创伤一体化救治方案用于重度创伤性颅脑损伤的效果及对患者凝血功能与神经功能的影响

Efficacy of a trauma-integrated treatment program for severe traumatic brain injury and its effect on patients'coagulation and neurological functions

目的探讨创伤一体化救治方案用于重度创伤性颅脑损伤的效果及对患者凝血功能与神经功能的改善作用。方法采取回顾性分析法,将2020年4月至2022年10月金华市中心医院创伤外科收治的重度创伤性颅脑损伤患者114例按救治方案不同分成A组与B组,A组57例采用急诊常规救治方案,B组57例采用创伤一体化救治方案。观察两组的急诊救治效率(急诊室停留时间、辅助检查等待时间、多学科会诊等待时间、急诊转手术时间)、凝血功能(凝血酶原时间、凝血酶时间、活化部分凝血活酶时间)、神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]、并发症发生率(应激性溃疡、肺部感染、高钠血症、脑性盐耗综合征)以及预后情况。结果B组急诊室停留时间、辅助检查等待时间、多学科会诊等待时间、急诊转手术时间[(21.94±6.21)min、(5.78±1.12)min、(10.58±2.47)min、(8.57±2.01)min]短于A组[(32.59±6.83)min、(9.46±2.57)min、(17.36±3.71)min、(15.36±4.49)min](t=8.71、9.91、11.48、10.42,均P<0.001);B组治疗后的凝血酶原时间、凝血酶时间、活化部分凝血活酶时间[(19.78±2.32)s、(21.16±2.60)s、(39.35±4.60)s]均短于A组[(21.83±2.63)s、(23.28±2.95)s、(42.16±5.52)s](t=4.41、P<0.001,t=4.07、P<0.001,t=2.95、P=0.002);B组治疗后的NIHSS评分为(13.55±3.17)分,低于A组的(18.36±3.83)分(t=7.30、P<0.001);B组并发症发生率[7.02%(4/57)]低于A组[22.81%(13/57)](χ^(2)=5.60、P=0.018);B组预后良好率[66.67%(38/57)]高于A组[47.37%(27/57)](χ^(2)=4.33、P=0.037)。结论创伤一体化救治方案用于重度创伤性颅脑损伤的效果较好,能够提高急诊救治效率,改善患者的凝血功能与神经功能,且能减少并发症发生,有利于预后。

Objective To investigate the efficacy of a trauma-integrated treatment program for severe traumatic brain injury and its effect on patients'coagulation and neurological functions.Methods A total of 114 patients with severe traumatic brain injury who received treatment at the Department of Trauma Surgery at the Jinhua Municipal Central Hospital from April 2020 to October 2022 were retrospectively included in this study.The patients were divided into two groups based on different treatment protocols:Group A(n=57 patients)received the conventional emergency treatment protocol,while Group B(n=57 patients)received the trauma-integrated treatment protocol.The emergency treatment efficiency(including emergency room stay time,waiting time for auxiliary examinations,waiting time for multidisciplinary consultations,and time from emergency to surgery),coagulation function(prothrombin time,thrombin time,activated partial thromboplastin time),neurological function(National Institutes of Health Stroke Scale),incidence of complications(stress ulcers,pulmonary infections,hypernatremia,and cerebral salt-wasting syndrome),and prognosis were compared between the two groups.Results The emergency room stay time,waiting time for auxiliary examinations,waiting time for multidisciplinary consultations,and time from emergency to surgery in Group B[(21.94±6.21)minutes,(5.78±1.12)minutes,(10.58±2.47)minutes,and(8.57±2.01)minutes]were significantly shorter than those in Group A[(32.59±6.83)minutes,(9.46±2.57)minutes,(17.36±3.71)minutes,(15.36±4.49)minutes,t=8.71,9.91,11.48,10.42,all P<0.001].After treatment,the prothrombin time,thrombin time,and activated partial thromboplastin time in Group B[(19.78±2.32)seconds,(21.16±2.60)seconds,(39.35±4.60)seconds]were significantly shorter than those in Group A[(21.83±2.63)seconds,(23.28±2.95)seconds,(42.16±5.52)seconds,t=4.41,P<0.001,t=4.07,P<0.001,t=2.95,P=0.002].The National Institutes of Health Stroke Scale score after treatment in Group B[(13.55±3.17)points]was significantly lower than that in Group A[(18.36±3.83)points,t=7.30,P<0.001].The incidence of complications in Group B[7.02%(4/57)]was significantly lower than that in Group A[22.81%(13/57),χ^(2)=5.60,P=0.018].The rate of good prognosis in Group B[66.67%(38/57)]was significantly higher than that in Group A[47.37%(27/57),χ^(2)=4.33,P=0.037].Conclusion The trauma-integrated treatment protocol is effective for severe traumatic brain injury,as it improves emergency treatment efficiency,enhances coagulation and neurological functions,reduces the incidence of complications,and is beneficial for prognosis.