实时远程会诊系统对严重交通伤救治的应用效果研究

Application of a real-time remote consultation system based on augmented reality technology

目的探讨基于增强现实(AR)技术的交通伤医疗资源共享平台在交通伤患者处置过程中的应用效果。方法回顾性分析2016年6月—2020年12月厦门大学附属东南医院急诊科应用基于AR的交通伤医疗资源共享平台模式救治严重交通伤患者56例(观察组),2012年6月—2016年5月该平台启用前严重交通伤患者68例(对照组)。两组患者均按创伤中心严重创伤患者常规救治流程进行规范救治,观察组在此基础上由院前“120”急救医师利用实时远程视频会诊信息系统实时传输患者情况,院内急救专家根据实时音视频远程指导事发现场与运送途中抢救,指导包括建立人工气道、损伤控制性复苏、大血管夹闭等救命性操作。比较两组患者急诊室滞留时间,入院至手术时间和住院天数,漏诊发生率和并发症发生率,会诊次数,在呼吸机使用、抢救、休克、器官功能障碍等方面的发生率,抢救成功率及病死率。结果两组患者性别、年龄、ISS等指标比较差异无统计学意义(P>0.05);观察组急诊室滞留时间(18.8±5.4)min、入院至手术时间(44.1±9.1)min、住院天数(21.5±3.4)d均短于对照组(27.0±4.1)min、(62.6±7.2)min、(31.0±5.6)d(P<0.05);观察组漏诊发生率12.5%和并发症发生率19.6%低于对照组30.8%、38.2%(P<0.05);观察组会诊次数(1.2±0.2)次少于对照组(2.1±0.3)次(P<0.001);观察组呼吸机使用(21.4%)、抢救(19.6%)、休克(17.8%)、器官功能障碍(23.2%)发生率均低于对照组39.7%、44.1%、38.2%、42.6%(P<0.05);观察组抢救成功率89.3%高于对照组82.4%(P<0.05),病死率10.7%低于对照组17.6%(P<0.05)。结论基于AR技术的交通伤医疗资源共享平台模式在急诊室滞留时间,入院至手术时间和住院天数,漏诊发生率和并发症发生率,会诊次数,在呼吸机使用、抢救、休克、器官功能障碍等方面的发生率,抢救成功率,病死率等方面均优于该平台启用前,降低了患者的漏诊和并发症风险,在危重症患者的救治方面有更好的效果。

Objective To investigate the application effect of a real-time remote consultation system based on augmented reality(AR)technology in the treatment of severe road traffic injury(RTI)patients.Methods A retrospective analysis was conducted on 56 severe RTI patients admitted to Southeast Hospital affiliated to Xiamen University between Jun.2016 and Dec.2020 after(observational group)and 68 RTI patients between Jun.2012 and May 2016 before(control group)the application of this real-time remote consultation system.All the patients were treated according to the standard rescue procedures for severe trauma patients.For the 56 patients in the observational group,via the real-time remote video consultation information system,the pre-hospital"120"emergency physicians were able to transmit patient conditions,and the in-hospital emergency experts could provide on-line guidance for rescue operations at the scene of RTI and during transport,including life-saving procedures of artificial airway establishment,damage control resuscitation,and major vascular clamping.The two groups were compared in terms of emergency room stay,time from admission to surgery,length of hospital stay,missed diagnosis rate,complication rate,number of consultations,incidence of ventilator use/resuscitation/shock/organ dysfunction,rescue success rate,and mortality rate.Results There were no statistical differences in gender,age,ISS,etc.between the two groups(all P>0.05).Compared with the control group,the observational group showed a shorter time of emergency depart-ment stay(min,18.8±5.4 vs.27.0±4.1),admission to surgery(min,44.1±9.1 vs.62.6±7.2)and hospital stay(d,21.5±3.4 vs.31.0±5.6),lower incidence of missed diagnosis(12.5%vs.30.8%)and complications(19.6%vs.38.2%),less numbers of consultation(1.2±0.2 vs.2.1±0.3)and less incidence of mechanical ven-tilation use(21.4%vs.39.7%),resuscitation(19.6%vs.44.1%),shock(17.8%vs.38.2%)and organ dys-function(23.2%vs.42.6%),all revealing statistically significant difference(all P<0.05).Moreover,the obser-vation group had a much higher success rate of resuscitation(89.3%vs.82.4%)and a much lower mortality rate(10.7%vs.17.6%,both P<0.05).Conclusion The use of the real-time remote consultation system based on AR technology can well manage the pre-and in-hospital information change,shorten the in-hosptial preparation and surgery time,improve rescue success and decrease complications and mortality,and thus is beneficial for the rescue of severe RTI patients.