

Clinical analysis of 229 cases of inter-hospital transport in critically ill children with accidental injury

作　　者：袁远宏[1] 张慧[2] 肖政辉[1] 卢秀兰[1] 胥志跃[1] 张新萍[1] 康霞艳 赵小平[1] 朱丽凤[1] YUAN Yuanhong;ZHANG Hui;XIAO Zhenghui;LU Xiulan;XU Zhiyue;ZHANG Xinping;KANG Xiayan;ZHAO Xiaoping;ZHU Lifeng(Emergency Center,Hunan Province Children’s Hospital,Changsha Hushan 410007,China;不详)

机构地区：[1]湖南省儿童医院急救中心,湖南长沙410007 [2]湖南省儿童医院肝病中心,湖南长沙410007

出　　处：《中国急救复苏与灾害医学杂志》2023年第8期1016-1020,1037,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：湖南省科技厅临床医疗技术创新引导项目(编号:2021SK50501);湖南省科技厅重点实验室项目(编号:2018TP1028);湖南省科技创新重点工程项目(编号:2020SK10141-3)。

摘　　要：目的回顾性分析儿童院际转运意外伤害危重患儿的现状和临床特征,探讨意外伤害危重患儿院际转运的安全性和预后。方法收集湖南省儿童医院2016年1月—2021年1月转运中心主动院际转运的229例小儿意外伤害危重患儿的资料,对其转运前的一般情况、小儿危重病例评分(PCIS)情况、转运路程和时间、转运过程中的处理和转归情况进行分析。结果229例转运患儿中男153例(66.8%),女76例(33.2%);平均年龄4.62岁,3岁1个月~6岁为人数最多年龄段(92例,40.2%)。转运距离的中位数为80 km,总的转运花费时间为(1.54±1.02)h。PCIS评分>80分107例(46.7%),PCIS评分80~71分80例(34.9%),PCIS评分≤70分42例(18.3%),三组患儿性别、年龄分布无统计学差异(P>0.05),但在转运距离和转运时间构成比上,差异有统计学意义(P<0.05)。转运重症患儿意外伤害类型中以异物最常见,其次是烧/烫伤和钝器伤/锐器伤,除了<1岁的患儿以烧/烫伤最常见外,其他年龄段的患儿均以异物且主要为气道异物为主。转运前PCIS总分为(89.56±9.05),转运后PCIS总分为(90.42±8.09),差异无统计学意义(t=3.57,P>0.05)。转运过程中未出现呼吸、心跳骤停等严重不良事件。住院后130例(56.8%)经手术处理、99例(43.2%)非手术处理,经手术处理的主要为创伤性意外,未行手术的主要为中毒、溺水和其他意外伤害。最终好转/治愈206例(89.9%),出现伤残/后遗症17例(7.4%),死亡6例(2.6%)。结论目前通过儿童专科医院院际转运体系进行意外伤害危重患儿转运,有助于解决下级医院医疗条件和水平不足的问题。根据意外伤害危重患儿的特点制定和优化处置流程和方案,特别是加强小儿外科在转运体系中的作用,更有利于意外伤害危重患儿能及时得到有效的救治。Objective To analyze the current situation and clinical characteristics of inter-hospital transport in critically ill children with accidental injury,and to explore the safety and prognosis of inter-hospital transport in critically ill children with accidental injury.Methods Data were collected from 229 critically ill children with accidental injuries who were actively transferred between hospitals at the Hunan Children's Hospital from January 2016 to January 2021.Their general condition before transfer,pediatric critical case score(PCIS),transfer route and time,and treatment and outcome during the transfer process were analyzed.Results Among the 229 cases of pediatric transport,there were 153 males(66.8%)and 76 females(33.2%);The average age was 4.62 years old,with the age range of 3 years,1 month to 6 years old being the most common age group(92 cases,40.2%).The median transfer distance was 80 km,and the total transfer time was(1.54±1.02)hours.There were 107 cases(46.7%)with a score of PCIS>80,80 cases(34.9%)with a score of PCIS 80-71,and 42 cases(18.3%)with a score of PCIS≤70.There was no statistically significant difference in gender and age distribution among the three groups of children(P>0.05),but the difference was statistically significant in the composition ratio of transport distance and transport time(P<0.05).Foreign bodies were the most common types of accidental injuries in critically ill children during transportation,followed by burns/scalds and blunt/sharp injuries.Except for children under 1 year old who are most common in burns/scalds,children of other age groups are mainly affected by foreign bodies and mainly have airways foreign bodies.The total score of PCIS before transportation was(89.56±9.05),while the total score of PCIS after transportation was(90.42±8.09),with no statistically significant difference(t=3.57,P>0.05).There were no serious adverse events such as respiratory or cardiac arrest during the transportation process.After hospitalization,130 cases(56.8%)underwent surgical tr

关 键 词：意外伤害 危重患儿 院际转运 小儿危重病例评分 

分 类 号：R729[医药卫生—儿科]