急救网络建设在危重氢氟酸烧伤患者早期救治中的作用

The role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns

目的探讨急救网络建设在危重氢氟酸烧伤患者早期救治中的作用。方法以浙江省、江西省、福建省、内蒙古自治区的27家氟化工企业,浙江省内有烧伤/整形科或烧伤专业组的包括浙江衢化医院在内的22家医院及省外5家医院为成员单位,进行氢氟酸烧伤急救网络建设,其中浙江衢化医院是急救网络的主体单位,负责急救网络的日常维护和技术指导。20家氟化工企业的定点急救医院是浙江衢化医院,7家氟化工企业就近指定1家定点急救医院。收集2006年1月—2021年6月5家急救网络医院收治的符合入选标准的56例(均为男性)危重氢氟酸烧伤患者的病历资料,进行回顾性队列研究。按照患者所在企业是否纳入急救网络建设,将患者分为急救网络组[27例,年龄(41±9)岁]和非急救网络组[29例,年龄(42±10)岁]。急救网络组的患者伤后所在企业立即与医院联动,接诊医院利用急救网络,提前调集救治力量、设备和物资药品,做到院前急救与院内治疗无缝对接。非急救网络组患者到达医院急诊科后启动急救流程,临时调集救治力量、设备和物资药品。统计2组患者的院前时间、血钙首次检出时间、急诊科停留时间、低钙血症与低镁血症持续时间,以及治疗转归情况。对数据行χ^(2)检验、Fisher确切概率法检验、独立样本t检验、Wilcoxon秩和检验。结果急救网络组患者的院前时间、血钙首次检出时间、急诊科停留时间分别为40.0(30.0,55.0)、23.0(17.5,37.5)、42.0(37.0,53.0)min,明显短于非急救网络组的180.0(120.0,240.0)、31.0(22.5,47.5)、61.0(52.0,65.5)min(Z=-6.17、-1.98、-4.15,P<0.05或P<0.01)。急救网络组患者伤后低钙血症、低镁血症持续时间为1.2(1.1,1.6)、1.9(1.7,2.1)h,明显短于非急救网络组的4.6(3.1,6.2)、3.2(2.5,4.6)h(Z=-5.80、-4.81,P<0.01)。急救网络组患者死亡3例(11.1%),其中2例患者于伤后40 min死亡,另1例患者于伤后9.0 h死亡;非急救网络组患者死亡4例(13.8%),分别于伤后3.0、3.0、4.5、7.0 h死亡。2组患者病死率相近(P>0.05)。结论危重氢氟酸烧伤是临床上遇到的非常紧急的状况,急救网络建设为患者就地救治创造了条件,提高了急救效率,从而为挽救生命赢得时间。

Objective To explore the role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns.Methods Twenty-seven fluorine chemical enterprises distributed in Zhejiang province,Jiangxi Province,Fujian Province,and Inner Mongolia Autonomous Region and 22 hospitals with burn/plastic department or professional burn treatment group in Zhejiang province,including Zhejiang Quhua Hospital,and 5 hospitals outside Zhejiang province were involved in the first-aid network construction as member units.As the main unit,Zhejiang Quhua Hospital was responsible for the daily maintenance and technical guidance of the first-aid network.Zhejiang Quhua Hospital was assigned as the designated emergency hospital for 20 fluorine chemical enterprises,a near emergency hospital to the other 7 fluorine chemical enterprises was assigned as the designated hospital for them.Medical records of 56 patients(all males)with critically severe hydrofluoric acid burns who admitted to 5 first-aid network hospitals from January 2006 to June 2021,meeting the inclusion criteria,were involved in the retrospective cohort study.Based on whether the enterprise belonging to the first-aid network construction or not,the patients were divided into first-aid network group(27 cases,aged(41±9)years)and non first-aid network group(29 cases,aged(42±10)years).After the patients in the first-aid network group were injured,the enterprises and hospitals linked up immediately.The hospital where the patient was treated mobilize the treatment force,equipment,materials,and drugs in advance by the first-aid network,thereby realizing seamless joint between pre-hospital first-aid and in-hospital treatment.The hospital started the first-aid process and temporarily mobilized the rescue forces,equipment,materials,and drug after patients in non first-aid network group arrived at the department of emergency of the hospital.The time from injury to medical service,the first detection time of serum calcium,the time staying in department of emergency,the duration of hypocalcemia and hypomagnesemia,and the treatment outcome of patients in the two groups were recorded.Data were statistically analyzed with chi-square test,Fisher's exact probability test,independent-sample t test,and Wilcoxon rank-sum test.Results The time from injury to medical service,the first detection time of serum calcium,and the time staying in department of emergency of patients in first-aid network group were 40.0(30.0,55.0),23.0(17.5,37.5),and 42.0(37.0,53.0)min,which were significantly shorter than 180.0(120.0,240.0),31.0(22.5,47.5),61.0(52.0,65.5)min in non first-aid network group(Z=-6.17,-1.98,-4.15,P<0.05 or P<0.01).The duration of hypocalcemia and hypo-magnesemia of patients in first-aid network group were 1.2(1.1,1.6)and 1.9(1.7,2.1)h,which were significantly shorter than 4.6(3.1,6.2)and 3.2(2.5,4.6)h in non first-aid network group(Z=-5.80,-4.81,P<0.01).Three patients(11.1%)in first-aid network group died,among whom 2 patients died at 40 min after injury and 1 patient died 9.0 h after injury.Four patients(13.8%)died in non first-aid network group at 3.0,3.0,4.5,and 7.0 h after injury,respectively.The mortality rates of patients in the two groups were similar(P>0.05).Conclusions Critically severe hydrofluoric acid burn is an extremely urgent situation encountered in clinical practice.The construction of a first-aid network creates condition for on-site treatment of patients and improves the first-aid efficiency,thereby gaining time to save lives.