严重多发伤的医院-社区一体化救治

Hospital and community integration treatment of severe multiple injuries

目的观察严重多发伤的医院-社区一体化救治效果。方法回顾2014—04～2016—03柳州市柳铁中心医院急诊科在所属南站社区卫生服务中心管辖区域内救治的严重多发伤患者83例，入选标准：ISS≥16分；未成年、孕妇及合并慢性病患者除外。“120”指派或直接电联社区卫生服务中心通过医院-社区联动救治患者49例为A组，通过“120”指派直接从同一区域救治患者34例为B组，观察两组病例在急救反应时间、急诊处置时间、急诊补液量、急诊病死率、有效救治时间、输血量、SICU住院时间、住院并发症发生率、总病死率、远期（6个月）致残率、远期精神障碍发生率以及患者满意度等指标，综合性评判医院-社区一体化创伤救治效果。结果A组病例急救反应时间、急诊处置时间、急诊病死率、有效救治时间、输血量、ICU住院时间、并发症发生率和总病死率、远期致残率、精神障碍发生率等均低于B组病例，两组比较差异有统计学意义（P〈0．05）；A组对医疗的整体满意度高于B组，两组比较差异有统计学意义（P〈0．05）；急诊补液量A组略低于B组，两组比较差异无统计学意义（P〉0．05）。结论医院-社区一体化救治有利于缩短急救反应时间，提高救治时效性，降低ICU住院时间，降低创伤病死率，改善远期预后。

Objective To observe the effect of hospital - community integration in the treatment of severe multiple injuries. Methods The retrospective study included 83 patients with severe multiple injuries （inclusion criteria （1）ISS ≥ 16; （2）except minors, pregnant women; patients with chronic diseases） , who have be treated in the area under the jurisdiction of the community health service center of Liuzhou Railway Central Hospital. 49 cases of patients who have been helped through the hospital - community linkage treatment by the way of assignment by ＂120＂ or directly connecting to the community health service center were sent to A group; 34 cases who have been directly helped through the ＂120＂ instruction were sent to B group. The two groups were observed in the emergency response time, emergency handling time, emergency emergency fluid volume, mortality rate, effective treatment time, blood transfusion, SICU hospitalization time, complication rate, total mortality, long - term （ 6 months） and long - term morbidity, the incidence of mental disorders and the patients satisfaction index, comprehensive evaluation of hospital - community integration trauma treatment effect. Results The difference between the lwo groups was statistically significant in the emergency response time, emergency handling time, emergency emergency fluid volume, mortality rate, effective treatment time, blood transfusion, SICU hospitalization time, complication rate, total mortality, long - term （6 months） and long - term morbidity, the incidence of mental disorders and the patient satisfaction index. Conclusion Hospital -community integration treatment is conducive to shorten the emergency response time, improve the treatment of timeliness, reduce the length of hospital stay of ICU, reduce mortality, and improve the long- term prognosis.