广东山区颅脑损伤急救治疗模式的探讨

Way of emergency treatment on patients with traumatic brain injuries in Guangdong mountain area

目的 探讨提高广东山区颅脑损伤救治成功率的救治模式. 方法 通过实施新模式（2006年6月至2008年6月）两年间的住院前（拨打120后到医院办理住院手续前的时间）死亡率,住院死亡率,颅脑外科治疗前间期（伤后运送至颅脑专科诊疗时间）、急救半径（事故现场至可实施急救的医疗单位的距离）及心肺复苏成功率与旧模式（2004年6月至2006年5月1的数据进行比较分析. 结果 旧模式下住院患者死亡率为29.06%（68/234）.住院前患者死亡率为32.76%（114/348）,分别高于新模式住院患者死亡率[10.49%（28/267）]、住院前患者死亡率[18.10%（59/326）],差异均有统计学意义（P〈0.05）.新模式的最大急救半径为10km、平均颅脑损伤治疗前间期为50min,均分别低于旧模式的最大急救半径（70 km）、平均颅脑损伤治疗前间期（85 min）.新模式的心肺复苏成功率（80.32%）明显高于旧模式的（23.24%）,差异有统计学意义（P〈0.05）.新模式的颅脑损伤治疗前间期≥1 h的患者死亡率[24.31%（35/144）]明显高于30-60 min[6.93%（7/101）]和〈30 min[4.55%（1/22）的患者的死亡率,差异均有统计学意义（P〈0.05）. 结论 山区利用120急救中心依托当地综合医院,增设服务网点,缩短急救半径及急救反应时间,加强医务人员尤其是基层网点工作人员颅脑专业院前急救技术,增强院前急救中心人员及出诊设备,可明显提高重型颅脑损伤救治的成功率.

Objective To investigate the new way that can improve the emergency treatment rate on patients with traumatic brain injuries in Guangdong mountain area. Methods New emergency treatment way was adopted from June 2006 to June 2008 in patients traumatic brain injuries and these patients were chosen as experimental group. Control group is composed of patients treated with old emergency treatment way from June 2004 to June 2006. The pre-hospital mortality rate, in-hospital mortality rate and CPR success rate in the 2 groups were compared; the interphase between injury and receiving treatment, and the rescuing radius in these 2 groups were analyzed. Results Control grouphad the in-hospital mortality rate and pre-hospital mortality rate reaching 29.06% （68/234） and 32.76%（114/348）, respectively, which was significantly higher than the experimental group （in-hospital mortality rate： 10.49% [28/267], pre-hospital mortality rate：18.10% [59/326]） （P〈0.05）. The maxima rescuing radius and mean interphase between injury and receiving treatment in the experimental group （10 km, 50min） were statistically different as compared with those in the control group （70 km, 85 min） （P〈0.05）.CPR success rate in the experimental group （80.32%） was obviously higher man that in the control group （23.24%） （P〈0.05）. The death rate in the experimental group was increased following the prolonged interphase between injury and receiving treatment. Conclusion The new way, by increasing 120urgent care centre, shortening the rescuing radius and reaction time, strengthening the care technique ofthe doctors and nurses and reinforcing the equipment in the urgent care centre, can obviously increase the emergency treatment rate.