多学科协作模式在血流动力学不稳定闭合性骨盆骨折早期救治的临床研究
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摘要
目的探讨多学科协作(multidisciplinary team,MDT)模式在血流动力学不稳定闭合性骨盆骨折早期救治中的临床疗效。方法回顾性分析MDT模式实施后救治的23例血流动力学不稳定骨盆骨折患者临床资料(MDT组),以及MDT诊疗模式实施前传统分诊会诊制一体化模式救治的20例患者(一体化组),其中MDT组男性15例,女性8例;年龄19～70岁,平均38. 82岁;骨盆骨折侧方挤压型(LC型) 4例、前后挤压型(APC型) 11例、纵向剪切型(VS型) 5例、复合应力型(CM型) 3例。一体化组男性13例,女性7例;年龄18～62岁,平均41. 45岁; LC型3例、APC型9例、VS型4例、CM型4例。记录两组患者围手术期心率、收缩压、术后24h尿量、总输血量、ICU平均住院时间以及病死率。结果与一体化组相比,MDT组术后6h心率明显降低(P <0. 05),术后6h收缩压升高(P <0. 01),术后24h尿量明显增多(P <0. 01);一体化组总输血量高于MDT组(P <0. 05);一体化组ICU平均住院时间高于MDT组,但差异无明显统计学意义(P=0. 272);患者病死率一体化组为15. 0%,MDT组为8. 7%,差异无明显统计学意义(χ2=0. 551,P=0. 392)。结论 MDT模式在血流动力学不稳定骨盆骨折早期救治中能稳定血流动力学,有效提高患者救治成功率。
Objective To investigate the clinical effects of multidisciplinary team approach in early treatment of hemodynamically unstable pelvic fractures. Methods All clinical data of 23 patients with hemodynamically unstable pelvic fractures was assessed after treatment by multidisciplinary team approach( MDT group). In the MDT group,there were 15 males and 8 females,with an average age of 38. 82 years( range 19-70 years). There were 4cases of lateral compression( LC),11 cases of anterior-posterior compression( APC),5 cases of vertical shearing( VS) and 3 cases of composite stress( CS) according to Young-Burgess classification. There were 20 patients in the control group,including 13 males and 7 females,with an average age of 41. 45 years( range 18-62 years). There were 3 cases of LC,9 cases of APC,4 cases of VS and 4 cases of CS. The perioperative heart rate( HR),systolic pressure( SP),24 h urine volume after operation,the total amount of blood transfusion,the average stay in ICU and mortality were analyzed. Results Compared with the control group,HR decreased( P < 0. 05),SP and 24 h urine volume increased( P < 0. 01) at 6 h after surgery in the MDT group. The total amount of blood transfusion of patients in the control group was greater than that in the MDT group( P < 0. 05); The average stay in ICU of the control group was longer than that of the MDT group,but the difference was not statistically significant( P = 0. 272). The mortality of the control group was 15. 0%,and 8. 7% in the MDT group,and the difference was not statistically significant( χ~2= 0. 551,P = 0. 392). Conclusion Multidisciplinary team approach in early treatment of hemodynamically unstable pelvic fractures can stabilize the hemodynamics,and effectively improve the success rate of therapy.
Objective To investigate the clinical effects of multidisciplinary team approach in early treatment of hemodynamically unstable pelvic fractures. Methods All clinical data of 23 patients with hemodynamically unstable pelvic fractures was assessed after treatment by multidisciplinary team approach( MDT group). In the MDT group,there were 15 males and 8 females,with an average age of 38. 82 years( range 19-70 years). There were 4cases of lateral compression( LC),11 cases of anterior-posterior compression( APC),5 cases of vertical shearing( VS) and 3 cases of composite stress( CS) according to Young-Burgess classification. There were 20 patients in the control group,including 13 males and 7 females,with an average age of 41. 45 years( range 18-62 years). There were 3 cases of LC,9 cases of APC,4 cases of VS and 4 cases of CS. The perioperative heart rate( HR),systolic pressure( SP),24 h urine volume after operation,the total amount of blood transfusion,the average stay in ICU and mortality were analyzed. Results Compared with the control group,HR decreased( P < 0. 05),SP and 24 h urine volume increased( P < 0. 01) at 6 h after surgery in the MDT group. The total amount of blood transfusion of patients in the control group was greater than that in the MDT group( P < 0. 05); The average stay in ICU of the control group was longer than that of the MDT group,but the difference was not statistically significant( P = 0. 272). The mortality of the control group was 15. 0%,and 8. 7% in the MDT group,and the difference was not statistically significant( χ~2= 0. 551,P = 0. 392). Conclusion Multidisciplinary team approach in early treatment of hemodynamically unstable pelvic fractures can stabilize the hemodynamics,and effectively improve the success rate of therapy.
引文
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[2] Tanizaki S,Maeda S,Matano H,et al. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min[J]. Injury,2014,45(4):738-741.
[3] Mauffrey C,Cuellar III DO,Pieracci F,et al. Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy[J]. Bone Joint J,2014,96-B(9):1143-1154.
[4] Nancarrow SA,Booth A,Ariss S,et al. Ten principles of good interdisciplinary team work[J]. Human Resources for Health,2013,11:19.
[5]姚元章.多发伤院内早期急救[J].创伤外科杂志,2013,15(1):93-95.
[6]吕扬,周方,郑亚安,等.多学科合作模式创伤中心救治严重多发伤患者的初步探索[J].中华创伤杂志,2016,32(12):1111-1114.
[7] Zhao XG. Emergency management of hemodynamically unstable pelvic fractures[J]. Chin J Traumatol,2011,14(6):363-366.
[8]彭吾训,吴建华,龚翔,等.液体复苏在未控制性创伤失血性休克中的应用[J].中华急诊医学杂志,2012,21(8):895-897.
[9]邓进,张连阳.我国创伤中心建设的困境与对策[J].中华灾害救援医学,2017,5(8):464-466.
[10] Yang F,Bai XJ,Li ZF. Analysis of misdiagnosis in patients with multiple trauma[J]. Chin J Traumatol,2011,14(1):20-24.