背景:NHS英格兰在急性主动脉夹层工具包中建议对转诊途径进行标准化以及将急性主动脉综合征(AAS)患者转移到区域中心。将胸主动脉血管紧急情况转移到区域专家研究所小组研究的目的是就AAS患者的院际转移到专科高容量主动脉中心建立跨学科共识。
方法:使用德尔菲法建立了关于AAS患者院间转院关键方面的共识,符合Delphi研究指南的执行和报告。一个全国性的主动脉夹层患者慈善机构参与了Delphi研究的设计。血管和心胸外科医生,急诊医生,介入放射科医生,心脏病学家,英国的重症医师和麻醉师通过各自的专业协会应邀参加。
结果:由212、101和58名受访者完成了连续三轮电子Delphi调查,分别。使用预定义的共识标准,调查的117份声明中有60份(51%)被纳入共识声明。该研究得出的结论是,如果患者在已知的主动脉疾病或先前的主动脉介入治疗的背景下出现AAS的典型症状,则可以直接将患者送往专科主动脉中心。接受的患者应转移到2类救护车中(响应时间<18分钟),理想情况下由转院培训人员或成人重症监护转院服务陪同。在转移过程中发生心脏骤停的情况下,应达成明确的计划。患者应在从当地医院初次转诊后4小时内到达主动脉中心。
结论:这一共识声明是关于AAS患者院间转诊的第一套国家跨学科建议。它的实施可能有助于更安全,更标准化的急诊转诊途径,以进入区域高容量专科主动脉单元。
BACKGROUND: Standardisation of referral pathways and the transfer of patients with acute aortic syndromes (AAS) to regional centres are recommended by NHS England in the Acute Aortic Dissection Toolkit. The aim of the Transfer of Thoracic Aortic
Vascular Emergencies to Regional Specialist INstitutes Group study was to establish an interdisciplinary
consensus on the interhospital transfer of patients with AAS to specialist high-volume aortic centres.
METHODS: Consensus on the key aspects of interhospital transfer of patients with AAS was established using the Delphi method, in line with Conducting and Reporting of Delphi Studies
guidelines. A national patient charity for aortic dissection was involved in the design of the Delphi study.
Vascular and cardiothoracic surgeons, emergency physicians, interventional radiologists, cardiologists, intensivists and anaesthetists in the United Kingdom were invited to participate via their respective professional societies.
RESULTS: Three consecutive rounds of an electronic Delphi survey were completed by 212, 101 and 58 respondents, respectively. Using predefined consensus criteria, 60 out of 117 (51%) statements from the survey were included in the
consensus statement. The study concluded that patients can be taken directly to a specialist aortic centre if they have typical symptoms of AAS on the background of known aortic disease or previous aortic intervention. Accepted patients should be transferred in a category 2 ambulance (response time <18 min), ideally accompanied by transfer-trained personnel or Adult Critical Care Transfer Services. A clear plan should be agreed in case of a cardiac arrest occurring during the transfer. Patients should reach the aortic centre within 4 hours of the initial referral from their local hospital.
CONCLUSIONS: This consensus statement is the first set of national interdisciplinary recommendations on the interhospital transfer of patients with AAS. Its implementation is likely to contribute to safer and more standardised emergency referral pathways to regional high-volume specialist aortic units.