重症多发伤急诊时间窗内一体化救治效果分析  

Effect of integrated treatment within emergency time window on patients with severe multiple injury

作　　者：钟源波 王进 单爱军 许士海 杨超 吕文 谢曼英 田素萍 徐建忠 林慧绒 ZHONG Yuan-bo;WANG Jin;SHAN Ai-jun;XU Shi-hai;YANG Chao;LV Wen;XIE Man-ying;TIAN Su-ping;XU Jian-zhong;LI Hui-rong(The Second Clinical Medical College of Ji nan University,Emergency Center of Shenzhen People s Hospital,the First Affiliated Hospital of South University of Science and Technology,Sehnzhen,Guangdong 518020,China)

机构地区：[1]南方科技大学第一附属医院深圳市人民医院急诊中心(暨南大学第二临床医学院)

出　　处：《创伤外科杂志》2019年第8期570-573,共4页Journal of Traumatic Surgery

基　　金：深圳市卫计委科研项目(201601013);深圳市科技计划项目(JCYJ20160422152608675)

摘　　要：目的探讨急诊时间窗内一体化救治重症多发伤(SMI)的效果。方法回顾性分析2004年1月—2018年12月深圳市人民医院收治SMI患者(ISS评分≥16分)2 861例。自2010年6月笔者医院启动急诊时间窗内一体化救治模式。在建立急诊时间窗内一体化救治前(2004年1月—2010年5月)共救治SMI患者1 328例,其中男性831例,女性497例;年龄18~86岁,平均38.8岁。2010年6月—2018年12月实行时间窗内一体化救治后共救治SMI患者1 533例,男性974例,女性559例;年龄18~91岁,平均38.6岁。两时间段致伤原因均以道路交通伤为主(71.6%和70.9%)。比较采用新模式救治前后,SMI患者的病死率、入院-确定性治疗启动时间、ICU住院时间和总住院时间。结果采用急诊时间窗内一体化救治模式之后,不仅显著缩短患者的入院至确定性治疗时间间隔[(2.2±0.3)h vs.(1.4±0.2)h,P<0.001],也缩短患者ICU的天数[(9.6±3.2)d vs.(5.3±2.1)d,P<0.001],总住院时间[(28.1±8.6)d vs.(19.5±6.7)d,P<0.001],从而显著降低SMI患者的病死率(14.6%)vs.(5.5%),P<0.001。结论急诊时间窗内一体化救治能够改善SMI的救治效率及生存率。Objective To investigate the effect of integrated treatment within emergency time window on patients with severe multiple injury(SMI).Methods A retrospective analysis was conducted to collect the data of SMI patients admitted to our hospital from Jan.2004 to Dec.2018.Since Jun.2010,the emergency department of our hospital has started the integrated treatment mode within the emergency time window.A total of 1,328 SMI patients were treated before the establishment of integrated emergency treatment window(Jan.2004-May 2010).Among them,831(62.6%)were males and 497(37.4%)were females.Their age was 38.8(18-86)years.From Jun.2010 to Dec.2018,1,533 SMI patients were treated with integrated treatment within the time window,including 974 males(63.5%)and 559 females(36.5%).The age was 38.6(18-91)years.Road traffic accident injury was the main reason of injury in both periods(accounting for 71.6%and 70.9%).The mortality rate,admission-deterministic treatment start time,ICU hospitalization time and total hospitalization time of severe multiple trauma patients before and after the new treatment mode were compared.Results After using the integrated treatment mode in emergency time window,not only the time interval from admission to definite treatment(2.2±0.3 vs.1.4±0.2h,P<0.001),but also stay in ICU of patients(9.6±3.2 vs.5.3±2.1d,P<0.001)and the total hospitalization time(28.1±8.6 vs.19.5±6.7d,P<0.001)were significantly shortened,thus the mortality rate of SMI patients was significantly reduced[(14.6%)vs.(5.5%),P<0.001].Conclusion Integrative treatment within emergency time window can improve the treatment efficiency and survival rate of severe multiple injuries.

关 键 词：多发伤 急诊 时间窗 一体化救治 

分 类 号：R54[医药卫生—心血管疾病]