不同等级医院交通事故伤伤员分布特征与结局的比较研究

Comparison of the Characteristics and Outcomes of Patients Injured by Traffic Accidents in Hospitals of Different Ranks

目的：比较不同医院的车祸伤员分布特点和伤情、抢救水平和疗效．方法：临床流行病学调查与创伤评分相结合，抽取车祸重伤员１９１５例，按医院等级分组，进行创伤评分和统计处理．结果：（１）伤员分布：大医院的伤员解剖损伤和生理紊乱重而生存概率低，二三级医院平均ＩＳＳ＞１６．（２）转诊的影响：重伤员向上级医院转运使院前时间延长５～９小时．（３）死亡因素分析：①评分值：生理评分ＲＴＳ与死亡概率Ｐｓ密切相关；解剖评分ＩＳＳ／ＡＰ与死亡概率Ｐｓ中度相关，ｍａｘＡＩＳ＝５组和院前时间＜６小时组死亡率明显升高．②并发症：死亡组并发症率显著高于生存组．③医院等级：大医院死亡率高于基层医院，但非预期死亡率较低，平均住院日较短．结论：上述结果能反映车祸伤员在各级医院的分布特点．

Aim: To compare the characteristics and outcomes of patients injured by traffic accidents in various hospitals. Methods: From 8 hospitals 1915 cases were sampled and divided into 4 groups according to the ranks of the hospitals, and injuries of all the patients were scaled by the methods of RTS, AIS ISS and AP Profile as well as ASCOT. Results: (1)In the higher rank hospitals the injuries were severe, with mean ISS> 16 which was recommended as a standard of severe trauma. (2)Transplacement of severe patients to the high rank hospitals lengthend the pre hospital time by 5-9 hours. (3) Factors effecting death were trauma scores, complications and hospital ranks that reflect the qualities of the medical care. Conclusion: The sample of 1915 cases matches the conditions of most Chinese hospitals and can reflect the characteristics of traffic trauma patients in various hospitals.