休克指数与创伤评分在腹部闭合伤早期评估中的应用
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摘要
目的探讨休克指数与创伤评分在腹部闭合伤患者早期病情评估中的应用。方法选择上海市某三级甲等医院急诊科2011年11月—2012年2月收治的腹部闭合伤患者45例,以2011年11—12月的19例患者为对照组,以2012年1—2月的26例患者为观察组。观察组采用休克指数与创伤评分结合对腹部闭合伤患者进行病情评估,对照组采用创伤评分对患者病情进行评估。观察两种方法判断腹腔内出血的准确率、灵敏度和抢救时间。结果在判断腹部闭合伤患者腹腔内出血的准确率方面,观察组与对照组比较差异有统计学意义(P=0.027);休克指数>0.7用于判断脏器破裂腹腔出血的灵敏度高于单纯使用心率(HR)>100次/min和收缩压(SBP)<90 mm Hg时的灵敏度;与仅用创伤评分评估相比,休克指数与创伤评分结合评估使抢救患者的总时间缩短了30 min。结论在腹部闭合伤患者早期病情评估中,采用休克指数结合创伤评分法更能提高对患者休克状态的检出,及时判断腹部脏器是否出血,有利于患者早日得到准确与正确的诊治。
Objective To study the application of shock index combined with circulation, respiration,abdomen,motor and speech( CRAMS) scale in the early assessment of anti-shock treatment of closed abdominal injury. Methods A total of 45 cases with closed abdominal injury in a tertiary hospital in Shanghai were chosen in the study. Nineteen cases hospitalized from November to December 2011 were enrolled in the control group. Twenty-six cases hospitalized from January to February 2012 were enrolled in the observation group. All the cases received conventional anti-shock treatment. The anti-shock index combined with CRAMS scale was used in the observation group,and CRAMS scale was used in the control group. The accuracy and sensitivity of judging abdominal cavity hemorrhage and rescue time were compared between the two groups.Results There was no significant difference in the accuracy of judging abdominal cavity hemorrhage between the two groups( P = 0. 027). Compared with heart rate > 100 beats / min and systolic blood pressure( SBP) <90 mm Hg,the sensitivity of shock index > 0. 7 in judging abdominal cavity hemorrhage was higher. Compared with the control group,the total rescue time reduced 30 min in the observation group. Conclusion In the early assessment of anti-shock treatment of closed abdominal injury,anti-shock index combined with CRAMS scale could significantly improve the detection rate of shock,judge abdominal cavity hemorrhage in time,and make the early diagnosis and treatment available.
Objective To study the application of shock index combined with circulation, respiration,abdomen,motor and speech( CRAMS) scale in the early assessment of anti-shock treatment of closed abdominal injury. Methods A total of 45 cases with closed abdominal injury in a tertiary hospital in Shanghai were chosen in the study. Nineteen cases hospitalized from November to December 2011 were enrolled in the control group. Twenty-six cases hospitalized from January to February 2012 were enrolled in the observation group. All the cases received conventional anti-shock treatment. The anti-shock index combined with CRAMS scale was used in the observation group,and CRAMS scale was used in the control group. The accuracy and sensitivity of judging abdominal cavity hemorrhage and rescue time were compared between the two groups.Results There was no significant difference in the accuracy of judging abdominal cavity hemorrhage between the two groups( P = 0. 027). Compared with heart rate > 100 beats / min and systolic blood pressure( SBP) <90 mm Hg,the sensitivity of shock index > 0. 7 in judging abdominal cavity hemorrhage was higher. Compared with the control group,the total rescue time reduced 30 min in the observation group. Conclusion In the early assessment of anti-shock treatment of closed abdominal injury,anti-shock index combined with CRAMS scale could significantly improve the detection rate of shock,judge abdominal cavity hemorrhage in time,and make the early diagnosis and treatment available.
引文
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[11]张佳丽,王先英,辛敏.98例多发伤病人的急救护理[J].全科护理,2013,11(7):615-616.
[12]由悦.休克指数与异位妊娠破裂的相关性研究[J].首都医药,2010,17(12):33.
[13]Birkhahn RH,Gaeta TJ,Terry D,et al.Shock index in diagnosing early acute hypovolemia[J].Am J Emerg Med,2005,23(3):323-326.
[14]汪洋,王玉芝,刘志.休克指数在腹腔实质性脏器闭合性损伤休克早期中的应用[J].山东医药,2009,49(48):93-94.
[15]张秀英,何力.利用休克指数指导失血性休克病人的急救观察与护理[J].家庭护士(下旬刊),2008,6(27):2478.
[16]项涛.休克指数对急性危重病人预后的判断价值[J].四川省卫生管理干部学院学报.2006,25(3):208.
[17]任秀聪.生命体征和休克指数预测异位妊娠破裂的应用价值[J].中国医药导刊,2008,10(5):658,660.
[18]景炳文.创伤与失血性休克[J].中华急诊医学杂志,2003,12(3):215-216.
[19]吴恒义,杨春华,白涛.休克指数补液公式在严重创伤休克治疗中的应用[J].华南国防医学杂志,1999,13(3):1-2.
[20]刘芳年,陈淑华.用休克指数估计创伤病人失血量[J].青海医药杂志,1998,28(7):54.
[2]邓普珍.临床休克学[M].上海:上海科学技术出版社,2006:57.
[3]Cannon CM,Braxton CC,Klig-Smith M,et al.Utility of the shock index in predicting mortality in traumatically injured patients[J].J Trauma,2009,67(6):1426-1430.
[4]Gormican SP.CRAMS scale:field triage of trauma victims[J].Ann Emerg Med,1982,11(3):132-135.
[5]李玉乐,孙红,胡英丽,等.休克指数在失血性危重症患者救护中的应用现状[J].护理管理杂志,2010,10(9):655-657.
[6]田利华,廖忆刘.创伤评分法应用评价[J].中华创伤杂志,2001,17(3):138-140.
[7]张开伟,项舟,段宏.创伤评分法在地震伤骨盆骨折并多发损伤中的运用及相应的伤害控制策略[J].实用医学杂志,2010,26(2):254-256.
[8]Toosi MS,Merlino JD,Leeper KV.Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism[J].Am J Cardiol,2008,101(5):700-705.
[9]Eichhorn V,Goepfert MS,Eulenburg C,et al.Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution:A meta-analysis of the literature[J].Med Intensiva,2012,36(7):467-474.
[10]郜向阳,王献良.小儿腹部闭合性损伤的特点及治疗体会[J].中国实用医药,2011,6(5):86-87.
[11]张佳丽,王先英,辛敏.98例多发伤病人的急救护理[J].全科护理,2013,11(7):615-616.
[12]由悦.休克指数与异位妊娠破裂的相关性研究[J].首都医药,2010,17(12):33.
[13]Birkhahn RH,Gaeta TJ,Terry D,et al.Shock index in diagnosing early acute hypovolemia[J].Am J Emerg Med,2005,23(3):323-326.
[14]汪洋,王玉芝,刘志.休克指数在腹腔实质性脏器闭合性损伤休克早期中的应用[J].山东医药,2009,49(48):93-94.
[15]张秀英,何力.利用休克指数指导失血性休克病人的急救观察与护理[J].家庭护士(下旬刊),2008,6(27):2478.
[16]项涛.休克指数对急性危重病人预后的判断价值[J].四川省卫生管理干部学院学报.2006,25(3):208.
[17]任秀聪.生命体征和休克指数预测异位妊娠破裂的应用价值[J].中国医药导刊,2008,10(5):658,660.
[18]景炳文.创伤与失血性休克[J].中华急诊医学杂志,2003,12(3):215-216.
[19]吴恒义,杨春华,白涛.休克指数补液公式在严重创伤休克治疗中的应用[J].华南国防医学杂志,1999,13(3):1-2.
[20]刘芳年,陈淑华.用休克指数估计创伤病人失血量[J].青海医药杂志,1998,28(7):54.