1162例严重胸部创伤的院前急救分析

Prehospital first aid of 1162 cases of severe thoracic trauma

目的：总结严重胸部创伤院前救治经验，提高院前救治水平。方法收集2009年1月～2014年12月经院前“120”现场救治后转入我院的严重胸部创伤（ AIS）≥3分患者病例资料1162例，其中男性827例，女性335例；年龄13～98岁，平均（45．3±10．8）岁。分析胸部损伤情况，院前、院内救治方法和救治结果等。结果1162例中，院前平均急救反应时间（46．52±17．33）min，平均急救时间（16．73±7．32） min。清除呼吸道异物31例，气管插管机械通气42例，紧急气管切开23例，张力性气胸减压25例，呼吸机正压通气纠正反常呼吸运动43例，纱垫填塞或包扎胸壁开放性伤口151例，呼吸心跳停止者现场进行徒手心肺复苏16例，胸部伤情未进行特殊处理者735例。本组死亡29例。结论院前快速准确判断，熟练正确急救为严重胸部创伤院内进一步救治创造机会和争取时间。

Objective To summarize the experiences of prehospital first aid in patients with severe thoracic trauma and to improve the skills of prehospital first aid. Methods A total of 1162 patients with severe thoracic trauma （AIS≥3） in Chongqing Emergency Medical Center from Jan.2009 to Dec.2014 were retrospectively ana-lyzed in respect of the injury severity of chest,methods of prehospital first aid,hospital treatment and outcome,etc. Among those patients 827 were male and 335 were female. The average age was （ 45.3 ±10.8 ） years （ 13-98 years） .Results Airway foreign bodies were removed in 31 patients.Intubation and ventilation were performed in 41 patients.Emergency tracheotomy was carried out in 23 patients and 25 patients with tension pneumothorax were decompressed by a needle or tube thoracostomy. Forty three patients with paradoxical respiratory movement were corrected by rib sunpension traction or positive-pressure ventilation.151 patients with open chest wounds were closed by medical dressing.Sixteen patients with cardiac arrest underwent unarmed cardiopulmonary resuscitation. No special measures were taken in 735 patients.Twenty-nine patients died.Conclusion Quick and accurate as-sessment,skilled and proper rescue are keys for severe thoracic trauma patients in demand of first aid and earn chance and time for further treatment in hospital.