移动监护与急救手术前移在严重胸部创伤急救中的应用  

Mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries

作　　者：都定元[1] 孔令文[1] 赵兴吉[1] 谭远康[1] 苏泓洁[1] 张为民[1] 蔡平军[2] 

机构地区：[1]重庆市急救医疗中心、重庆市急救医学研究所胸心外科,400014 [2]重庆市急救医疗中心、重庆市急救医学研究所院前急救部,400014

出　　处：《中华创伤杂志》2009年第2期107-111,共5页Chinese Journal of Trauma

基　　金：重庆市科委应用基础研究基金资助项目（97-4714）,重庆市科委科技攻关计划资助项目（CSTC,2008AA0011）

摘　　要：目的探讨将确定性急救与手术处理前移至基层医院的可行性，以进一步提高危重胸部创伤的救治成功率。方法对1998年4月-2008年8月应“120”急救邀请，赴我市基层医院进行院前院内紧急救治的72例严重胸部创伤（AIS≥3）患者的资料进行回顾性分析。分为院前组（院前紧急确定性急救或手术后转回我院）36例和院内组（经院前确定性急救后转回我院手术）36例。结果（1）伤后到基层医院时间两组间差异无统计学意义（P〉0．05），获确切手术时间院前组显著短于院内组[（3．9±4．1）h比（9．6±8．2）h]（P〈0．05）。（2）院前组失血量、输血量均大于院内组，但差异无统计学意义（P〉0．05）。（3）ISS值两组差异无统计学意义（P〉0．05），RTS值院前组显著低于院内组（P〈0．05）；院前组总休克发生率显著多于院内组（86．1％比41．7％）（P〈0．05）。（4）术式：单纯胸腔闭式引流院前组多于院内组（16．7％比5．6％），“胸腔闭式引流＋剖胸术”、“胸腔闭式引流＋剖腹术”、“胸腔闭式引流＋其他”两组间差异无统计学意义，院前组穿透伤“胸腔闭式引流＋剖胸术”率是钝性伤的4．8倍，院内组为1．9倍；院前组钝性伤“胸腔闭式引流＋剖腹术”率是穿透伤的5倍，院内组为4．5倍。（5）总治愈率95．8％（69／72），院前组中濒死患者8例，生存5例，13．9％（5／36）的院前创伤死亡得以避免。结论在伤后“黄金时刻”迅速携带移动监护手术设备，将救命陛外科处理前伸至基层医院实施急救或确定性手术后，再安全转送到高级急救中心（医院）进一步救治是安全、有效、可行的，可显著降低严重胸部创伤的院前死亡率。Objective To explore the feasibility, safety and effectiveness of mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries so as to further improve success rate of treatment of severe thoracic trauma. Methods A retrospective study was done on the clinical data of 72 patients with severe thoracic injuries （AIS≥3） treated by surgeons from Chongqing Emergency Medical Center （CEMC） from April 1998 to August 2008. The patients were divided into pre-hospital group （ n = 36） and in-hospital group （n = 36） according to the time that the definite surgery performed. Results （1） There was no significant statistical difference upon arrival time from scene to primary hospital between two groups （P 〉 0.05）. For patients in pre-hospital group, the time to receive definite surgery was （3.9 ±4.1 ） hours, which was significant shorter than （9.6 ±8.2） hours in in-hospital group （P 〈 0.05）. （2） There were no statistical significant differences upon blood loss volume and blood transfusion volume between two groups （P 〉 0.05）. （3） There was no significant statistical difference upon ISS value between two groups （ P 〉 0.05 ） , but the RTS value of pre-hospital group was significandy lower than that of in-hospital group （P 〈 0.05）. The incidence rate of shock in pre-hospital group was 86.1%, which was significantly higher than 41.7% in in-hospital group （P 〈0.05）. （4） The percentage of patients who received thoracic close drainage in pre-hospital group was 16.7%, which was significantly higher than 5.6% in in-hospital group. There was no significant statistical difference upon thoracic close drainage plus thoracotomy, thoracic close drainage plus laparotomy and thoracic close drainage plus other operations between two groups. However, the operative rate of thoracic close drainage plus thoracotomy for penetrating injury was 4.8 times higher than that for blunt injury in pre-hospital group, and 1.9 times higher than th

关 键 词：多处创伤 胸部损伤 院前急救 

分 类 号：R655[医药卫生—外科学]