一站式创伤救治体系对严重交通伤的救治效果研究  

Effect of one-stop trauma care system on patients with severe road traffic injuries

作　　者：姚猛飞 郁毅刚 林宝丽 郑志鹏 郑泽源 莫群 Yao Mengfei;Yu Yigang;Lin Baoli;Zheng Zhipeng;Zheng Zeyuan;Mo Qun(Department of Emergency,909th Hospital of PLA Joint Logistics Support Force(Southeast Hospital Affiliated to Xianmen University,Zhangzhou,Fujian 363000,China;Department of Hospital Office,909th Hospital of PLA Joint Logistic Support Force(Southeast Hospital Affiliated to Xiamen University),Zhangzhou,Fujian 363000,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)急诊医学科,福建漳州363000 [2]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)院部,福建漳州363000

出　　处：《创伤外科杂志》2023年第9期659-663,共5页Journal of Traumatic Surgery

基　　金：省部级重点课题(BLB18J006)。

摘　　要：目的探讨联勤保障部队第九〇九医院一站式创伤救治体系对严重交通伤患者的救治效果。方法采用回顾性病例对照研究分析2018年5月—2022年5月联勤保障部队第九〇九医院收治的202例严重交通伤患者的临床资料,其中男性127例,女性75例;年龄15~83岁,平均48.1岁。损伤严重度评分(injury severity score,ISS)16~52分,平均25.9分。以联勤保障部队第九〇九医院一站式创伤中心建成后两年内(2020年5月11日—2022年5月10日)救治的99例患者为观察组,建成前两年内(2018年5月11日—2020年5月10日)救治的103例患者为对照组。观察组救治患者从院前开始干预,为军队一站式创伤救治体系,对照组患者到达医院后开始救治,为传统交通伤患者救治体系。比较两组患者到达医院急诊至抢救开始的时间、专科医师到达抢救室会诊时间、就诊到患者开始输血时间、就诊到影像学检查完成时间、患者到达医院至进手术室时间、术后从手术室到达ICU时间、总住院时间及预后。结果观察组到达医院就诊至开始抢救时间[(2.9±0.9)min]、专科医师到达抢救室会诊时间[(5.4±1.8)min]、就诊到患者开始输血时间[(40.2±10.9)min]、就诊到影像学检查完成时间[(43.7±10.9)min]、患者到达医院至进手术室时间[(63.4±19.3)min]、术后从手术室到达ICU时间[(3.5±1.6)min]显著短于对照组[(6.8±1.6)min、(9.6±2.4)min、(63.8±12.6)min、(71.3±16.6)min、(93.1±22.5)min、(10.4±3.7)min,P<0.001],观察组治愈率显著高于对照组(85.8%vs.70.8%,P<0.05),病死率、致残率显著低于对照组(6.1%vs.11.7%、8.1%vs.17.5%,P<0.05)。两组患者总住院时间比较差异无统计学意义(P>0.05)。结论一站式创伤中心建设能有效地使用信息和空间缩短抢救时间,降低严重交通伤患者病死率,提高患者治愈率。Objective To explore the effect of the one-stop trauma care system for patients with severe road traffic injuries(RTIs)at the 909th Hospital of PLA Joint Logistics Support Force.Methods A retrospective case-control study was performed to analyze the clinical data of 202 patients with severe RTIs admitted to our hospital from May 2018 to May 2022,including 127 male and 75 female aged 15-83 years(mean 48.1 years).The injury severity score(ISS)was 16-52,mean 25.9.Patients treated from May 11,2020 to May 10,2022 when the one-stop trauma center has been started for use were enrolled in the observation group(n=99),while the patients treated from May 11,2018 to May 10,2020 were taken as the control group(n=103).For patients in the observation group,treatment began from the pre-hospital phase(one-stop trauma care system)while the controls received treatment after their arrival at the hospital(traditional model).The time interval from patient’s arrival at the emergency department to resuscitation,time needed for specialists to arrive at the resuscitation room and prepare for consultation,time intervals from consultation to blood transfusion and finish of imaging exam,from admission to surgery,from operating room leave to ICU admission and total length of hospital stay as well as outcomes were recorded and compared between two groups.Results The observation group had a much shorter time interval from patient’s arrival at the emergency department to resuscitation(min,2.9±0.9 vs.6.8±1.6),time needed for specialists to arrive at the resuscitation room and prepare for consultation(min,5.4±1.8 vs.9.6±2.4),time intervals from consultation to blood transfusion(min,40.2±10.9 vs.63.8±12.6)and finish of imaging exam(min,43.7±10.9 vs.71.3±16.6),from admission to surgery(63.4±19.3 vs.93.1±22.5),and from operating room leave to ICU admission(min,3.5±1.6 vs.10.4±3.7,all P<0.001).The full recovery rate was also significantly higher(85.8%vs.70.8%,P<0.05),together with much a lower mortality rate(6.1%vs.11.7%)and disability

关 键 词：交通伤 休克 一站式创伤救治 预后 

分 类 号：R64[医药卫生—外科学]