交通事故性重型颅脑损伤院内急救后效果分析（附1107例报告）

Hospital first aid effect on patients with traffic accident severe craniocerebral injury： a report of 1107 cases

目的通过对交通事故性重型颅脑损伤在院内急救期间各生命体征、意识、瞳孔及时间等环节上的变化，显示院内急救的重要性和一般规律．为我国相关部门制定急性颅脑创伤的预防和控制措施做出参考依据。方法以南方医科大学珠江医院神经外科组织制定及7l家医院专家委员会审定的《交通事故性重型颅脑损伤统计表》为依据收集自2008年4月1日至2009年3月30日因交通事故致重型颅脑损伤患者1107例的临床资料，根据在院内急救过程中患者意识状态、瞳孔变化、GCS评分、血压、呼吸、脉搏等指标在转入及转出急诊科间的变化，进行函数推算，分析判断病情发展趋势、抢救效果和下一步治疗措施。结果根据院内急救时间显示在10～60min内入急诊的患者最多．尤其在10～30min占总就诊患者的38．9％。直观发现，患者经过院内急救有效治疗后，意识状态、瞳孔变化、GCS评分、血压、呼吸、脉搏等指标中表现差的患者例数逐渐减少，表现中等、较好和好的例数增多，在进入下一步专科治疗之前，患者各项生命体征及检测指标逐渐趋于平稳。函数推算支持此结果。结论院内急救有效的治疗，及时控制各项指标稳定，正确判断伤情，提高院内急救一切合理措施，有助于提高交通事故性重型颅脑损伤患者的急救质量。

Objective To make reference for relevant departments of our country to develop acute craniocerebral trauma prevention and control measures based on the general rule of hospital first aid by changing the links as signs of life, consciousness, pupil and time for hospital emergency in patients with traffic accident severe traumatic brain injury. Methods The clinical data of 1107 patients with severe traumatic brain injury, collected from April 1, 2008 to March 30, 2009, were analyzed; these patients were chosen according to the severe traumatic brain injury statistical table made by Department of Neurosurgery of Zhujiang Hospital and authorized by committee of experts from 71 other hospitals. The consciousness, pupil changes, GCS scores, blood pressure, respiration, pulse index changes on admission and at time out of emergency department were analyzed and compared; according to these results, function projections was performed; development tendency of the disease and rescue effect were judged, and the next treatment measure step was determined. Results According to the hospital emergency time, most patients got to the Emergency at 10-60 min after the injury, mostly at 10-30 min after the injury （38.9%）. The consciousness, pupil changes, GCS scores, blood pressure, respiration, pulse index changes of most patients gradually developed to good trends after hospital first aid; before the patients received further specific treatment, the vital signs and indicators of them were gradually stabilized. Function projections supported these results. Conclusion Hospital first aid and effective treatment, timely controlling indicators, correct diagnosis and all reasonable measures improving hospital first aid can help to improve the first aid quality of patients with traffic accident severe traumatic brain injury.