分诊制下326例口腔颅颌面创伤急诊住院患者临床分析

Clinical analysis of emergency treatment of 326 patients with oral craniomaxillofacial trauma under triage system

目的:总结分诊制下口腔颅颌面创伤急诊救治经验。方法:回顾分析2020年9月—2021年8月间上海交通大学医学院附属第九人民医院南部院区口腔颅颌面创伤患者急诊接诊救治情况。期间共接诊36 599例患者,急诊留观处理1 683例,住院治疗326例。收集住院患者入院前处理情况,包括基础生命支持(急诊止血、液体复苏、损伤控制手术)、伤情、高级生命支持、多学科联合救治及转归情况等。采用SPSS 13.0软件包对数据进行统计学分析。结果:326例急诊入院患者中,男253例,女73例,男女比例3.47∶1;年龄20~73岁,平均(41.64±15.34)岁。最常见原因为道路交通伤(169例),其中电瓶车事故伤138例,占81.63%;其次为生活意外伤(89例),其中跌伤65例,占73.01%;工伤33例,其中坠落伤14例,占42.42%;其他损伤35例。83例进行初级生命支持(心电监护、液体复苏,清创止血),其中输血30例,气管插管或切开7例,石膏或支具外固定9例。65例实施损害控制性手术。235例直接收住口腔颅颌面科,54例根据创伤情况收入相应专科,37例收入EICU继续高级生命支持。所有患者均成功救治,326例患者经急诊或延期手术得到确切治疗,4例出院后做二期修复。结论:采取急救辅助下的专科诊治是有效解决分诊制下日益增多口腔颅颌面创伤救治需求的有效措施。由急诊科牵头,强调以生命救治、器官功能保护和重建、社会回归为中心,在各个专科之间开展协作,是口腔颅颌面多发伤救治成功的关键。

PURPOSE:To summarize the experience of emergency treatment of oral craniomaxillofacial trauma under triage system.METHODS:The emergency treatment of patients with craniomaxillofacial trauma in the Southern District of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine from September 2020 to August2021 was retrospectively analyzed.A total of 36 599 patients were treated during the period,1 683 cases were treated by emergency observation and 326 were hospitalized.Pre-admission treatment of inpatients,including basic life support(emergency hemostasis,fluid resuscitation,injury control surgery),injury situations,advanced life support,multidisci-plinary treatment and outcomes,were collected.SPSS 13.0 software package was used for statistical analysis.RESULTS:Among 326 emergency patients,253 were male and 73 were female,with a ratio of 3.47 to 1.Their age ranged from 20 to73 years,with an average of 41.64±15.34 years.The most common cause was road traffic injury(169 cases),including 138cases due to electric vehicle accident(81.63%).Life accident injury was followed by 89 cases,including 65 cases of fall injury,accounting for 73.01%.Thirty-three cases had work-related injury,including 14 of fall injury,accounting for 42.42%.Other caused of injuries were noted in 35 cases.Eighty-three patients received primary life support(ECG monitoring,fluid resuscitation,debridement and hemostasis),including 30 patients with blood transfusion,7 patients with endotracheal intubation or incision,and 9 patients with plaster or braces fixation.Damage control surgery was performed in 65 patients.A total of 235 patients were admitted directly to the Department of Oral and Craniomaxillofacial Surgery,54 patients were admitted to the corresponding specialty based on trauma,and 37 patients were admitted to EICU to continue advanced life support.All patients were successfully treated,326 patients were treated by emergency or delayed surgery,and 4 patients were discharged from hospital for secondary repair.CONCLUSIONS:Specialized diagnosis and treatment with first aid is an effective measure to solve the increasing demand for treatment of oral and maxillofacial trauma under triage system.The key to successful treatment of multiple maxillofacial injuries is to take life saving,organ function protection and reconstruction,and social regression as the center to carry out cooperation among various specialties,led by the emergency department.