多学科联合急救系统在血流动力学不稳定骨盆骨折患者的临床应用  

Clinical application of multidisciplinary combined first aid system in patients with hemodynamically unstable pelvic fractures

作　　者：刘丹[1] 刘纪宁[1] 朱伦刚[1] 黄彬[1] LIU Dan;LIU Jining;ZHU Lungang;HUANG Bin(Department of Emergency,Mianyang Municipal Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川省绵阳市中心医院急诊科,621000

出　　处：《重庆医学》2021年第15期2606-2610,共5页Chongqing medicine

基　　金：四川省卫生健康委员会项目(19PJ113)。

摘　　要：目的评估多学科联合急救系统在动脉出血所致血流动力学不稳定的骨盆骨折中的诊治作用。方法收集该院2016年2月至2019年11月收治的91例动脉出血造成血流动力学不稳定的骨盆骨折患者的临床资料,其中经多学科联合急救系统进行救治的23例患者纳入试验组,经传统会诊分诊系统进行救治的68例患者纳入对照组。比较两组患者一般资料、损伤严重程度评分(ISS)、改良创伤评分(RTS)、严重创伤生存概率评分[Ps(TRISS)],120呼叫至到达急诊室时间、到达急诊室至诊断时间、诊断至实施AE时间、AE手术时间,患者到达时外科医师、放射医师到场情况,以及24 h内使用悬浮红细胞(RBC)、新鲜冰冻血浆(FFP)、血小板情况等资料。结果试验组RTS明显高于对照组[7.8(2.4,7.9)分vs.6.0(2.4,7.8)分,P<0.01],Ps(TRISS)明显低于对照组[60(1,98)分vs.80(1,96)分,P<0.01],两组ISS无明显差异(P=0.13)。两组120呼叫至到达急诊室时间、AE手术时间无明显差异(P>0.05)。试验组到达急诊室至诊断时间、诊断至实施AE时间较对照组明显缩短[23(15,39)min vs.40(34,63)min,15(9,23)min vs.25(22,51)min,P<0.05]。试验组到达时外科医师存在、到达时放射医师存在、到达时外科和放射医师均存在患者比例均明显高于对照组(73.9%vs.27.9%,78.3%vs.30.9%,65.2%vs.19.1%,P<0.05)。试验组住院死亡率明显低于对照组(8.7%vs.27.9%,P<0.05)。结论多学科联合急救系统可改善诊治动脉出血所致血流动力学不稳定的骨盆骨折的及时性,降低患者死亡率。Objective To evaluate the diagnostic and treatment role of the multidisciplinary combined first aid system in hemodynamically unstable pelvic fractures caused by arterial bleeding.Methods The clinical data of 91 cases of hemodynamically unstable pelvic fractures caused by arterial bleeding treated in this hospital from February 2016 to November 2019 were collected.Among them,23 cases treated by the multidisciplinary combined first aid system were included into the experimental group,and 68 cases treated by the traditional consultation and triage system were included into the control group.The general data,injury severity score(ISS),revised trauma score(RTS),survival probability score for severe trauma[Ps(TRISS)],time of calling 120 to the emergency room,time from arrival in the emergency room to diagnosis,time from diagnosis to implementing AE,AE operation time,presence of surgeon and radiologist when patient arrival,use of suspended red blood cells(RBC),fresh frozen plasma(FFP)and platelets within 24 h,etc.were compared between the two groups.Results The RTS score of the experimental group was significantly higher than that of the control group[7.8(2.4,7.9)points vs.6.0(2.4,7.8)points,P<0.01].The Ps(TRISS)score of the experimental group was significantly lower than that of the control group[60(1,98)points vs.80(1,96)points,P<0.01].There was no significant difference in the ISS score between the two groups(P=0.13).There was no significant difference in the time from calling 120 to the emergency room and AE operation time between the two groups(P>0.05).The time from the arrival in the emergency room to diagnosis and the time from diagnosis to implementation of AE in the experimental group were significantly shortened,compared with the control group[23(15,39)min vs.40(34,63)min,15(9,23)min vs.25(22,51)min,P<0.05].The proportion of the patients when the patients arrived at the emergency room with the presence of surgeons,the presence of radiologists,the presence of both surgeons and radiologists in the experimental

关 键 词：多学科联合 急救 血流动力学不稳定 骨盆骨折 

分 类 号：R683.3[医药卫生—骨科学]