国际创伤生命支持技术在院前严重创伤救治中的应用研究
|
摘要
目的探讨院前严重创伤救治中引入国际创伤生命支持(international trauma life support,ITLS)技术的临床应用。方法选择2017-06至2018-05院前严重创伤救治后收住镇江市第一人民医院的150例患者为研究对象,采用回顾性对照方式,将院前创伤常规救治病例(n=75)为对照组,而运用ITLS技术处置病例(n=75)列为观察组,对比分析两组创伤病例从急救反应时间、现场救治时间、急诊停留时间及临床满意度。结果观察组现场处置[(24.49±4.13)vs(32.19±4.42)]、急诊停留的时间[(5.24±2.13)vs(39.18±15.67)]比对照组明显缩短,临床满意度也高于对照组,差异具有统计学意义(P<0.05)。结论引入ITLS技术,能大大缩短创伤救治时间,减少危重创伤患者的病死率、伤残率,提高救治成功率,值得临床推广应用。
Objective The objective of this study was to explore the clinical application of international trauma life support(ITLS in the treatment of severe pre-hospital trauma. Methods A total of 150 patients admitted to No.1 People's Hospital of Zhenjiang from June2017 to May 2018 were selected as research subjects. Retrospective case-control method was used. Those who were given routine treatment for pre-hospital trauma were the control group(n=75), while those treated by ITLS technology were included as the observation group(n=75).The time for emergency response, site disposal, emergency stay and clinical satisfaction were compared between the two groups. Results The times for site disposal [(24.49±4.13) vs(32.19±4.42)] and emergency stay [(5.24±2.13) vs(39.18±15.67)] for the observation group were shorter than those for the control group, and the differences were statistically significant(P<0.05). And the clinical satisfaction of the observation group was higher than that of control group, and the difference was statistically significant(P<0.05). Conclusions The introduction of ITLS technology can greatly shorten the treatment time for trauma, reduce the mortality rate and disability rate of critical trauma patients, and improve the treatment success rate, thus making ITLS technology worthy of clinical promotion and application.
Objective The objective of this study was to explore the clinical application of international trauma life support(ITLS in the treatment of severe pre-hospital trauma. Methods A total of 150 patients admitted to No.1 People's Hospital of Zhenjiang from June2017 to May 2018 were selected as research subjects. Retrospective case-control method was used. Those who were given routine treatment for pre-hospital trauma were the control group(n=75), while those treated by ITLS technology were included as the observation group(n=75).The time for emergency response, site disposal, emergency stay and clinical satisfaction were compared between the two groups. Results The times for site disposal [(24.49±4.13) vs(32.19±4.42)] and emergency stay [(5.24±2.13) vs(39.18±15.67)] for the observation group were shorter than those for the control group, and the differences were statistically significant(P<0.05). And the clinical satisfaction of the observation group was higher than that of control group, and the difference was statistically significant(P<0.05). Conclusions The introduction of ITLS technology can greatly shorten the treatment time for trauma, reduce the mortality rate and disability rate of critical trauma patients, and improve the treatment success rate, thus making ITLS technology worthy of clinical promotion and application.
引文
[1]杜晓冬.ISS、补液量、BE对创伤失血性休克患者的影响[J].现代预防医学,2005,30(7):837-839.DOI:10.3969/j.issn.1003-8507.2005.07.072.
[2]王正国.创伤医学发展的思路[J/OL].中华神经创伤外科电子杂志,2015,1(1):2-3.DOI:10.3877/cma.j.issn.2095-9141.2015.01.001.
[3]Duan L,Deng X,Wang Y,et al.The National Injury Surverillance System in China:a six-year review[J].Injury,2015,46(4):572-579.DOI:10.1136/injuryprev-2012-040590d.18.
[4]国际创伤生命支持教程/(美)坎贝乐(Campbell,J.E.)原著;国际创伤生命支持中国分部(120)译[M].7版.北京:人民军医出版社,2014:11.ISBN 978-7-5091-7972-7.
[5]肖仁举,张连阳.创伤登记提升创伤中心救治能力[J].创伤外科杂志,2019,21(4):319-320.
[6]陆美凤.创伤并休克患者的院前急救联合护理干预应用价值[J].中外医学研究,2016,14(5):78-79.DOI:10.14033/j.cnki.cfmr.2016.5.041.
[7]吕扬.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.DOI:10.3760/cma.j.issn.1001-8050.2016.12.013.
[8]张进祥,潘文明.多学科团队模式在创伤救治中的作用[J].临床外科杂志,2018,26(8):572-573.DOI:CNKI:SUN:LCWK.0.2018-08-005.
[9]项鹏,章芸.探究创伤救治管理模式在创伤病人院前急救中的应用效果[J/OL].临床医药文献电子杂志,2019,6(12):177.
[10]黄顺忠,陆启峰,林起庆.严重创伤的院前和急诊科急救模式现状及展望[J].中华灾害救援医学,2017,5(9):536-540.DOI:CNKI:SUN:JYZH.0.2017-09-022.
[11]冯庚,杨萍芬,付大庆,等.院前急救预案:现场急救攻防策略[M].北京:中国协和医科大学出版社,2010:24-57.
[12]许永安,张茂.严重创伤损害控制治疗策略的应用进展[J].创伤外科杂志,2018,20(11):879-881.DOI:CNKI:SUN:CXWK.0.2018-11-025.
[13]赵会民,普光,张剑峰,等.推广初级创伤救治培训提高急诊创伤救治能力[J].中国急救医学,2012,32(10):949-950.DOI:10.3969/j.issn.1002-1949.2012.10.021.
[14]张建荣,黄艳芳,曾永宜,陈晓琳.999应急创伤救治体系对老年严重多发伤患者救治成功率的影响[J].现代医院,2019,19(3):406-409.
[15]Zhang L Y,Zhang X Z,Bai X J,et al.Current trauma care system and trauma care training in China[J].Chin JJrauma,2018,21(2):73-76.DOI:10.1016/j.cjtee.2017.07.005.
[16]张连阳,白祥军,张茂.“中国创伤救治培训”回顾与展望[J].创伤外科杂志,2019,21(1):1-4.
[17]Stone H H,Strom P R,Mullins R J.Management of the major coagulopathy with onset during laparotomy[J].Ann Surg,1983,197(5):532-535.DOI:10.1097/00000658-198305000-00005.
[18]Harvin J A,Wray C J,Steward J,et al.Control the damage:morbidity and mortality after emergent trauma laparotomy[J].Am J Surg,2016,212(1):34-39.DOI:10.1016/j.amjsurg.2015.10.014.
[19]Holcomb J B,Jenkins D,Rhee P,et al.Damage control resuscitation:directly addressing the early coagulopathy trauma[J].J Trauma,2007,62(2):307-310.DOI:10.1097/TA.0b013e3180324124.
[20]Khan S,Davenport R,Raza I,et al.Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage[J].Intensive Care Med,2015,41(2):239-247.DOI:10.1007/s00134-014-3584-1.
[2]王正国.创伤医学发展的思路[J/OL].中华神经创伤外科电子杂志,2015,1(1):2-3.DOI:10.3877/cma.j.issn.2095-9141.2015.01.001.
[3]Duan L,Deng X,Wang Y,et al.The National Injury Surverillance System in China:a six-year review[J].Injury,2015,46(4):572-579.DOI:10.1136/injuryprev-2012-040590d.18.
[4]国际创伤生命支持教程/(美)坎贝乐(Campbell,J.E.)原著;国际创伤生命支持中国分部(120)译[M].7版.北京:人民军医出版社,2014:11.ISBN 978-7-5091-7972-7.
[5]肖仁举,张连阳.创伤登记提升创伤中心救治能力[J].创伤外科杂志,2019,21(4):319-320.
[6]陆美凤.创伤并休克患者的院前急救联合护理干预应用价值[J].中外医学研究,2016,14(5):78-79.DOI:10.14033/j.cnki.cfmr.2016.5.041.
[7]吕扬.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.DOI:10.3760/cma.j.issn.1001-8050.2016.12.013.
[8]张进祥,潘文明.多学科团队模式在创伤救治中的作用[J].临床外科杂志,2018,26(8):572-573.DOI:CNKI:SUN:LCWK.0.2018-08-005.
[9]项鹏,章芸.探究创伤救治管理模式在创伤病人院前急救中的应用效果[J/OL].临床医药文献电子杂志,2019,6(12):177.
[10]黄顺忠,陆启峰,林起庆.严重创伤的院前和急诊科急救模式现状及展望[J].中华灾害救援医学,2017,5(9):536-540.DOI:CNKI:SUN:JYZH.0.2017-09-022.
[11]冯庚,杨萍芬,付大庆,等.院前急救预案:现场急救攻防策略[M].北京:中国协和医科大学出版社,2010:24-57.
[12]许永安,张茂.严重创伤损害控制治疗策略的应用进展[J].创伤外科杂志,2018,20(11):879-881.DOI:CNKI:SUN:CXWK.0.2018-11-025.
[13]赵会民,普光,张剑峰,等.推广初级创伤救治培训提高急诊创伤救治能力[J].中国急救医学,2012,32(10):949-950.DOI:10.3969/j.issn.1002-1949.2012.10.021.
[14]张建荣,黄艳芳,曾永宜,陈晓琳.999应急创伤救治体系对老年严重多发伤患者救治成功率的影响[J].现代医院,2019,19(3):406-409.
[15]Zhang L Y,Zhang X Z,Bai X J,et al.Current trauma care system and trauma care training in China[J].Chin JJrauma,2018,21(2):73-76.DOI:10.1016/j.cjtee.2017.07.005.
[16]张连阳,白祥军,张茂.“中国创伤救治培训”回顾与展望[J].创伤外科杂志,2019,21(1):1-4.
[17]Stone H H,Strom P R,Mullins R J.Management of the major coagulopathy with onset during laparotomy[J].Ann Surg,1983,197(5):532-535.DOI:10.1097/00000658-198305000-00005.
[18]Harvin J A,Wray C J,Steward J,et al.Control the damage:morbidity and mortality after emergent trauma laparotomy[J].Am J Surg,2016,212(1):34-39.DOI:10.1016/j.amjsurg.2015.10.014.
[19]Holcomb J B,Jenkins D,Rhee P,et al.Damage control resuscitation:directly addressing the early coagulopathy trauma[J].J Trauma,2007,62(2):307-310.DOI:10.1097/TA.0b013e3180324124.
[20]Khan S,Davenport R,Raza I,et al.Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage[J].Intensive Care Med,2015,41(2):239-247.DOI:10.1007/s00134-014-3584-1.