256例颅脑出血患者院前长距离转运效果与转运策略分析

目的:分析研究颅脑出血患者院前长距离转运的效果和危险因素,有针对性的加强救治措施,以求为急救人员转运此类患者提供指导,提高转运成功率.方法:回顾调查2016年1月-2020年12月期间256例颅脑出血患者由郊区医院长距离转运到市区三甲医院的流行病学特点和转运效果,将转运到目标医院时患者生命体征较转院前无明显改变的定为病...

Analysis of effects and strategy of long-distance transportation before hospital in 256 patients with craniocerebral hemorrhage

Objective: To analyze and study the effects and risk factors of long distance transport in patients with craniocerebral hemorrhage, and to strengthen the treatment measures in order to provide guidance for emergency personnel to transport such patients and improve the success rate of transport. Methods: We investigated the epidemiological characteristics and effects of 256 cases of craniocerebral hemorrhage from January 2016 to December 2020 who were transported from suburban hospitals to a grade Ⅲ level A hospital in urban areas. The patients with vital signs were classified as stable group(n=175) and the patients with deterioration of vital signs or serious complications were classified as deterioration group(n=81). Risk factors from univariate analysis were screened, and the association of risk factors and disease changes was assessed by multivariate logistic regression analysis. Results: The overall deterioration rate of patients was 31.6%(81/256), of which 59.3% due to traumatic craniocerebral. The high risks of deterioration were internal capsule/basal node hemorrhage(accounted for 25.9%), cerebral contusion(accounted for 24.7%), cerebral stem hemorrhage(accounted for 19.8%) and subarachnoid hemorrhage(accounted for 17.3%). Causes of bleeding, blood sites, Glasgow Coma Scale(GCS) score ≤8, amounts of bleeding ≥30 mL, time interval from onset to arriving in hospital <2 h, hospital oxygen saturation <90%, long target hospital distance, prehospital hypertension were risk factors for deterioration(P<0.05), while prehospital catheterization and application of hemostatic drugs were protective factors for stability(P<0.05). Conclusion: Causes of bleeding, the bleeding sites(inner capsule/basal segment region, brain contusion, brainstem, and subarachnoid cavity), GCS score ≤8, amount of bleeding ≥30 mL, time interval from onset to arriving in hospital <2 h, finger oxygen saturation <90% before transfer, long target hospital distance, hypertension increases the risk of long-distance transfer deterioration. In these circumstances, patients cannot be blindly transferred. Long-distance transfer to hospital in patients with brainstem bleedingseldom brings benefits, and acute phase transfer is not recommended. Urinary catheterization and hemostatic drugs should be given before long-distance transfer. If the deterioration index of the condition occured on the way to the hospital, first aid should be treated or the target hospital should be re-selected nearby. If there were already existing deterioration indexes before hospitalizing, the transfer should be postponed, so as not to increase the risk of death on the way.