武汉市某医院急诊室早期院内死亡创伤患者诊治分析  

Analysis of Diagnosis and Treatment of Early Trauma- related In- hospital Mortality in Emergency Room in a Large Hospital,Wuhan

作　　者：彭芳[1] 涂顺桂[1] 胡友珍[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院门诊办公室,武汉430030 [2]华中科技大学同济医学院附属同济医院急诊外科,武汉430030

出　　处：《医学与社会》2015年第12期52-54,共3页Medicine and Society

摘　　要：目的:分析武汉市某医院急诊室早期院内死亡的创伤患者诊治过程中存在的不足,为改进急诊创伤救治流程提供依据。方法:收集2004年1月-2013年12月武汉市某医院急诊室早期院内死亡创伤患者(来院时间<1小时)的临床资料,对患者诊疗过程进行评估,分析患者死亡原因,评估院内救治过程是否存在不足。结果:2004年1月-2013年12月共有398例创伤患者早期院内死亡。最常见的致伤原因为道路交通伤、高处坠落伤和锐器刺伤。最多见的受伤部位依次为颅脑损伤、四肢骨折、胸部损伤、腹部和骨盆损伤。诊治过程中存在的主要问题是在急诊室停留时间过长、呼吸道管理存在不足、液体复苏不够充分、过多检查和搬动。采取针对性改进措施后,可能预防与可以预防的死亡患者比例显著下降(P<0.01)。结论:提高创伤急诊救治体系效率,改进急诊创伤救治流程,有助于减少创伤死亡。Objective： To evaluate the management of early trauma- related in- hospital mortality in a teaching hospital of Wuhan,to provide basis for improving the process of emergency treatment. Methods： We collected the clinical data of early trauma- related in- hospital mortality occurring within 2 hours after arrival,from January,2004 to December,2013 in Department of Emergent Surgery,Tongji Hospital. The causes of injury,diagnosis,injury severity,and the management were re- evaluated by two senior physicians and a senior nurse. The causes of mortality,as well as the quality of management were analyzed. Results： There were 398 early trauma- related in- hospital mortalities from January,2004 to December,2013. The most common causes of injury were traffic accidents,high- falling,and stab. The most common sites of injury were brain,limbs,chest,abdomen and pelvis. The most frequent defects of care were lengthy pre- hospital time,elongated stay in emergency room,improper management of airway and inadequate resuscitation,excessive move for imaging examination. After targeted improvement of the emergent care system for trauma,the ratio of preventable and potentially preventable deaths decreased markedly（ P〈0. 01）. Conclusion： Improvement of the emergent care system and therapy procedure could significantly enhance the efficiency of management for trauma patients,and decrease trauma- related mortality.

关 键 词：创伤 早期院内死亡 急诊救治 

分 类 号：R197.323[医药卫生—卫生事业管理] R459.7[医药卫生—公共卫生与预防医学]