院外院内无缝隙链接对院外重度颅脑损伤急救关系的探讨

Pre-hospital seamless link to the hospital and the emergency of severe traumatic brain injury

目的分析院外重度颅脑损伤的特点、急救处置方式，探讨院外与院内联合救治提高此类患者抢救成功率的方法。方法回顾性分析2006年7月～2008年8月在院外重度颅脑损伤、并送达脑系科专科医院进行手术治疗的114例特点，将不同院外处置方式的病例分为2组，A组（n=54）按常规转运方式，B组（n=60）转运同时直接与院内手术医生建立联系。2组患者病死率进行比较。结果2组病例受伤至入院时间比较无显著差异（P〉0．05）；2组患者入院到手术时间比较。A组显著小于B组（P〈0．01）。A组患者成活率（59．26％），显著低于B组成活率（76．67％，P〈0．05）。结论重度颅脑损伤治疗成功的关键是加强现场急救和初期诊治，尽早做到全面诊断，掌握好手术时机，及早手术。急救中心、急诊、抢救室、手术室、颅脑外科病房的无缝隙链接模式，能够提高颅脑损伤患者的抢救成功率、成活率及生活质量。做到院外与院内急救的无缝隙链接，不仅需要建立一个院外急救医生与院内专业医生之间的信息交流平台，还需要相关行政部门的支持，制定相应法规政策和运行机制，才能让这种模式长期良好运行。

Objective To analyze the features and treatment of severe traumatic brain injury at pre-hospital, to explore the joint treatment of the pre-hospital and hospital for improving survival rate. Methods the characteristics of the patients with pre-hospital severe traumatic brain injury by ambulance to hospital and surgical treatment in July 2006 - August 2008 was analyzed, the patients were divided into two groups according to different treatment at pre-hospital, A group by conventional transit mode, B group of transit and directly set up contact surgeon with the hospital at the same time. The mortality between the two groups was compared. Results There was no significant difference at the time of from Injured to admission in the two groups （P〉 0.05）; Comparing the time of from admitted to the surgical between the two groups, A group was significantly lower than the B group （P〈0.01）.The survival rate of 59.26% in A group, group B was significantly lower than the survival rate （76.67%, P〈0.05）. Conclusion The key to success of treatment of severe traumatic brain injury is to strengthen the scene and initial pre-hospital treatment, as soon as possible to achieve a comprehensive diagnosis, mastering the timing of operation and operation early. Seamless link model of emergency center, emergency, emergency treatment rooms, operating theaters and brain surgery wards, can improve the survival rate and quality of life of patients with traumatic brain injury; To make the pre-hospital and hospital emergency seamless link model a good long-term operation, not only necessary to establish a exchange information platform between the pre-hospital doctors and hospital medical professionals, but also required the support of the relevant administrative departments, formulate corresponding regulations and policies and operational mechanism.