急救网络建设在危重氢氟酸烧伤患者早期救治中的作用  

The role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns

作　　者：张元海[1] 田鹏飞 张惟 叶春江[1] 毛书雷 韩春茂[2] 张建芬[1] 王新刚[2] Zhang Yuanhai;Tian Pengfei;Zhang Wei;Ye Chunjiang;Mao Shulei;Han Chunmao;Zhang Jianfen;Wang Xingang(Department of Burns and Plastic Surgery,Zhejiang Quhua Hospital,Quzhou 324004,China;Department of Burn and Wound Repair,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江衢化医院烧伤整形科,衢州324004 [2]浙江大学医学院附属第二医院烧伤与创面修复科,杭州310009

出　　处：《中华烧伤杂志》2021年第10期921-928,共8页Chinese Journal of Burns

基　　金：国家重点研发计划(2018YFC0808600);浙江省基础公益研究计划(LGF18H150001)。

摘　　要：目的探讨急救网络建设在危重氢氟酸烧伤患者早期救治中的作用。方法以浙江省、江西省、福建省、内蒙古自治区的27家氟化工企业,浙江省内有烧伤/整形科或烧伤专业组的包括浙江衢化医院在内的22家医院及省外5家医院为成员单位,进行氢氟酸烧伤急救网络建设,其中浙江衢化医院是急救网络的主体单位,负责急救网络的日常维护和技术指导。20家氟化工企业的定点急救医院是浙江衢化医院,7家氟化工企业就近指定1家定点急救医院。收集2006年1月—2021年6月5家急救网络医院收治的符合入选标准的56例(均为男性)危重氢氟酸烧伤患者的病历资料,进行回顾性队列研究。按照患者所在企业是否纳入急救网络建设,将患者分为急救网络组[27例,年龄(41±9)岁]和非急救网络组[29例,年龄(42±10)岁]。急救网络组的患者伤后所在企业立即与医院联动,接诊医院利用急救网络,提前调集救治力量、设备和物资药品,做到院前急救与院内治疗无缝对接。非急救网络组患者到达医院急诊科后启动急救流程,临时调集救治力量、设备和物资药品。统计2组患者的院前时间、血钙首次检出时间、急诊科停留时间、低钙血症与低镁血症持续时间,以及治疗转归情况。对数据行χ^(2)检验、Fisher确切概率法检验、独立样本t检验、Wilcoxon秩和检验。结果急救网络组患者的院前时间、血钙首次检出时间、急诊科停留时间分别为40.0(30.0,55.0)、23.0(17.5,37.5)、42.0(37.0,53.0)min,明显短于非急救网络组的180.0(120.0,240.0)、31.0(22.5,47.5)、61.0(52.0,65.5)min(Z=-6.17、-1.98、-4.15,P<0.05或P<0.01)。急救网络组患者伤后低钙血症、低镁血症持续时间为1.2(1.1,1.6)、1.9(1.7,2.1)h,明显短于非急救网络组的4.6(3.1,6.2)、3.2(2.5,4.6)h(Z=-5.80、-4.81,P<0.01)。急救网络组患者死亡3例(11.1%),其中2例患者于伤后40 min死亡,另1例患者于伤后9.0 hObjective To explore the role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns.Methods Twenty-seven fluorine chemical enterprises distributed in Zhejiang province,Jiangxi Province,Fujian Province,and Inner Mongolia Autonomous Region and 22 hospitals with burn/plastic department or professional burn treatment group in Zhejiang province,including Zhejiang Quhua Hospital,and 5 hospitals outside Zhejiang province were involved in the first-aid network construction as member units.As the main unit,Zhejiang Quhua Hospital was responsible for the daily maintenance and technical guidance of the first-aid network.Zhejiang Quhua Hospital was assigned as the designated emergency hospital for 20 fluorine chemical enterprises,a near emergency hospital to the other 7 fluorine chemical enterprises was assigned as the designated hospital for them.Medical records of 56 patients(all males)with critically severe hydrofluoric acid burns who admitted to 5 first-aid network hospitals from January 2006 to June 2021,meeting the inclusion criteria,were involved in the retrospective cohort study.Based on whether the enterprise belonging to the first-aid network construction or not,the patients were divided into first-aid network group(27 cases,aged(41±9)years)and non first-aid network group(29 cases,aged(42±10)years).After the patients in the first-aid network group were injured,the enterprises and hospitals linked up immediately.The hospital where the patient was treated mobilize the treatment force,equipment,materials,and drugs in advance by the first-aid network,thereby realizing seamless joint between pre-hospital first-aid and in-hospital treatment.The hospital started the first-aid process and temporarily mobilized the rescue forces,equipment,materials,and drug after patients in non first-aid network group arrived at the department of emergency of the hospital.The time from injury to medical service,the first detection time of serum calcium,the time staying in depa

关 键 词：烧伤 化学 氢氟酸 氟中毒 急救网络 

分 类 号：R605[医药卫生—外科学] R753.1[医药卫生—临床医学]