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目的评价两种长途转诊模式对急危重症病例的临床效果,探讨专业化、规范化的院前急救流程,以达到安全快捷的转诊目的。方法选择2010年1月至2014年8月由应城市人民医院单向转往武汉的516例病例为调查对象。原模式组转诊214例,由所属临床专科医生和护士负责途中转诊;新模式组转诊302例,由该院急救中心院前急救医生和护士负责;对两组转诊效果进行统计学比较。结果原模式组平均转诊时间(121±8)min,生命体征不稳定63例,窒息18例,死亡6例。新模式组的平均转诊时间(90±8)min,生命体征不稳定45例,窒息12例,死亡5例。两组平均转诊时间比较,差异有统计学意义(t=1.028,P<0.05);生命体征不平稳率、窒息发生率比较,差异均有统计学意义(χ2=15.997、4.504,P<0.05),两组转诊途中病死率比较,差异无统计学意义(χ2=0.791,P>0.05)。结论科学化的管理模式,专业化的院前急救队伍,制度化的院前急救流程,规范化的转诊临床路径,是基层医院安全快捷转诊急危重症患者的重要保证。
Objective To evaluate the clinical effect of two long-distance referral patterns on acute and critically ill cases and to explore a professional and standardized pre-hospital emergency procedure to achieve safe and rapid referral. Methods From January 2010 to August 2014, 516 cases of one-way transfer from Wuhan Municipal People’s Hospital to Wuhan were selected as the survey subjects. In the original model group, 214 cases were referred, and their clinical specialists and nurses were responsible for the referral on the way; 302 cases were referred to the new model group by the hospital emergency center doctors and nurses; the two groups were statistically analyzed Compare Results The average time of referral in the original model group was (121 ± 8) min, the vital signs were unstable in 63 cases, asphyxiation in 18 cases and death in 6 cases. The average time of referral (90 ± 8) min in the new model group, 45 cases of unstable vital signs, 12 cases of asphyxia and 5 cases of death. There was significant difference between the two groups in the average referral time (t = 1.028, P <0.05); the differences of vital signs instability and asphyxia were statistically significant (χ2 = 15.997, 4.504, P <0.05 ). There was no significant difference in mortality between the two groups (χ2 = 0.791, P> 0.05). Conclusion Scientific management mode, specialized pre-hospital emergency teams, institutionalized pre-hospital emergency procedures and standardized referral clinical pathways are important guarantees for safe and prompt referral of emergency-critical patients in primary hospitals.