体外膜肺氧合支持下患者院内转运安全管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.12.007

摘要/Abstract

摘要：

目的检索、评价并总结体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）辅助支持下患者行院内转运安全管理的最佳证据,为临床实践提供参考。方法计算机检索BMJ Best Practice、UpToDate、加拿大安大略注册护士协会网、美国国立指南数据库、英国国家卫生与临床优化研究所指南库、医脉通、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库、Cochrane Library、CINAHL、PubMed、中国知网、万方数据库和体外生命支持组织网站中与ECMO患者院内转运安全管理相关的临床指南、专家共识、证据总结、系统评价,并补充检索设计良好的原始研究,检索时限为建库至2021年8月。采用JBI循证卫生保健中心的文献评价标准和证据分级系统,进行文献质量评价及证据级别评定。结果共纳入11篇文献,其中专家共识5篇、系统评价2篇、随机对照试验1篇、类实验研究1篇、队列研究1篇、横断面调查1篇,共总结出30条关于ECMO患者院内转运安全管理的最佳证据,涉及转运团队组成及能力要求、转运前准备、转运中监测、不良事件防控和转运交接管理5个方面。结论建议结合医院实际情况构建专业化的ECMO患者院内转运团队,应用最佳证据规范ECMO患者院内转运流程,建立不良事件防控体系,保证患者安全。

关键词: 体外膜肺氧合, 院内转运, 安全管理, 护理, 证据总结

Abstract:

Objective To retrieve,evaluate and summarize the best evidence of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation（ECMO）,and to provide a reference for clinical practice. Methods The BMJ Best Practice,UpToDate,Registered Nurses’ Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,CNKI,Wanfang Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including guidelines,consensuses,evidence summaries,systematic reviews,and well-designed original studies. The time limit for the retrieval is from the inception of databases until August 2021. Results 11 pieces of the literature were retrieved,including 5 consensuses,2 system reviews,1 randomized controlled trial,1 quasi-experimental study,1 cohort study and 1 cross-section survey. Totally 30 pieces of evidence were summarized,including team composition and ability requirements,transport preparation,monitoring during transport,prevention and control of adverse events and management of handover. Conclusion It is suggested to build a professional ECMO intra-hospital transport team based on the actual hospital situation,to apply the best evidence to standardize the intra-hospital transport process of patients on ECMO,and to establish an adverse event prevention and control system and information communication mechanism to ensure patient safety.

Key words: Extracorporeal Membrane Oxygenation, Intra-Hospital Transport, Safety Management, Nursing Care, Evidence Summary

梁江淑渊, 曾妃, 黄冰瑛, 章骥韬, 鲁涓涓, 曾洁, 姚晓月, 杨旻斐. 体外膜肺氧合支持下患者院内转运安全管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(12): 1456-1461.

LIANG Jiangshuyuan, ZENG Fei, HUANG Bingying, ZHANG Jitao, LU Juanjuan, ZENG Jie, YAO Xiaoyue, YANG Minfei. Evidence summary of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation[J]. Chinese Journal of Nursing, 2022, 57(12): 1456-1461.

图/表 2

参考文献 25

[1]	Betit P. Technical advances in the field of ECMO[J]. Respir Care, 2018, 63(9):1162-1173. DOI URL
[2]	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[J]. 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[J]. Chin J Nurs, 2017, 52(5):561-563.
[3]	王淑芹, 张春艳, 万娜, 等. 体外膜肺氧合支持危重患者院内转运核查单的编制及应用[J]. 护理学杂志, 2019, 34(18):22-25.
	Wang SQ, Zhang CY, Wan N, et al. Development and application of a checklist for intra-hospital transport of the critically ill patients supported by extracorporeal membrane oxygenation[J]. J Nurs Sci, 2019, 34(18):22-25.
[4]	王淑芹, 孙兵, 张春艳, 等. 体外膜肺氧合支持危重患者进行转运的不良事件的分析[J]. 中国实用护理杂志, 2020, 36(27):2124-2128.
	Wang SQ, Sun B, Zhang CY, et al. Analysis of adverse events of transport in critical patients with extracorporeal membrane oxygenation[J]. Chin J Pract Nurs, 2020, 36(27):2124-2128.
[5]	Ericsson A, Frenckner B, Broman LM. Adverse events during inter-hospital transports on extracorporeal membrane oxygenation[J]. Prehosp Emerg Care, 2017, 21(4):448-455. DOI PMID
[6]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence-based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[7]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[8]	Brouwers MC, Kho ME, Browman GP, et al. AGREE II:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI PMID
[9]	Lu CC, Lu TT, Ge L, et al. Use of AMSTAR-2 in the methodological assessment of systematic reviews:protocol for a methodological study[J]. Ann Transl Med, 2020, 8(10):652. DOI URL
[10]	Porritt K, McArthur A, Lockwood C, et al. JBI handbook for evidence implementation[EB/OL]. [2021-08-10]. https://jbi-glo-bal-wiki.refined.site/space/JHEI.
[11]	米元元, 沈月, 郝彬, 等. ICU患者肠内营养支持并发腹泻的循证护理实践[J]. 中华护理杂志, 2017, 52(11):1291-1298.
	Mi YY, Shen Y, Hao B, et al. Evidence-based nursing practice of enteral nutrition support among ICU patients with diarrhea[J]. Chin J Nurs, 2017, 52(11):1291-1298.
[12]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[13]	辛晨, 郭小靖, 周蒙, 等. 清单式管理在体外膜肺氧合患者院内转运中的应用效果研究[J]. 护理管理杂志, 2021, 21(4):296-300.
	Xin C, Guo XJ, Zhou M, et al. Application effect of checklist management in intra-hospital transport of extracorporeal membrane oxygenation[J]. J Nurs Adm, 2021, 21(4):296-300.
[14]	Fletcher-Sandersjöö A, Frenckner B, Broman M, A single-center experience of 900 interhospital transports on extracorporeal membrane oxygenation[J]. Ann Thorac Surg, 2019, 107(1):119-127. DOI PMID
[15]	Mendes PV, de Albuquerque Gallo C, Besen BAMP, et al. Transportation of patients on extracorporeal membrane oxygenation:a tertiary medical center experience and systematic review of the literature[J]. Ann Intensive Care, 2017, 7(1):14. DOI URL
[16]	Puslecki M, Baumgart K, Ligowski M, et al. Patient safety during ECMO transportation:single center experience and literature review[J]. Emerg Med Int, 2021, 2021:6633208.
[17]	Extracorporeal Life Support Organization. Guidelines for ECMO Transport[EB/OL]. (2017)[2021-08-10]. https://www.elso.org/Portals/0/Files/ELSO%20GUIDELINES%20FOR%20ECMO%20TRAN-SPORT_May2015.pdf.
[18]	急诊危重症患者院内转运共识专家组. 急诊危重症患者院内转运共识-标准化分级转运方案[J]. 中国急救医学, 2017, 37(6):481-485.
	Consensus Expert Group on Intra-hospital Transport of Critically Ill Emergency Patients. Intra-hospital transfer consensus-standardized graded transport protocol for emergency critical patients[J]. Chin J Crit Care Med, 2017, 37(6):481-485.
[19]	中国医药教育协会急诊专业委员会,中华医学会急诊分会复苏学组,中国急诊体外膜肺氧合联盟. 成人体外膜肺氧合患者院际转运专家共识[J]. 中华急诊医学杂志, 2020, 29(2):165-170.
	Emergency Professional Committee of Chinese Medical Education Association,Recovery Group of Emergency Branch of the Chinese Medical Association,Chinese Emergency Extracorporeal Membrane Oxygenation Union. Expert consensus on intra-hospital transport in adult patients with extracorporeal membrane oxygenation[J]. Chin J Emerg Med, 2020, 29(2):165-170.
[20]	李尊柱, 孙红, 崔文博, 等. 新型冠状病毒肺炎重症、危重症患者院内转运专家共识[J]. 协和医学杂志, 2020, 11(6):676-681.
	Li ZZ, Sun H, Cui WB, et al. Intra-hospital transport of patients with severe coronavirus disease 2019:an expert consensus[J]. Med J Peking Union Med Coll Hosp, 2020, 11(6):676-681.
[21]	成人体外膜肺氧合患者院内转运护理共识专家组. 成人体外膜肺氧合患者院内转运护理专家共识[J]. 中国临床医学, 2021, 28(4):716-722.
	Consensus Expert Group on Intra-hospital Transport Care for Adult Patients with Extracorporeal Membrane Oxygenation. Nursing consensus of intra-hospital transfer for adult patients with extracorporeal membrane oxygenation[J]. Chin J Clinic Med, 2021, 28(4):716-722.
[22]	Ericsson A, Frenckner B, Broman LM. Adverse events during inter-hospital transports on extracorporeal membrane oxygenation[J]. Prehosp Emerg Care, 2017, 21(4):448-455. DOI PMID
[23]	徐磊, 王志勇, 李彤, 等. 体外膜肺氧合与机械通气用于严重急性呼吸窘迫综合征患者院间转运的对比研究[J]. 中华危重病急救医学, 2014, 26(11):789-793.
	Xu L, Wang ZY, Li T, et al. Comparison of extracorporeal membrane oxygenation and mechanical ventilation for inter-hospital transport of severe acute respiratory distress syndrome patients[J]. Chin Cri Care Med, 2014, 26(11):789-793.
[24]	陈燕, 陈婷, 刘姗萍, 等. 预见性护理在院前急救急危重症患者转运中的应用[J]. 护理实践与研究, 2020, 17(6):158-159.
	Chen Y, Chen T, Liu SP, et al. Application of foresight care in transport of acute and critical patients[J]. Nurs Pract Res, 2020, 17(6):158-159.
[25]	Ranney DN, Bonadonna D, Yerokun BA, et al. Extracorporeal membrane oxygenation and interfacility transfer:a regional referral experience[J]. Ann Thorac Surg, 2017, 104(5):1471-1478. DOI PMID