重度创伤急救原则的临床研究  

Clinical study of emergency treatment principles of severe trauma

作　　者：顾永峰[1] 李能平[1] 方伟敏[1] 卢小兵[1] 丛建农 惠小平[1] 林兆奋[2] 李文放[2] 杨兴易[2] 

机构地区：[1]上海市浦东新区公利医院急诊外科,200135 [2]解放军第二军医大学附属长征医院急救科上海市创伤急救中心,上海200003

出　　处：《中国急救医学》2007年第10期885-887,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨重度创伤（ISS评分≥16分）的急救原则。方法应用“ATP三原则”救治重度创伤：①外科主治以上医师（Attending）首诊并全权、全程指挥抢救原则；②患者人院后立即成立急救小组（Teamwork）救治原则；③抢救、检查、诊断同时进行，使抢救时间最短的并联（Parallel）原则。分析比较应用“ATP三原则”前、后各2年救治重度创伤的临床效果。结果应用“ATP三原则”前2年（2002-01-01-2003-12-31）共抢救、收治重度创伤388例，ISS评分（25．9±6．4）分，死亡152例，死亡率39．2％，抢救室抢救时间、人院至急诊手术时间分别为（102．84±16．7）min、（140．34±20．6）min。应用“ATP三原则”后2年（2004-01-01-2005-12-31）共抢救、收治重度创伤438例，ISS评分（28．6±7．8）分，死亡87例，死亡率19．9％，抢救室抢救时间、入院至急诊手术时间分别为（69．5±11．5）min、（89．64±9．3）min。两组治疗前ISS评分比较差异无统计学意义（P〉0．05）；两组治疗后死亡率、抢救时间、入院至手术时间比较差异均有统计学意义（P〈0．05），应用“ATP三原则”后均明显降低。结论 应用“ATP三原则”救治重度创伤能显著缩短抢救时间，降低创伤死亡率。Objective To study the emergency treatment principles of severe trauma （ injury severity score ≥ 16）. Methods The application of ＂ATP three principles＂ to treat severe trauma patients ： ①attending principle, surgeon diagnosed and treated at the all stages ;②teamwork principle, immediately after patients were admitted to hospital; ③parallel principle, emergency resuscitation, examination and laboratory test were performed at the same time. To retrospectively analyse and compare the clinical effect 2 years before and after the application of ATP principles. Results Two years （ from January 1,2002 to December 31,2003） before the application of ATP principles, severe trauma 388 cases accepted emergency treatment, ISS was 25.9 ±6.4,152 cases died, the mortality was 39.2%, the time in emergency department and the time to operation room after admission were （ 102.8±16.7） min, （ 140.3±20.6） min respectively. Two years （from January 1,2004 to December 31,2005） after the application of ATP principles, severe trauma 438 cases accepted emergency treatment, ISS was 28.6 ±7.8,87 cases died, the mortality was 19.9%, the time in emergency department and the time to operation room after admission were （69.5 ± 11.5 ） rain, （ 89.6± 9.3 ） min respectively. There were no significant differences in ISS between two groups （ P 〉 0.05 ）, but the differences of the mortality, the time in emergency department and the time to operation room were significant between two groups （ P 〈 0.05 ）, and all decreased significantly after the application of ATP principles. Conclusions The application of ATP principles to treat severe trauma patients can shorten emergency time and decrease mortality.

关 键 词：创伤 急救 原则 

分 类 号：R641[医药卫生—外科学]