徒手颅骨固定法联合颈托制动在颈椎损伤院前急救的临床研究
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摘要
目的探讨徒手颅骨固定法联合颈托制动在颈椎损伤院前急救的临床研究。方法回顾性分析2014-01-2016-02期间我院确诊治疗的颈椎损伤患者160例,依据院前急救方法分为固定制动组(n=85例)和常规组(n=75例),常规组患者给予常规院前急救干预,固定制动组患者在此基础上给予徒手颅骨固定法联合颈托制动干预,采用卡诺夫斯基健康状况量表(KPS)评估生存质量,随访6个月,统计分析所有患者干预前(T0)、上急救车时(T1)、下车时(T2)、上楼梯时(T3)的心率(HR)、平均动脉压(MAP)水平和瘫痪、院内死亡、生存质量情况。结果固定制动组患者T1、T2、T3时刻的HR水平明显低于常规组,有显著性差异(P<0.05);固定制动组患者T1、T2、T3时刻的MAP水平明显低于常规组,有显著性差异(P<0.05);固定制动组患者瘫痪、院内死亡发生率明显低于常规组,前者KPS得分明显高于后者,有显著性差异(P<0.05)。结论徒手颅骨固定法联合颈托制动干预可有效改善颈椎损伤患者院前急救过程中的生命体征状态,有利于改善患者救治后的生存质量,值得临床作进一步推广。
Objective To discuss the clinical application of unarmed skull collar fixed method combined with neck braking in pre-hospital care of cervical spine injury. Methods From January2014 to February 2016, the clinical data of 160 patients with cervical spine injury in our hospital were retrospectively analyzed. According to the pre-hospital first aid methods, the patients were divided into fixed braking group(85 cases) and control group(75 cases). The control group was given regular prehospital emergency intervention, on the basis of this, fixed braking group was given unarmed skull collar fixed method combined with neck braking. The Kanofsky health status scale(KPS) was used to assess the quality of life. The patients were followed up for 6 months, the heart rate(HR), mean arterial pressure(MAP), paralysis, in-hospital death, quality of life before intervention(T0), when on the ambulance(T1), got off the bus(T2), climbing upstairs(T3) were analyzed. Results At T1, T2, T3 moments, HR levels of fixed braking group were significantly lower than those of the control group, the differences were significant(P <0.05). MAP levels at T1, T2 and T3 in fixed braking group were significantly lower than those in the control group, the differences were significant(P <0.05). The incidence rates of paralysis, hospital death in fixed braking group were obviously lower than those in the control group, the former KPS score was significantly higher than the latter, there were significant differences(P<0.05). Conclusions Application of unarmed skull collar fixed method combined with neck braking in the patients with cervical spine injury can effectively improve state of vital signs in the process of pre-hospital first aid, it can improve the quality of life in patients after treatment, it's worthy of further clinical promotion.
Objective To discuss the clinical application of unarmed skull collar fixed method combined with neck braking in pre-hospital care of cervical spine injury. Methods From January2014 to February 2016, the clinical data of 160 patients with cervical spine injury in our hospital were retrospectively analyzed. According to the pre-hospital first aid methods, the patients were divided into fixed braking group(85 cases) and control group(75 cases). The control group was given regular prehospital emergency intervention, on the basis of this, fixed braking group was given unarmed skull collar fixed method combined with neck braking. The Kanofsky health status scale(KPS) was used to assess the quality of life. The patients were followed up for 6 months, the heart rate(HR), mean arterial pressure(MAP), paralysis, in-hospital death, quality of life before intervention(T0), when on the ambulance(T1), got off the bus(T2), climbing upstairs(T3) were analyzed. Results At T1, T2, T3 moments, HR levels of fixed braking group were significantly lower than those of the control group, the differences were significant(P <0.05). MAP levels at T1, T2 and T3 in fixed braking group were significantly lower than those in the control group, the differences were significant(P <0.05). The incidence rates of paralysis, hospital death in fixed braking group were obviously lower than those in the control group, the former KPS score was significantly higher than the latter, there were significant differences(P<0.05). Conclusions Application of unarmed skull collar fixed method combined with neck braking in the patients with cervical spine injury can effectively improve state of vital signs in the process of pre-hospital first aid, it can improve the quality of life in patients after treatment, it's worthy of further clinical promotion.
引文
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[8]Sik H,Saracoglu E,Harmanci H,et al.Designof a cervical collar device to facilitate andaccelerate implementation of first aid[J].JMed Syst,2010,34(4):573-578.
[2]唐春福,付卫林.院前高能量创伤颈椎损伤特点分析与急救策略[J].浙江创伤外科,2016,21(4):695-696.
[3]Dietrich WD,Levi AD,Wang M,et al.Hypothermic treat-ment for acute spinal cord injury[J].Neurotherapeutics,2011,8(2):229-239.
[4]Knox JB,Schneider JE,Cage JM,et al.Spine traumain very young children:a retrospective study of206patients presenting to a level 1pediatric traumacenter[J].J Pediatr Orthop,2014,34(7):698-702.
[5]王莉.颈椎损伤合并重型颅脑损伤患者38例的早期护理[J].江苏医药,2016,42(6):740-741.
[6]杜敏.颈托制动在急性脑血管意外患者院前急救中的初步应用[J].中国当代医药,2014,21(5):20-22.
[7]刘志明.颅脑损伤患者院前急救中应用颈托制动的效果分析[J].中国当代医药,2014,21(14):62-64.
[8]Sik H,Saracoglu E,Harmanci H,et al.Designof a cervical collar device to facilitate andaccelerate implementation of first aid[J].JMed Syst,2010,34(4):573-578.