不同院前干预救治模式对重症多发创伤患者预后的影响

The effects of different pre-hospital intervention of treatment modes on the prognosis of patients with severe multiple trauma

目的探讨不同院前救治模式对重症创伤患者预后的影响。方法收集2008年1月1日至2012年1月1日因严重创伤就诊于北京同仁医院急诊科患者相关资料[创伤严重度评分（ injuryseverity score, ISS）≥25分]。以2010年1月1日为界，此后就诊于我院创伤患者采用的是本院急诊医师随车出诊的“急救型”急救模式分为研究组，而此日期以前是传统由120及999担任院前急救的急救模式则为对照组，采用创伤数据库记录创伤患者伤情、救治与结局信息，比较严重创伤救治效率和质量。结果研究组较对照组在急诊处理时间、住院时间、入住ICU率、住院前病死率、远期（6个月）致残率、并发症出现率等方面有所降低，分别为（78．23±21．57）minvs．（96．45±35．14）min，（23．55±12．46）dvs．（28．67±20．72）d，8．1％（18／222）vs．65．5％（114／174），13．3％（34／256）vs．21．6％（48／222），4．1％（9／222）vs．9．2％（16／174），8．1％（18／222）vs．18．4％（32／174），差异均具有统计学意义（P〈0．05）；在住院病死率方面，研究组也较对照组低，为8．1％（18／222）vs．12．6％（22／174），但差异无统计学意义（P〉0．05）。两组患者受伤到医院的时间差异无统计学意义。结论由医院急诊医师随车出诊的“急救型”院前急救模式相对于常规采用的急救模式在提高多发严重创伤的救治成功率以及降低病死率方面有一定优势，是一种良好的备选急救模式。

Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma. Methods The general data of 396 patients with severe trauma [ injurey severity scores （ISS） ≥25 ] in our hospital emergency for treatment from January 1, 2008 to January 1, 2012 was collected. The trauma patients were divided into study group and control group. In the study group, the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1, 2010. In the control group, the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1, 2010. The injury severity score, medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups. Results The emergency treatment time, length of hospital stays, ICU admission rate, pre- hospital mortality rate, long-term （6 months） disability rate, and complication rate in the study group were lower than those in the control group, presenting （78.23±21.57） min vs. （96. 45 ± 35.14） rain, （23.55±12.46） dvs. （28.67±20.72） d, 8. 1% （18/222） vs. 65.5% （114/174）, 13.3% （34/256） vs. 21.6% （48/222）, 4.1% （9/222）vs. 9.2% （16/174）, 8.1% （18/222）vs. 18.4% （32/174）, in which the differences were statistically significant （ P 〈 0. 05 ） . Hospital mortality in the study group was also lower than that in the control group, showing 8. 1% （18/222） vs. 12.6% （22/174）, but there was nostatistically significant difference （ P 〉 0. 05 ）. There was no significant difference in time from occurrence of injury to receiving treatment between the two groups. Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode. It is a good alternative emergency mode.