综合创伤中心模式救治严重多发伤患者的临床探索

Clinical exploration of treating the patients of severe multiple injuries with comprehensive trauma center mode

目的探讨以综合医院重症监护病房(ICU)创伤单元为主导,联动院前、院内一体化救治的闭环式区域性创伤救治体系,以综合医院创伤中心及多学科协作诊疗(MDT)团队替代发达国家的独立创伤中心建设思路,探索本地区现阶段创伤体系建设的有效模式。方法采用回顾性病例对照研究分析2021年1月前后两年251例严重多发伤患者的临床资料,其中2021年1月至2023年6月采用以ICU创伤单元为主导的综合创伤中心救治模式救治的严重多发伤患者126例为观察组,2019年1月至2020年12月采用MDT的严重多发伤患者125例为对照组,分析两组患者一般资料,观察记录两组患者的28 d病死率,同时分析记录两组患者的抢救厅滞留时间、开始急诊手术时间及完成影像学检查时间。结果两组患者急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、损伤严重度评分(ISS)差异无统计学意义(P>0.05);观察组患者28 d病死率明显低于对照组,差异有统计学意义(P<0.05);同时观察组患者完成影像学检查时间(min:14.40±3.10 vs.26.00±5.28)、抢救厅滞留时间(min:32.90±10.65 vs.68.20±21.33)、急诊手术时间(min:39.8±13.72 vs.108.10±59.94)均明显短于对照组,差异有统计学意义(P<0.001)。结论以ICU为主导的综合创伤中心救治模式的建立,构建了严重创伤救治的一体化流程,能够规范严重创伤救治体系,提高严重多发伤患者救治成功率,极大缩短严重多发伤患者的救治时间,值得临床推广。

Objective To explore a closed-loop regional trauma treatment system based on the intensive care Unit(ICU)trauma unit in general hospitals and integrated pre-hospital and in-hospital treatment,and to replace independent trauma centers in developed countries with comprehensive trauma centers and multidisciplinary treatment(MDT)teams in general hospitals,and to explore an effective mode of trauma system construction in this region.Methods A retrospective case-control study was used to analyze the clinical data of 251 patients with severe multiple injuries in the two years before and after January 2021,126 patients with severe multiple injuries were treated with comprehensive trauma center mode in which the trauma unit of ICU played a leading role from January 2021 to June 2023 as the observation group,and 125 patients with severe multiple injuries were treated with MDT mode from January 2019 to December 2020 as the control group.The general data of the patients in two groups were analyzed,the 28-day fatality rate of the patients in two groups was observed and recorded,and the time of staying in the emergency room,the time of starting emergency surgery and the completion time of image examination were analyzed and recorded.Results There was no significant difference in acute physiology and chronic health evaluationⅡ(APACHEⅡ)and injury severity score(ISS)between the two groups(P>0.05),and the 28-day fatality rate in the observation group was significantly lower than that in the control group(P<0.05).At the same time,the completion time of image examination(min:14.40±3.10 vs.26.00±5.28),the time of staying in the emergency room(min:32.90±10.65 vs.68.20±21.33)and the emergency operation time(min:39.80±13.72 vs.108.10±59.94 min)of the observation group were significantly shorter than those of the control group,the difference was statistically significant(P<0.001).Conclusions The establishment of a comprehensive trauma center mode led by the trauma unit of ICU can achieve an integrated process of severe trauma treatment,standardize severe trauma treatment system,improve the success rate of treatment,and greatly shorten the treatment time for the patients with severe multiple injuries,which is worthy of clinical promotion.