互助型急诊模式对胸部创伤的救治

Emergency management of chest trauma in the cooperative type of emergency department

目的探讨互助型创伤急救模式下胸部创伤的急救规律和存在问题。方法回顾性总结分析2001年1月-2006年12月胸部创伤病例的救治。急诊科以“白金10分钟”为理念，采用链式流程复苏，由胸外专科实行确定性救命手术的互助型创伤救治。结果本组共有972例，依据ISS评分：轻度757例、中度103例、重度72例、极重度40例。死亡28例，死亡率7．9％。闭合性与开放性胸部损伤分别为805、167例。手术操作总项次为107次，胸部22．4％（24项次），其他科室手术操作77．6％（83项次）。在确定性手术中，其它非开胸手术同时伴有胸腔闭式引流术85．5％（71／83）。急救部单独完成抢救165例、急救部＋胸科50例、急救部＋SICU完成50例。在探查手术指征上，急诊部与专科存在认识分歧。结论互助型创伤急救模式在当前胸部创伤救治中仍具有重要作用，加强急诊科与胸心外科等专科的密切协作、共同发展是这一模式的方向。

Objective To explore the rule and significance of chest trauma management in the cooperative type of emergency department（ ED）. Methods To collect and analysize 972 chest trauma patients from Jan 2001 to Dec 2006, and manage the chest trauma patients by cooperative type of trauma team （ consisted of emergency and thoracological doctors ）, with trauma flow-chain resuscitation. The emergency doctors performed the breath and circulation accesses management within ＂platinum 10 mins＂, followed by exploratory thoracotomy and pulmonary lobectomy et al. Results According to ISS score,972 cases were divided into minimal severe group 757 cases, moderate midrange severe group （ ISS 〈 13 ） 103 cases, severe group （ ISS13 - 25 ） 72 cases, critical group （ ISS 〉 25 ） 40 cases. 11 of the 28 died before admitted to hospital,6 died in the ED and 9 died in the thoracological ward. The mortality in the later three groups was 7.9%. The closed chest trauma were 805 vs open 167 cases. The resuscitation was operated by ED,ED ＋ cardiothoracic surgery and ED ＋ SICU were 165,50 and 50 cases respectively. The 107 operations in the chest were 22.4% （ 24 ） and chest plus others were 77.6% （ 83 ）. Conclusion The cooperative type of ED plays an important role in the management of chest trauma,cooperation among ED, cardiothoracic surgery and SICU is the key to improve the cooperative type ED.