重度颅脑损伤急救模式的研究

Effects of integrated treatment model for severe craniocerebral injury： study of 145 cases

目的探讨院外院内急救一体化模式在重度颅脑损伤救治的临床价值的应用。方法145例重度颅脑损伤患者根据是否采用院外院内急救一体化模式分为A组（新方法组）和B组（传统组）。对两组患者基本临床资料、急救时间、预后情况进行统计学比较分析。再根据出院时格拉斯哥预后评分（GOS）分为预后良好组和预后不良组，进一步探讨患者临床资料及时间等相关因素对重度颅脑损伤预后的影响。结果①A组患者的急诊至进行手术时间、ICU住院时间、死亡率显著短于B组（均P〈0．05）。A组患者出院时GOS评分4分和5分）较B组患者高，差异有统计学意义。②年龄、GCS、病后急救车送达医院时间，急诊至进行手术时间是影响重度颅脑损伤预后的因素，均有差异统计学意义。结论重度颅脑损伤治疗成功的关键是及时的院外救治和尽早的完善检查手术治疗。院外急救、院内急救及神经外科专科处理的一体化救治，有助于重度颅脑损伤抢救的成功率及生活质量的提高。

Objective To discuss the clinic value of integrated treatment for severe craniocerebral injury. Methods 145 severe craniocerebral injury patients were randomly divided into 2 groups, Group A （n=65）undergoing integration treatment , and Group B undergoing conventional treatment.A statistical analysis was performed based on their respective clinical data, emergency treatment time and prognosis, followed by an assessment on all the patients＇ prognosis according to GOS scores discharge which was known as Glasgow Outcome Score, GOS. Based on the results, the patients were divided into good prognosis groups ,and poor prognosis group. A further study on how their clinical data affected their prognosis. Results 1. The time between emergency treatment and operation of Group was shorter than group B, so were ICU time and a lower mortality, which carried statistical differences. In addition, group A left the hospital on a good prognosis rate of Glasgow outcome score 4 or 5, higher than group B. 2. The factors like age, GCS score, the time frame ambulance arriving at hospital, and emergency surgery to time ＇affected their prognosis. Conclusion The key for a successful treatment to severe craniocerebral injury is considered timely pre-hospital emergency cure and early check and operation. Tile integration of pre-hospital emergency cure and in-hospital neurosurgery treatment contributes to the successful rescue rate and improving patients＇ quality of life.