模拟场景下临床路径对提高院前创伤救治质量的研究

Effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition

目的探讨在模拟场景下临床路径对提高院前创伤救治质量的有效程度。方法设计创伤的模拟病例场景和创伤的院前临床路径,以传统的创伤救治和临床路径的救治方式分别对模拟病例进行救治。结果培训后进行现场评估、显性大出血评估、气道评估、呼吸评估、循环评估、快速查体评估、救治沟通、协助救治的急救小组比例较培训前有明显提高(χ2分别=80.81、88.17、66.78、55.54、74.67、84.41、64.07、74.67,P均<0.05)。止血、包扎、长骨固定、颈椎固定、气道管理等各单项技能操作的成绩也较培训前明显提高(t分别=-42.97、-35.37、-54.34、-88.75、-52.28,P均<0.05),现场救治总时间、评估总时间、止血包扎总时间、颈椎骨折固定总时间、长骨固定总时间通过培训明显缩短(t分别=4.88、12.81、6.63、3.92、4.58,P均<0.05)。结论在模拟场景下临床路径可以提高院前创伤救治的评估质量,减少现场救治时间,提高救治效率和质量。

Objective To explore the effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition. Methods The traumatic mimic patients and pre-hospital clinical pathway were designed and the traditional traumaic treatment and clinical pathway treatment were used on simulated patients. Results After training, the percentage of locale assessment, life-threatening bleeding assessment, airway assessment, breathing assessment, circula- tion assessment, rapidly trauma assessment and communication with teammates and assistants were significantly increased （X^2=-80.81, 88.17, 66.78, 55.54, 74.67, 84.41, 64.07, 74.67,P〈0.05）. The scores of control bleeding, dressing, cervi- cal spine immobilization, airway management were also significantly improved （t=-42.97,-35.37,-54.34,-88.75,-52.28, P〈0.05）. Moreover, the time of locale treatment, assessment, control bleeding and dressing, cervical spine immobiliza- tion, fracture fixation were significantly shortened than that of before training （t=4.88,12.81,6.63,3.92,4.58,P〈0.05）. Conclusion The clinical pathway under clinical simulations condition can improve the quality of trauma assessment, re- duce time of treatment, improve the efficiency and the quality of treatment.