1 174例基层院际转运患者流行病学特征及影响因素分析

赵仔超; 胡北; 姜峰爵; 蒋政; 石小艳; 李林霏

doi:10.16766/j.cnki.issn.1674-4152.004059

1 174例基层院际转运患者流行病学特征及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004059

1.
邵东市人民医院急救中心，湖南邵阳 422800
2.
南方医科大学附属广东省人民医院急诊科，广东广州 510080

基金项目:

国家自然科学基金项目 82072139

广东省杰出青年人才配套基金项目 KJ012021184

详细信息

通讯作者:
胡北，E-mail：hubei@gdph.org.cn

中图分类号: R605.97
计量
- 文章访问数: 22
- HTML全文浏览量: 15
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-19
- 网络出版日期: 2025-09-04

Epidemiological characteristics and risk factors of 1 174 patients transferred between primary healthcare institutions

1.
Emergency Center, Shaodong People's Hospital, Shaoyang, Hunan 422800, China

摘要

摘要: 目的分析基层院际转运患者的流行病学特征及影响因素，为优化区域医疗能力和院际转运流程提供依据。方法收集2021年1月1日—2023年12月31日邵东市急救中心所有院际转运患者的数据。分析转运患者人口学特征、转运距离、转出和接收科室、病情评估及治疗措施，并通过统计分析评估影响转运结果的因素。结果本研究共纳入1 174例患者，其中男性804例(68.48%)，女性370例(31.52%)，年龄集中在50~79岁。61.33%的患者为短途转运(＜50 km)，转运距离中位数为45 km。主要转出科室为急诊内科(16.70%)、心血管内科(12.95%)和神经内科(11.41%)，主要接收科室为急诊内科(38.07%)、急诊外科(13.88%)和ICU(10.39%)。97.10%的患者成功转运，2.90%的患者转运失败。不同转运结果患者的意识状态、病情评估、呼吸支持及途中治疗措施差异均有统计学意义。国家早期预警评分可以预测转运结果，评分越高，转运成功率越低。结论基层院际转运患者多为中老年男性，且以短途转运为主。当前缺乏单一可靠的转运风险评估工具，需综合多因素评估患者的转运风险。未来应通过加强区域医联体建设，优化医疗资源配置，完善信息共享机制，以提升院际转运的效率和安全性。此外，应进一步开发和验证新的转运风险评估工具，以提高转运过程中的风险预测能力。
- 基层急救 /
- 急救中心 /
- 院际转运 /
- 风险因素 /
- 流行病学
Abstract: Objective To analyze the epidemiological characteristics and influencing factors of inter-hospital patient transfers at the grassroots level, in order to provide a basis for optimizing regional healthcare capabilities and inter-hospital transfer processes. Methods Collected data on all inter-hospital transfers conducted by the Shaodong Emergency Medical Center from January 1, 2021 to December 31, 2023. The data included demographic characteristics, transfer distances, departments involved in sending and receiving, clinical assessments, and treatment measures. Statistical analysis was conducted to evaluate the factors influencing transfer outcomes. Results A total of 1 174 patients were included, with 804 males (68.48%) and 370 females (31.52%), and ages primarily concentrated between 50 and 79 years. Short-distance transfers (less than 50 km) accounted for 61.33% of all cases, with a median transfer distance of 45 km. The main sending departments were emergency medicine (16.70%), cardiology (12.95%), and neurology (11.41%), while the main receiving departments were emergency medicine (38.07%), emergency surgery (13.88%), and the intensive care unit (10.39%). Successful transfers were achieved in 97.10% of cases, while 2.90% resulted in transfer failure. There were statistically significant differences in the consciousness status, clinical assessments, respiratory support, and treatment measures of patients with different transfer results. The national early warning score can predict transfer result, with higher scores correlating with lower transfer success rates. Conclusion Grassroots inter-hospital transfers predominantly involve middle-aged and elderly male patients, with most transfers being short-distance. There is currently no single reliable tool for assessing transfer risk, necessitating a multifactorial evaluation approach. Future efforts should focus on strengthening regional medical alliances, optimizing resource allocation, and improving information-sharing mechanisms to enhance the efficiency and safety of inter-hospital transfers. Additionally, further development and validation of new transfer risk assessment tools are required to improve risk prediction during the transfer process.
- Primary emergency care /
- Emergency center /
- Inter-hospital transfer /
- Risk factors /
- Epidemiology

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图 1 院际转运患者转出科室与接收科室的流向对比

Figure 1. Comparison of patient transfer numbers between transferring and receiving departments in interhospital transfers

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图 2 各时间段院际转运频数分布

Figure 2. Frequency distribution of interhospital transfers over different time periods

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图 3 院际转运患者主要诊断分布

Figure 3. Distribution of primary diagnoses in interhospital transferred patients

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表 1 院际转运患者性别与年龄分布[例(%)]

Table 1. Distribution of gender and age in interhospital transferred patients [cases (%)]

年龄	男性	女性	总计
＜10岁	31(3.86)	16(4.32)	47(4.00)
10~19岁	19(2.36)	12(3.24)	31(2.64)
20~29岁	18(2.24)	15(4.05)	33(2.81)
30~39岁	41(5.10)	28(7.57)	69(5.88)
40~49岁	73(9.08)	31(8.38)	104(8.86)
50~59岁	206(25.62)	67(18.11)	273(23.25)
60~69岁	163(20.27)	79(21.35)	242(20.61)
70~79岁	179(22.26)	92(24.86)	271(23.08)
≥80岁	74(9.20)	30(8.11)	104(8.86)
合计	804(100.00)	370(100.00)	1 174(100.00)

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表 2 院际转运患者临床评分及风险评估

Table 2. Clinical scores and risk assessment of interhospital transferred patients

项目	类别	频数	百分率(%)	累积百分比(%)
出发前GCS(n=1 174)	正常(15分)	979	83.39	83.39
	轻型(13~14分)	24	2.04	85.43
	中型(9~12分)	45	3.83	89.27
	重型(4~8分)	84	7.16	96.42
	极重型(≤3分)	42	3.58	100.00
出发前NEWS(n=1 111)	低危(≤4分)	564	50.77	50.77
	中危(5~6分)	274	24.66	75.43
	高危(7~11分)	254	22.86	98.29
	极高危(≥12分)	19	1.71	100.00
出发前RAPS(n=1 165)	低危(≤7分)	869	74.59	74.59
	中危(8~13分)	291	24.98	99.57
	高危(≥14分)	5	0.43	100.00
出发前SI(n=1 165)	无休克(SI≤0.5)	131	11.24	11.24
	轻度休克(0.5<SI≤1.0)	893	76.65	87.90
	中度及以上休克(SI＞1.0)	141	12.10	100.00
创伤指数(n=183)	轻伤(≤7分)	13	7.10	7.10
	中度伤(8~16分)	129	70.49	77.60
	重伤(17~20分)	31	16.94	94.54
	危重伤(≥21分)	10	5.46	100.00

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表 3 院际转运患者转运途中的主要治疗措施

Table 3. Primary therapeutic interventions for patients during interhospital transferred

项目	频数	百分比(%)	累积百分比(%)
途中治疗(n=1 174)
1种药物	465	39.61	39.61
2种药物	253	21.55	61.16
3种及以上	230	19.59	80.75
无药物治疗	226	19.25	100.00
呼吸支持(n=1 174)
普通吸氧	1 014	86.37	86.37
面罩吸氧	62	5.28	91.65
无创通气	11	0.94	92.59
有创通气	58	4.94	97.53
无呼吸支持	29	2.47	100.00
血管活性药物(n=105)
去甲肾上腺素	55	52.38	52.38
多巴胺	39	37.14	89.52
其他	7	6.67	96.19
2种合用	4	3.81	100.00
途中扩容(n=520)
生理盐水	273	52.50	52.50
林格	79	15.19	67.69
电解质液	134	25.77	93.46
生理盐水+林格	25	4.81	98.27
林格+电解质液	5	0.96	99.23
生理盐水+电解质液	4	0.77	100.00

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表 4 不同转运结果患者各项目比较[例(%)]

Table 4. Comparison of each item among patients with different transfer results [cases (%)]

项目	转运结果		总计	χ²值	P值
项目	转运失败	转运成功	总计	χ²值	P值
意识状态				10.199	0.001
意识清楚	22(64.71)	968(84.91)	990(84.33)
意识不清	12(35.29)	172(15.09)	184(15.67)
病情评估				9.724	0.008
病危	31(91.18)	747(65.53)	778(66.27)
病重	3(8.82)	390(34.21)	393(33.48)
稳定	0	3(0.26)	3(0.26)
呼吸支持				20.751	< 0.001
普通吸氧	25(73.53)	989(86.75)	1 014(86.37)
面罩吸氧	1(2.94)	61(5.35)	62(5.28)
无创通气	1(2.94)	10(0.88)	11(0.94)
有创通气	7(20.59)	51(4.47)	58(4.94)
无呼吸支持	0	29(2.54)	29(2.47)
途中治疗				18.204	< 0.001
一种药物	7(20.59)	458(40.18)	465(39.61)
两种药物	10(29.41)	243(21.32)	253(21.55)
三种及以上	15(44.12)	215(18.86)	230(19.59)
无药物治疗	2(5.88)	224(19.65)	226(19.25)
途中扩容				11.857	0.037
NS	8(42.11)	265(52.89)	273(52.50)
林格	2(10.53)	77(15.37)	79(15.19)
电解质液	5(26.32)	129(25.75)	134(25.77)
NS+林格	4(21.05)	21(4.19)	25(4.81)
林格+电解质液	0	5(1.00)	5(0.96)
NS+电解质液	0	4(0.80)	4(0.77)

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表 5 不同转运结果患者GCS、NEWS及液体总量比较[M(P₂₅, P₇₅)]

Table 5. Comparison of GCS, NEWS, and total fluid volume in patients with different transport outcomes [M(P₂₅, P₇₅)]

指标	例数	出发时GCS 评分(分)	出发时NEWS 评分(分)	扩容液体总量 (mL)
转运失败	34	15.0(9.8, 15.0)	6.0(5.0, 8.0)	500.0(500.0, 1 000.0)
转运成功	1 140	15.0(15.0, 15.0)	4.0(3.0, 6.0)	500.0(500.0, 500.0)
Z值		-2.997	-3.153	-2.515
P值		0.003	0.002	0.012

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表 6 出发时NEWS对转运结果的logistic回归分析

Table 6. Logistic regression analysis of departure NEWS on transport outcomes

变量	B	SE	Waldχ²	P值	OR值	95% CI
出发时NEWS评分	-0.184	0.060	9.303	0.002	0.832	0.739~0.936
截距	4.527	0.414	119.577	< 0.001	92.520	41.098~208.285
注：因变量为转运结果(成功=1，失败=0)，自变量为出发时NEWS评分(连续变量，以实际值赋值)。

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