区域协同多院协作(MHT)模式救治血流动力学不稳定骨盆骨折的价值

Value of multi-hospital teamwork model in treatment of hemodynamically unstable pelvic fractures

目的探讨区域协同多院协作(MHT)模式在血流动力学不稳定骨盆骨折患者救治中的价值。方法回顾性分析2018年1月至2021年6月期间嘉兴市区域高级创伤中心救治的血流动力学不稳定骨盆骨折患者78例,其中男性55例,女性23例;年龄15~95岁,平均(55.7±15.7)岁。其中启动MHT救治机制的患者40例为MHT组,以单纯多学科协作(MDT)形式救治38例为MDT组。观察并比较两组患者的一般资料、主要致伤机制、创伤严重程度、主要化验结果、时间节点、住院指标及预后等。结果两组患者性别、年龄、创伤指数评分(TI)和创伤严重度评分(ISS)差异无统计学意义(P均>0.05)。两组患者均以交通事故为最主要的致伤机制(42.5%比60.5%),两组致伤机制比较差异无统计学意义(χ^(2)=3.899,P>0.05)。两组患者接受手术及操作治疗情况比较,差异无统计学意义(P均>0.05)。与MDT组相比,尽管MHT组入区域高级创伤中心时血红蛋白浓度(HGB)(87.7±21.9 g/L比110.3±28.5 g/L)更低,差异有统计学意义(P<0.05),但MHT组血乳酸水平(Lac)(3.5±2.1 mmol/L比5.3±3.4 mmol/L)也更低,差异有统计学意义(P<0.05)。两组碱剩余(BE)、凝血酶原时间(PT)未见明显异常,差异无统计学意义(P均>0.05)。与MDT组比较,MHT组入院至外出检查时间(19.5±7.7min比33.8±18.0min)、决定手术至送手术时间[25(18.3,36.0)min比31(20.0,41.3)min]、抢救室停留时间[45(31.3,63.3)min比78(52.8,92.5)min]明显缩短,差异有统计学意义(P均<0.05)。两组患者住院时间无明显差异,两组患者病死率分别为15.0%和15.8%,差异无统计学意义(P均>0.05)。两组患者的病死率分别为15.0%和15.8%,差异无统计学意义(P>0.05)。结论通过区域协同MHT一体救治,能提高血流动力学不稳定骨盆骨折患者的救治水平。

Objective To investigate the value of regional collaborative multi-hospital teamwork(MHT)in the treatment of patients with hemodynamically unstable pelvic fracture.Methods A retrospective analysis was performed on 78 patients with hemodynamically unstable pelvic fractures treated by Jiaxing Regional Advanced Trauma Center from January 2018 to June 2021,including 40 patients treated by MHT mechanism as MHT group and 38 patients treated by multi-disciplinary teamwork(MDT)as MDT group.The general information,main injury mechanism,severity of trauma,main laboratory results,time nodes,hospitalization indicators and prognosis of the two groups were observed and compared.Results There were no significant differences in gender,age,TI score and ISS score between two groups(P>0.05).Traffic accident was the main injury mechanism in both groups(42.5%vs60.5%),and the difference was not statistically significant(χ^(2)=3.899,P>0.05).The proportion of patients who underwent surgery and operation treatment in both groups had no statistical significance(P>0.05).Compared with MDT group,MHT group had lower blood HGB(87.7±21.9 g/L vs 110.3±28.5 g/L),but Lac level(3.5±2.1 mmol/L vs 5.3±3.4 mmol/L)was also lower;the differences were statistically significant(P<0.05).There was no significant difference in BE and PT between the two groups(P>0.05).In MHT group,the time from admission to check-up was(19.5±7.7 min vs.33.8±18.0 min),the time from decision to operation[25(18.3,36.0)min vs 31(20.0,41.3)min],and the stay time in the emergency room[45(31.3,63.3)min vs 78(52.8,92.5)min]were significantly shortened compared with MDT group,and the difference was statistically significant(P<0.05).There were no significant differences in length of hospital stay and ICU cost between the two groups,and the mortality rates were 15.0%and 15.8%,respectively,with no statistical significance(P>0.05).Conclusion Regional collaborative MHT integrated treatment can improve the treatment level of patients with hemodynamically unstable pelvic fractures.