城市医院急诊中严重创伤的救治探讨

Investigation on emergency treatment of severe trauma in urban hospital

目的 对我院急诊外科 2 0 0 3- 0 2～ 2 0 0 4 - 0 1收治的严重创伤病例进行回顾性分析 ,以期对城市中常见创伤的急救提出建设性意见。方法 从急诊危重病例中筛选出急需抢救的严重创伤 14 3例进行分析。结果 男性 10 8例 ,女性 35例 ,男 :女为 3.0 9:1;年龄平均 34.2岁 (9～ 73岁 ) ;创伤评分 (TS)平均 13.5± 3.8分 ;格拉斯哥昏迷评分 (GCS)平均 12 .3± 3.7分 ;创伤严重程度评分 (ISS)平均 19.6± 12 .5分 ,多发伤 6 2例 (4 3.4 % )。病因 :交通伤 83例 (5 8% ) ,械斗、工伤 4 3例 (30 % ) ,坠落伤 17例(12 % )。休克 112例 ,脱险率 92 % ,抢救成功率 83.9%。实施确定性抢救手术 116例。急诊滞留时间 :抢救脱险组 5 6± 2 3min ,死亡组 10 9± 4 3min ,两组差异非常显著 (P <0 .0 1)。结论 交通伤、械斗、工伤、坠落伤是城市中严重创伤的主要原因 ;观念上要重视“黄金 1h”、“白金 10min” ,缩短急诊滞留时间 ;早期实施确定性抢救手术 ,可以有效地提高严重创伤的抢救效果。

Objective We analysed in retrospect severe trauma cases admitted to emergency surgical department of our hospital from February 2003 to January 2004 in order to provide constructive suggestions for urban trauma emergency treatment. Methods Retrospective analysis of 143 severe trauma cases who were selected from trauma cases admitted to the emergency surgical department was carried out. Results There were 108 male and 35 female patients, the ratio of male to female was 3.09 : 1, mean age was 34.2 years old ( range 9～73 years), the mean trauma score (TC) was 13.5±3.8, the mean Glasgow Coma Score (GCS) was 12.3±3.7, the mean injury severity score (ISS) was 19.6±12.5. There were 62 cases with multiple injuries, 112 cases with shock, the survival rate was 92% and a rescue success rate was 839%. Definite rescue surgery was carried out in 116 cases. The mean hospitalization duration in the emergency department was : 56±23 min for the survival cases and 109±43 min for the dead, there was very significant difference between the two groups (P<0.01) . Conclusion Transportation accident(83,58%), fighting with weapons and trauma in the work site(43,30%) and falling injury(17,12%) were the major causes of urban severe trauma, and we should pay attention to concept of “the golden one hour” and “platinum 10 minutes”; shortening the duration of staying in the emergency department, early definite rescue surgery can effectively improve the result of urban severe trauma therapy.