院外放置四肢创伤止血带的效能评估  

Evaluation of the efficacy of out-of-hospital placement of tourniquets for extremity trauma

作　　者：纪学颖 章衡 樊冬雪 任艳 邱晨 燕宪亮 JI Xueying;ZHANG Heng;FAN Dongxue;REN Yan;QIU Chen;YAN Xianliang(Department of Emergency and Rescue Medicine,Second Clinical College,Xuzhou Medical University,221002,China)

机构地区：[1]徐州医科大学第二临床学院急救与救援医学系,江苏徐州221002 [2]镇江市急救中心,江苏镇江212003 [3]徐州医科大学附属医院急诊医学科,江苏徐州221002

出　　处：《中国急救复苏与灾害医学杂志》2023年第11期1507-1510,1536,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：徐州市国家临床重点专科培育项目(编号:2018ZK004);徐州市医学领军人才培养项目(编号:XWRCHT20210026);镇江市社会发展指导性科技计划项目(编号:FZ2022131)。

摘　　要：目的评估院前急救中四肢创伤出血患者止血带(TQ)的应用及效果。方法采用回顾性分析方法,依据ICD-10编码筛选出2022年7月1日—2023年6月30日经镇江市急救中心救治的创伤患者,并依据纳入标准收集相关患者的临床资料,所有患者按止血带操作者进行分组[紧急医疗服务人员(EMS)、警察、第一目击者(FR)、患者本人],比较各组放置止血带的适当性与临床效果等。结果共有291例院外四肢创伤性出血患者使用止血带,患者年龄17~68岁,平均(32±17.5)岁;男∶女=3.9∶1.0。所有患者的应急反应时间为10(3~15)min,现场停留时间为12(11~23)min,平均转运时间为9(5~12)min;导致创伤的原因主要是交通事故,穿刺伤/撕裂伤是最常见损伤类型。超过50%的病历没有记录止血带使用的时间。非EMS人员主要使用布条式的临时止血带,第一目击者组使用止血带的适当性和有效性相对最低。使用布条式临时止血带止血效果不佳的患者在EMS人员换用制式止血带后均实现了有效止血。EMS所使用的通常都是制式止血带,稳定患者临床体征取得较好效果。因TQ导致的并发症发生率较低,主要的并发症为止血带捆扎部位皮肤青紫肿胀。结论在院外要提高四肢创伤大出血的救治成功率,需帮助非EMS人员正确掌握四肢止血带应用指征并有效放置止血带,同时如果能普及制式止血带或许将更有助于提高四肢创伤止血成功率。Objective To assess the application and effect of tourniquet in patients with bleeding extremity trauma in prehospital emergency care.Methods A retrospective analysis was used to screen out trauma patients treated by Zhenjiang Emergency Medical Center from July 1,2022 to June 30,2023 based on ICD-10 codes,and the clinical data of the relevant patients were collected based on the inclusion criteria,and all the patients were grouped according to tourniquet operators(EMS group,police group,first responder group,and the patient's own group),and the groups were compared in terms of placing the The appropriateness of tourniquet placement and clinical outcomes were compared between the groups.Results A total of 291 patients with out-of-hospital traumatic hemorrhage of the extremities were tourniqueted;patients'ages ranged from 17-68 years,with a mean of(32±17.5)years,and M:F=3.9:1.0.Emergency response time for all patients was 10(3-15 minutes),on-scene stay time was 12(11-23)minutes,and the mean transfer time was 9(5-12)minutes.One of the main causes of trauma was traffic accidents,with puncture wounds/lacerations being the most common type of injury.The time of tourniquet application was not documented in more than 50%of the charts.Temporary tourniquets of the cloth type were predominantly used by non-EMS personnel,and the appropriateness and effectiveness of tourniquet use by first witnesses was relatively minimal.Patients who had poor hemostasis with a cloth temporary tourniquet achieved effective hemostasis after EMS personnel switched to a standard tourniquet.The standard tourniquet was usually used by EMS,with better results in stabilizing the patient's clinical signs.The incidence of complications due to TQ was low,with the main complication being bruising and swelling of the skin at the site of tourniquet binding.Conclusion In order to improve the success rate of hemorrhage in extremity trauma out-of-hospital,it is necessary to help non-EMS personnel to correctly grasp the indications for the application of ext

关 键 词：院外急救 四肢创伤 大出血 止血带 急救 

分 类 号：R459.7[医药卫生—急诊医学]