11例重症患者应用ECMO院间转运的管理
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摘要
目的 :总结2016年12月至2018年3月我院应用体外膜肺氧合(Extracorporeal Membrance Oxygenation,ECMO)院间转运重症患者的管理经验。方法 :转运前制定完善的预案,对转运途中可能出现的问题作好应对;转运过程中严密监测患者的生命体征、ECMO系统参数等变化,及时处理并发症或意外事件;转运到目的医院后认真交接;自行设计"ECMO重症患者院间转运查检表",防止遗漏要点,以确保转运过程安全有效。结果 :应用ECMO院间转运的11例重症患者经救护车顺利转至我院。转运距离6.5~400.0 km,ECMO运转时间1.0~4.5 h,转运过程中患者呼吸循环稳定,未出现并发症。结论:在完善的仪器设备支持和专业技术团队合作下,应用ECMO院间转运重症患者具有可行性和安全性,可为拯救患者生命争取宝贵时间。
Objective: To summarize the management experience of inter-hospital transfer for 11 critical patients with Extracorporeal Membrane Oxygenation(ECMO) from December 2016 to March 2018. Methods: A good plan to deal with possible problems in transfer, closely monitoring of patients' vital signs and ECMO system parameters, timely management of complications or accidents during transfer, serious shift changes between the two different hospitals, and self-designed "ECMO critical patient inter-hospital transfer checklist" was used to ensure a safe and effective transportation. Results: A total of 11 critical patients were transported with ECMO. The transport distance ranged from 6.5 km to 400.0 km, and the transport time was between 1.0 hour to 4.5 hours. All the patients showed stable respiratory and circulatory function and with no complications during transportation. Conclusions: It is feasible and safe to use ECMO in inter-hospital transfer of critical patients, with the supports of advanced equipments and a professional technical team. Inter-hospital transfer with ECMO saves valuable time for patients.
Objective: To summarize the management experience of inter-hospital transfer for 11 critical patients with Extracorporeal Membrane Oxygenation(ECMO) from December 2016 to March 2018. Methods: A good plan to deal with possible problems in transfer, closely monitoring of patients' vital signs and ECMO system parameters, timely management of complications or accidents during transfer, serious shift changes between the two different hospitals, and self-designed "ECMO critical patient inter-hospital transfer checklist" was used to ensure a safe and effective transportation. Results: A total of 11 critical patients were transported with ECMO. The transport distance ranged from 6.5 km to 400.0 km, and the transport time was between 1.0 hour to 4.5 hours. All the patients showed stable respiratory and circulatory function and with no complications during transportation. Conclusions: It is feasible and safe to use ECMO in inter-hospital transfer of critical patients, with the supports of advanced equipments and a professional technical team. Inter-hospital transfer with ECMO saves valuable time for patients.
引文
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[18]陆铸今,陆国平,闫钢风.儿童体外膜肺并发症及处理.中国小儿急救医学,2015,22(8):587-589.Lu ZJ,Lu GP,Yan GF.The complications and treatment of extracorporeal membrane oxygenation in children.Chinese Pediatric Emergency Medicine,2015,22(8):587-589.
[19]高关心,彭树良,李庚,等.医用救护车车载急救设备电源的改进设计.中国医疗设备,2008,23(7):91-92.Gao GX,Peng SL,Li G,et al.Power of ambulance vehicular first-aid devices ameliorating devise.Chine Medical Equipment,2008,23(7):91-92.
[20]岳俊伟,张婵,王观涛,等.长途转诊急危重症患者流行病学分析及对策.医药论坛杂志,2015,36(4):52-54.Yue JW,Zhang C,Wang GT,et al.Epidemiological analysis and countermeasures on long-distance referral of critical patients.Journal Medical Forum,2015,36(4):52-54.
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[22]Bryner B,Cooley E,Copenhaver W,et al.Two decades'experience with interfacility transport on extracorporeal membrane oxygenation.The Annals of Thoracic Surgery,2014,98(4):1363-1370.
[23]Javidfar J,Brodie D,Takayama H,et al.Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center.ASAIO Journal,2011,57(5):421-425.
[24]Forrest P,Ratchford J,Burns B,et al.Retrieval of critically ill adults using extracorporeal membrane oxygenation:an Australian experience.Intensive Care Medicine,2011,37(5):824-830.
[25]郑茹娜,潘利飞,陈琨,等.ECMO团队合作在基层医院危重病人抢救和转运中的应用.中国护理管理,2016,16(5):646-649.Zheng RN,Pan LF,Chen K,et al.ECMO teamwork for the resuscitation andtransportation of critically ill patients in rural hospitals.Chinese Nursing Management,2016,16(5):646-649.
[26]Arlt M,Philipp A,Voelkel S,et al.Handheld minimised extracor poreal membrane oxygenation:a new bridge to recovery in patients with out-of-centrecardiogenic shock.Eur J Cardiothorac Surg,2011,40(3):689-694.
[27]Muller T,Philipp A,Luchner A,et al.A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure.Crit Care,2009,13(6):R205.
[2]Cabrera AG,Prodhan P,Cleves MA,et al.Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction.Congenital Heart Disease,2011,6(3):202-208.
[3]Dirnberger D,Fiser R,Harvey C,et al.Guidelines for ECMO transport.(2015-05).https://www.elso.org/Portals/o/Files/ELSO%20G U I P E L I N E S%2 0 F O R%2 0 E C M O%2 0TRANSPORT_May 2015.pdf.
[4]Yeo HJ,Cho WH,Park JM,et al.Interhospital transport system for critically Ill patients:mobile extracorporeal membrane oxygenation without a ventilator.The Korean Journal of Thoracic and Cardiovascular Surgery,2017,50(1):8-13.
[5]Raspe C,Ruckert F,Metz D,et al.Interhospital transfer of ECMO-assisted patients with a portable miniaturized ECMO device:4 years of experience.Perfusion,2015,30(1):52-59.
[6]Starck C,Hasenclever P,Falk V,et al.Interhospital transfer of seriously sick ARDS patients using veno-venous Extracorporeal Membrane Oxygenation(ECMO):concept of an ECMO transport team.International Journal of Critical Illness and Injury Science,2013,3(1):46.
[7]Lindén V,Palmér K,Reinhard J,et al.Interhospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation-national and international experience.Intensive Care Medicine,2001,27(10):1643-1648.
[8]李华英,陆娟.ECMO治疗重症肺炎合并ARDS患者院间转运的管理.海南医学,2016,27(10):1717-1718.Li H Y,Lu J.ECMO t reat ment of severe pneumonia among hospital patients with ARDS transport management.Hainan Medical Journal,2016,10(20):1717-1718.
[9]魏见娣,吴美英,刘池拽,等.5例应用体外膜肺氧合危重患者院间转运的护理.护理学报,2015,22(24):56-57.Wei JD,Wu MY,Liu CZ,et al.Nursing care of 5cases of Extracorporeal Membrane Oxygenation critical patients with inter-hospital transport.Journal of Nursing(China),2015,22(24):56-57.
[10]王鑫洁.3例体外氧合膜肺支持患者院间转运的护理.天津护理,2014,22(5):419-420.Wang XJ.Nursing care of 3 cases of Extracorporeal Membrane Oxygenation critical patients with inter-hospital transport.Tianjin Journal of Nursing,2014,22(5):419-420.
[11]何洹,李鹏,屠伟峰.体外膜肺氧合用于潜在心脏死亡供者的院间转运.中华器官移植杂志,2013,34(12):737-739.He H,Li P,Tu WF.Extracorporeal membrane oxygenation support for inter-hospital transport of potential cardiac death.Chinese Journal of Organ Transplantation,2013,34(12):737-739.
[12]Lyphout C,Bergs J,Stockman W,et al.Patient safety incidents during interhospital transport of patients:a prospective analysis.International Emergency Nursing,2018(36):22-26.
[13]潘红,黄琴红,蔡英华,等.13例体外膜肺氧合治疗危重患者院内转运的护理.中华护理杂志,2017,52(5):561-563.Pan H,Huang QH,Cai YH,et al.Nursing care of 13 critically ill patients with extracorporeal membrane oxygenation for intra-hospital transfer.Chinese Nursing Journal,2017,52(5):561-563.
[14]郑吉锋,严汉民,黄岗.影响呼吸机耗氧量因素的分析与测量.北京生物医学工程,2010,29(4):405-408.Zheng JF,Yan HM,Huang G.Analyse and measure oxygen wastage of ventilator.Beijing Biomedical Engineering,2010,29(4):405-408.
[15]姜安丽.新编护理学基础.北京:人民卫生出版社,2012.Jiang AL.New nursing basics.Beijing:People's Medical Publishing House,2012.
[16]刘晓江.危重病人转送的指南.国外医学.麻醉学与复苏分册,1994,15(4):241-243.Liu XJ.Guidelines for the transfer of critically ill patients.Foreign Medicine.Anesthesiology and Resuscitation Volume,1994,15(4):241-243.
[17]齐建伟,张克标,古满平.清单制管理在危重患者院间长途转运中的应用.护理学杂志,2017,32(6):58-60.Qi JW,Zhang KB,Gu MP,Application of chenklist in long-distance inter-hosptial transport of the critically ill.Journal of Nursing Science,2017,32(6):58-60.
[18]陆铸今,陆国平,闫钢风.儿童体外膜肺并发症及处理.中国小儿急救医学,2015,22(8):587-589.Lu ZJ,Lu GP,Yan GF.The complications and treatment of extracorporeal membrane oxygenation in children.Chinese Pediatric Emergency Medicine,2015,22(8):587-589.
[19]高关心,彭树良,李庚,等.医用救护车车载急救设备电源的改进设计.中国医疗设备,2008,23(7):91-92.Gao GX,Peng SL,Li G,et al.Power of ambulance vehicular first-aid devices ameliorating devise.Chine Medical Equipment,2008,23(7):91-92.
[20]岳俊伟,张婵,王观涛,等.长途转诊急危重症患者流行病学分析及对策.医药论坛杂志,2015,36(4):52-54.Yue JW,Zhang C,Wang GT,et al.Epidemiological analysis and countermeasures on long-distance referral of critical patients.Journal Medical Forum,2015,36(4):52-54.
[21]中华医学会重症医学分会.中国重症患者转运指南(2010)(草案).中国危重病急救医学,2010,22(6):328-330.Society of Critical Care Medicine,Chinese Medical Association.Chinese guidelines for the transport of critically ill patients(2010).Chinese Critical Care Medicine,2010,22(6):328-330.
[22]Bryner B,Cooley E,Copenhaver W,et al.Two decades'experience with interfacility transport on extracorporeal membrane oxygenation.The Annals of Thoracic Surgery,2014,98(4):1363-1370.
[23]Javidfar J,Brodie D,Takayama H,et al.Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center.ASAIO Journal,2011,57(5):421-425.
[24]Forrest P,Ratchford J,Burns B,et al.Retrieval of critically ill adults using extracorporeal membrane oxygenation:an Australian experience.Intensive Care Medicine,2011,37(5):824-830.
[25]郑茹娜,潘利飞,陈琨,等.ECMO团队合作在基层医院危重病人抢救和转运中的应用.中国护理管理,2016,16(5):646-649.Zheng RN,Pan LF,Chen K,et al.ECMO teamwork for the resuscitation andtransportation of critically ill patients in rural hospitals.Chinese Nursing Management,2016,16(5):646-649.
[26]Arlt M,Philipp A,Voelkel S,et al.Handheld minimised extracor poreal membrane oxygenation:a new bridge to recovery in patients with out-of-centrecardiogenic shock.Eur J Cardiothorac Surg,2011,40(3):689-694.
[27]Muller T,Philipp A,Luchner A,et al.A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure.Crit Care,2009,13(6):R205.