危重患儿院内转运血氧饱和度降低的危险因素分析及预防策略

目的 采用前瞻性横断面调查法分析儿科危重患儿院内转运期间血氧饱和度(SpO₂)下降发生情况及影响因素,为临床优化危重患儿院内转运方案提供参考依据。 方法 纳入2019年9—11月期间浙江大学医学院附属杭州市第一人民医院危重患儿共计204例次。按照患儿转运过程是否发生SpO₂下降将其分为观察组和对照组。制定可能影响患儿转运过程中发生SpO₂下降的各项因素调查方案。转运全程跟踪记录各项可能影响因素并进统计分析。 结果 (1)危重患儿院内转运过程中SpO₂下降率为60.29%,转运过程中发生SpO₂降低时间以转运开始5 min内为主;(2)可能影响危重患儿院内转运SpO₂下降相关因素有:年龄、BMI、基础疾病、PEWS评分、血压、呼吸频率、转运护士年资、转运过程有无主治医生协助、转运路径、转运距离、转运过程意外事件、转运时间(P<0.05);(3)患儿年龄在0~6岁、呼吸系统和(或)神经系统疾病、PEWS评分为出现3分项目、转运护士年资<3年、转运路径、转运过程意外事件为危重患儿院内转运SpO₂降低的高危因素。 结论 危重患儿院内转运期间SpO₂下降发生率高,危险因素以患儿病情严重及转运过程效率低及防护措施不当为主,通过转运流程改造、强化转运人员培训及谨慎评估危重患儿院内转运风险等各项措施,提高转运效率及加强防护效果,提升患儿安全。 

Screening of risk factors and prevention strategies for the decrease of oxygen saturation during the intra-hospital transport of critically ill children

Objective To analyze the incidence of blood oxygen saturation(SpO₂) decrease influencing factors during the intra-hospital transport of pediatric critically ill children by using a prospective cross-sectional survey, and provide a reference for clinical optimization of the intra-hospital transport plan for critically ill children. Methods Two hundred and four critically ill children who met the research conditions in Hangzhou First People's Hospital Affiliated to Medical School of Zhejiang University from September 2019 to November 2019 were selected as the study subjects. They were divided into observation group and control group. An investigation scheme was developed for various factors that may affect SpO₂ reduction during the transportation of children. All possible influencing factors were recorded and analyzed statistically. Results (1) The incidence of SpO₂ decrease was 60.29% in the process of intra-hospital transport of critical children, and the time of SpO₂ decrease was mainly within 5 minutes of the beginning of the transfer;(2) The factors that may affect the decrease of SpO₂ during the transport in critically ill children were: age, body mass index(BMI), basic disease, pediatric early warning score(PEWS), blood pressure, respiratory rate, age of transfer nurse, assistance of attending doctor in the process of transfer, transfer path, transfer distance, accident in the process of transfer, transfer time(P<0.05);(3) Risk factors of SpO₂ decrease during the intra-hospital transportation of critically ill children: multivariate logistic analysis showed that the risk factors of SpO₂ reduction decrease during the intra-hospital transportation of critically ill children were the low age( 0-6 years old), respiratory and/or nervous system diseases, one or more items in PEWS score is 3 points, the experience of the transfer nurse was less than 3 years, transportation path, transportation process accidents the high risk factors of SpO₂ reduction intra-hospital transport of critically ill children. Conclusion The incidence of SpO₂ decrease is high during the intra-hospital transportation of critically ill children. The main risk factors are the serious condition of the children, the low efficiency of the transportation process and the improper protective measures. The optimization of the transportation process, the strengthening of the training of the transportation personnel and the careful assessment of the risk of intra-hospital transportation of critically ill children, raise the transportation efficiency and the protective effect, and can improve the safety of the critically ill children.