严重创伤院内早期救治策略探讨(附284例报告)

Early in-hospital management strategy for patients with serious traumatic injury:report of 248 cases

目的探讨严重创伤院内早期救治策略对提高创伤救治水平的作用。方法回顾分析2004年1月-2008年6月采用绿色通道救治程序救治的284例严重创伤患者的情况,以2004年前采用非绿色通道程序急救的46例严重创伤患者作为对照组。比较不同治疗方案在救治时间和预后等方面的差异。结果两组基线资料具有可比性(P>0.05);研究组急救部处理时间(16.4±3.7min)、特殊检查时间(17.5±2.6min)、急诊至手术室时间(6.3±1.3 min)较对照组(分别为22.5±4.8、25.8±3.2、8.2±1.6min)均明显缩短(P<0.05)。研究组121例(42.6%)患者采用了限制性液体复苏策略,171例应用了损害控制外科策略;并发症发生率明显低于对照组(P<0.05)。两组死亡率分别为3.52%(10例)和13.0%(6例),差异具有统计学意义(P<0.05)。结论严重创伤患者院内早期一体化救治,限制性液体复苏、损害控制外科策略的应用,缩短了患者的救治空间和时间,可显著降低伤死率,提高救治成功率,保证创伤急救的时效性和整体性。

Objective To investigate the effect of early in-hospital management strategy for the patients with serious traumatic injury. Methods Two hundred and eighty four cases with serious traumatic injury, who had been managed by Green Passage Procedure （GPP） in our hospital from Jan. 2004 to Jun. 2008, were reviewed retrospectively （research group）. Other 46 patients with serious traumatic injury who had not been managed by GPP before 2004 were grouped as the control. The differences of treatment time and prognosis of these two groups were compared statistically. Results No differences on the baseline data existed between the two groups（P〉0. 05）. For the patients in research group, the time spent in emergency treatment （16.4±3. 7min）, special exam （17.5±2.6min） and waiting for surgery （6.3±1.3min） were obviously shorter than those in the control group （P〈0.05）. One hundred and twenty one cases underwent the treatment of limited fluid resuscitation and 171 cases underwent operation according to damage control surgery （DCS） in research group. The incidence of complications decreased in the research group compared with that in the control group （P〈0.05）. The mortality in the research group （3.52%, 10/284） was much lower than that in the control group （13.04%, 6/46, P〈0.05）. Conclusions The early in-hospital management, so called GPP including integration care, limited fluid resuscitation and damage control surgery, to the patients with serious traumatic injury may shorten the space and time of trauma care, reduce the mortality significantly and increase the cure achievement ratio. GPP can guarantee the chronergy and integrity of emergency care for trauma.