抢救平台在严重多发伤患者的急诊救护中的应用

目的:探讨应用危重创伤抢救平台进行严重多发伤患者抢救的使用方法、救治过程.方法:选择2004年12月至2010年12月抢救的严重多发伤120例救治成功的病例,进行归纳总结.结果:抢救平台在多发伤患者抢救中应用缩短了患者救治时间,增加患者的舒适度,节省了护理人员人力资源.结论:抢救平台在严重多发伤患者抢救中有很好的应用价值,值得推广使用.     

基层医院创伤中心在老年严重多发伤救治中的应用价值

目的 析基层医院创伤中心在老年严重多发伤救治中的应用价值。方法 选取2021年3月启用创伤中心前后的72例患者作为主要观察对象,对比两组患者的抢救时间、抢救效果、总住院时间、总住院费用。结果 经规范救治,观察组的各项指标优于对照组。结论 成立创伤中心优势明显,应广泛用于基层医院。     

胸脊髓损伤为主严重多发伤的救治体会

随着我国工农业的发展，高能创伤所致严重多发伤越来越多见，由于创伤重，合并伤复杂，出血量多，常导致高死亡率和高致残率。以往文献对多发伤的治疗报道较多．但对胸脊髓损伤为主的严重多发伤的救治报道甚少。作者对2000年1月～2004年11月本院收治的28例此类患者进行回顾性分析，以探讨胸脊髓损伤为主严重多发伤的救治方法。     

严重多发伤救治成功的体会(附96例报告)

严重多发伤救治成功的体会（附９６例报告）海宁市创伤急救中心（３１４４００）张金海海宁市人民医院外科（３１４４００）戴晓华我们近年收治严重多发伤９６例，经多方面强化抢救措施，成功率比往年明显提高。１临床资料１９９４年１月至１９９６年１２月我院共收治损伤...     

56例严重多发性创伤回顾性分析

严重多发性创伤发生率近年有逐渐增多的趋势,其病情急、伤势重、伤情复杂,如救治不及时,则预后差、甚至死亡.严重多发伤的早期救治,应引起临床工作者的重视.本研究对本院急诊科自2003年1月至2004年6月救治的56例严重多发性创伤的救治作一回顾性分析.     

腹部创伤325例救治结果分析

目的总结腹部创伤的救治经验,以进一步提高救治的成功率。方法回顾分析1994年1月至2010年10月手术救治的325例腹部创伤患者的临床资料和诊治结果。结果单一腹内脏器损伤177例,2个以上腹内脏器损伤148例（45.5%）,受损频度高的脏器依次为：脾、小肠、肝、肾等。合并休克155例（47.7%）。有133例（40.9%）合并有轻重不一的腹外伤。B超检查阳性率为90.2%,诊断性腹腔穿刺阳性率为90.8%。15例死于术后不可逆休克、多脏器功能衰竭,4例死于合并伤。结论 B超和诊断性腹腔穿刺检查是诊断腹部创伤实用而有效的辅助检查。积极抗休克、正确处理合并伤、果断手术探查,是抢救腹部创伤成功的关键。     

外科基础

血清高迁移率蛋白-1水平变化与多发伤患者脏器功能不全及死亡率的关系，创伤休克并ARDS患者初诊救治因素分析，严重创伤患者早期胰岛素强化治疗对外周血IFN-γ和IL-18水平的影响，严重多发伤236例抢救分析，高速公路交通伤后创伤后应激障碍分析[编者按]     

选择性肝血流阻断处理创伤性肝右叶损伤

目的探讨应用选择性肝血流阻断技术手术治疗严重肝右叶创伤的临床意义。方法回顾性分析我院自2001年3月至2008年7月应用选择性肝血流阻断技术治疗创伤性肝右叶损伤98例的临床资料。结果本组救治成功77例（78．57％）,死亡21例（21．43％）。其中,因伤势严重术中死亡5例（Ⅵ级3例,Ⅴ级2例）,术后因严重多发伤和各种并发症死亡16例。结论根据肝脏损伤的情况采取适宜的肝血流阻断技术可有效控制出血,有利于严重肝损伤的救治。     

严重创伤的急救与护理体会

目的总结分析严重创伤的急救与护理体会。方法对2009年10月～2010年10月笔者所在科室诊治的253例严重创伤患者的急救与护理经验进行总结分析。结果 253例严重创伤患者中抢救脱险228例,抢救成功率为90.1%;死亡25例,病死率为9.9%,死亡原因为严重复合伤。结论急诊科进行的严重创伤的抢救与护理工作具有重要意义,护士应具有高度的责任心,掌握熟练的抢救及护理技术,才能提高护理质量和救治水平。     

多发性创伤的救治策略

多发性创伤是指单一致伤因素同时或相继造成的人体两个以上解剖部位创伤,而且这些创伤即使单独存在,也属较为严重者。创伤严重评分(ISS)≥16者为严重多发伤。多发伤并非各处创伤的简单叠加,而是一种对机体影响较大、病理生理变化严重、常可危及生命的损伤,具有伤情重、变化快、并发症多、死亡率高、易误诊漏诊、需要紧急处理等诸多特点。多发伤患者的有效救治,不但有赖于施救人员良好的思想道德素质和过硬的业务能力、良好的组织分工、有力的物质保障,还有赖于制定和执行一整套科学的救治策略。救治须从受伤现场开始,但不可把现场急救的目…     

Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome

BACKGROUND: Optimal timing of stabilization for thoracic spine injuries in multiply injured patients is still controversial because additional lung injury occurs frequently. Early operation might benefit clinical course and outcome in these patients. METHODS: We analyzed the German National Trauma Database (n = 8,057) and compared clinical parameters and outcome of patients with severe thoracic spine injuries (Abbreviated Injury Scale >2; n = 298) who underwent spine stabilization within 72 hours posttrauma (group I) or later (group II). RESULTS: In all, 95% of all patients had additional severe thoracic injuries such as lung contusion. In spite of comparable demographic data, patients in group I had a significant shorter intensive care unit (ICU) stay (median [range]: group I, 8 [0-237] days; group II, 16 [2-91] days; p = 0.001), shorter dependence on mechanical ventilation (group I: 2 [0-48] days; group II: 5 [0-91] days; p = 0.02), and shorter hospital stay (group I: 22 [1-255] days; group II: 31 [2-274] days; p = 0.048). Expected mortality calculated by Trauma and Injury Severity Score was significantly reduced in group I (calculated: 16%; documented: 6%; p < 0.05) but not in group II (19% versus 17%; p = NS). CONCLUSIONS: Almost 10% of all patients in the German National Trauma Registry had severe spine injuries. Severe thoracic injuries occurred in 95% of these patients with thoracic spine trauma. We provide further evidence that early stabilization of thoracic spine injuries in trauma patients reduces overall hospital and ICU stay and improves outcome. Thus early stabilization of thoracic spine injuries within 3 days after trauma appears to be favorable.     

Effective use of the air ambulance for pediatric trauma

BACKGROUND: The purpose of this study was to compare outcomes of pediatric trauma patients transported by helicopter from the injury scene (IS group) to a trauma center and those transported by air after hospital stabilization (HS group). METHODS: A retrospective analysis of pediatric trauma patients (<19 years of age) transported by air ambulance and admitted to a pediatric trauma center was conducted. Outcomes compared were mortality and length of stay. Patients were subdivided into minor (Injury Severity Score [ISS] < 15) and major (ISS > 15) trauma. TRISS analysis was performed to verify the overall quality of the care. RESULTS: Eight hundred forty-two HS and 379 IS patients were included. The mean age, median ISS, and distribution of penetrating and blunt injuries did not differ significantly between the groups. The overall death rate was significantly lower for the interfacility transfer patients (HS group, 5.5%; IS group, 8.7%; p < 0.05). Mean intensive care unit (ICU) and hospital length of stay did not differ significantly. HS patients with major trauma had significantly less mortality (HS group, 15.5%; IS group, 26.7%; p < 0.05) and shorter mean ICU stays (HS group, 118.3 hours; IS group, 149.1 hours; p < 0.05) than IS major trauma patients. No differences were seen in patients with minor trauma. TRISS analysis showed improved survival for all patients compared with Major Trauma Outcome Study norms. CONCLUSION: Retrospective analysis was not able to demonstrate any benefit to direct transport from the scene to a trauma center. Hospital stabilization before transfer by air ambulance may improve survival and shorten ICU stays for patients with major trauma.     

The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients

BACKGROUND: Several small series have had mixed conclusions regarding the impact of obesity on outcomes of trauma patients. The purpose of the present study was to evaluate a large cohort of critically injured patients to better understand the influence of obesity on the outcomes of patients after severe blunt trauma. METHODS: Retrospective review using the trauma registry and intensive care unit (ICU) database of all blunt trauma patients admitted to the ICU at our urban, Level I trauma center over a 5-year period (1998-2003). Obese patients (body mass index [BMI] > or = 30 kg/m) were compared with non-obese patients (BMI < 30 kg/m). RESULTS: There were 1,153 blunt trauma patients admitted to the ICU during the study period, including 283 (25%) obese (mean BMI = 35 +/- 6 kg/m) and 870 (75%) non-obese (mean BMI = 25 +/- 3 kg/m) patients. There was no difference between groups regarding age, sex, Injury Severity Score, or admission vitals. Obese patients had fewer head injuries (42 versus 55%; p = 0.0001) but more chest (45 versus 38%; p = 0.05) and lower extremity (53 versus 38%; p < 0.0001) injuries. There was no difference in the need for laparotomy, thoracotomy, or craniotomy. Obese patients suffered more complications (42 versus 32%; p = 0.002). Although there was only a trend toward higher mortality in obese patients (22 versus 17%; p = 0.10), stepwise logistic regression revealed obesity as an independent risk factor for mortality (odds ratio, 1.6; 95% confidence interval, 1.0-2.3; p = 0.03). Among survivors, obese patients required longer stays in the hospital (24 +/- 21 versus 19 +/- 17 days; p = 0.01), the ICU (13 +/- 14 versus 10 +/- 10 days; p = 0.005), and 2 more days of mechanical ventilation (8 +/- 13 versus 6 +/- 9 days; p = 0.07). CONCLUSION: Obese patients incur different injuries after severe blunt trauma than their non-obese counterparts. Despite sustaining fewer head injuries, obese patients suffer more complications, require longer stays in the hospital, more days of mechanical ventilation, and obesity is independently associated with mortality.     

Management of adult blunt splenic injuries: comparison between level I and level II trauma centers

BACKGROUND: The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated. STUDY DESIGN: We conducted a retrospective analysis of prospectively gathered data from the Pennsylvania Trauma Outcome Study database that collected information from 27 statewide trauma centers (Level I [15], Level II [17]). Adult patients (ages > or = 16 years) with blunt splenic injuries (ICD-9-CM 865) were evaluated. Demographic data, injury data, and trauma center level designation were collected, and patient management, length of stay, and mortality were analyzed. RESULTS: There were 2,138 adult patients who suffered blunt splenic injuries during the study period (1998-2000). Patients treated at Level II trauma centers (n = 772) had a higher rate of operative treatment (38.2% versus 30.7%) (p < 0.001), but a shorter mean length of stay (10.1 +/- 0.4 versus 12.0 +/- 0.4 days) (p < 0.01) compared with patients in Level I trauma centers (n = 1,366). The rate of failure of nonoperative treatment was lower at Level II trauma centers (13.0% versus 17.6%) (p < 0.05), but the mortality for patients managed nonoperatively was higher (8.4% versus 4.5%) (p < 0.05). Splenorrhaphy was performed more frequently in Level I trauma centers. CONCLUSIONS: Management differences exist in the treatment of adult blunt splenic injuries between institutions of different trauma center level designation. Multicenter studies should account for this finding in design and implementation.     

The impact of obesity on severely injured children and adolescents

Purpose/Background

In conjunction with the obesity epidemic in adults, we are starting to see an increase of obesity in children and adolescents. Obesity has been identified as risk factor for poor outcomes in adult trauma patients, but has not been investigated adequately in younger patients. The purpose of this study was to investigate the impact of obesity on the outcomes of a severely injured population of children and adolescents.

Methods

Retrospective review of traumatized children (age 6-12) and adolescents (age 13-19) admitted to the intensive care unit (ICU) at an urban, level I trauma center from 1998 to 2003. The trauma registry and ICU database were used for data acquisition. Height and weight were recorded for each patient upon admission to the ICU and used to calculate body mass index (BMI). Patients were categorized as either lean (BMI <95th percentile for age) or obese (BMI ≥95th percentile for age). The two groups were compared regarding admission demographics, vital signs, mechanism of injury, patterns of injury, Injury Severity Score, and operations required. Outcomes evaluated were need for and length of mechanical ventilation, complications, length of hospital and ICU stay, and mortality.

Results

There were 316 pediatric and adolescent trauma patients (262 [83%] lean, mean BMI = 23 kg/m² and 54 [17%] obese, mean BMI = 33 kg/m²) admitted to the ICU. The lean and obese groups were similar regarding age, sex, mechanism of injury, admission vitals, injury severity, and operations required. Injury patterns were similar, except obese patients had less severe head injuries. Although there was no difference in mortality among obese (15%) and non-obese (9%) patients (P = .39), obese children did have more complications (41% vs 22%, P = .04). In addition, obese patients required longer ICU stays (8 ± 9 vs 6 ± 6 days, P = .05) after severe trauma.

Conclusions

Despite similar admission characteristics and less severe head injuries, obese children and adolescents have more complications and require longer ICU stays than their lean counterparts.     

Validation of new trauma triage rules for trauma attending response to the emergency department

INTRODUCTION: The American College of Surgeons Committee on Trauma has suggested triage criteria for the immediate attendance of a trauma surgeon to an injured patient in the emergency department. This study validates the accuracy of these criteria in identifying high-risk trauma patients and assesses the impact of trauma surgeon response time. METHODS: A study group of trauma patients with a systolic blood pressure (SBP) < 90 mm Hg, Glasgow Coma Scale (GCS) score < 8, airway compromise managed with endotracheal intubation (ETI) or surgical airway, or gunshot wound (GSW) to the neck or torso were compared with a control group of patients meeting none of these criteria. Outcome measurements included Injury Severity Score (ISS), duration of hospitalization (length of stay [LOS]), intensive care unit (ICU) days, direct transfer to the ICU or operating room, and mortality. For the study group, trauma surgeon response times, < or = 15 minutes and > 15 minutes, were compared for age, ISS, LOS, ICU days, mortality, and direct transfer to the ICU or operating room. Statistical analysis was performed using the t test and the Yates-corrected chi(2) test (p < 0.05), with odds ratios calculated on the basis of trauma activation criteria and outcome measures. Multiple logistic regression was used to assess the relation between the independent variables SBP, GCS, ETI, and GSW with direct transfer to the ICU or operating room and mortality. RESULTS: A total of 4,910 patients were identified, including 791 study group patients. The mean ISS, LOS, ICU days, and mortality were significantly higher in the study group (p < 0.01). Odds ratios of the study group for direct transfer to the ICU or operating room were 91 and 2 for ETI, 23 and 1.4 for GCS score < 8, 8 and 2.2 for GSW, and 7 and 1.6 for SBP < 90 mm Hg, respectively. The odds ratios for mortality were 39 for ETI, 104 for GCS score < 8, 12 for GSW, and 74 for SBP < 90 mm Hg. Regression analysis demonstrated that GSW, SBP < 90 mm Hg, and ETI predicted ICU admission; GSW, SBP < 90 mm Hg, and ETI predicted operative intervention; and GCS score < 8, SBP < 90 mm Hg, and ETI were associated with mortality. Trauma surgeon response times were available for 658 (83%) of the study group patients. No significant differences were found between the two response groups. CONCLUSION: Trauma patients meeting the triage criteria proposed by the American College of Surgeons Committee on Trauma have more severe injuries, a higher mortality rate, and longer hospital and ICU stays than control patients. SBP < 90 mm Hg, ETI, and GSW are predictive of urgent operating room use and ICU admission. A significantly higher mortality rate is associated with SBP < 90 mm Hg, ETI, and GCS score < 8. Incorporating these criteria into trauma center triage rules to identify high-risk injured patients is warranted. However, trauma surgeon response time < or = 15 minutes was not associated with improved patient outcome, and optimal response time remains uncertain.     

Predictors of outcome in patients requiring surgery for liver trauma

INTRODUCTION: Severe bleeding from liver injury is one of the major causes of mortality in patients with abdominal trauma. The study was undertaken to assess factors that influence outcome following liver trauma. PATIENTS AND METHODS: This is a prospective study of patients with liver injury treated in one surgical ward at King Edward VIII Hospital over a 7-year period (from 1998 to 2004). Data collected included demographics, intra-operative findings, operative management and outcome. RESULTS: Of a total of 478 patients with abdominal trauma, 105 (22%) were found to have liver injuries, of whom only 7 were female. Their mean age was 27.81+/-10.33 years. Injuries were due to firearms (70), stabs (26) and blunt trauma (9). Nineteen patients presented with shock (systolic BP6h in 47 patients. Forty patients required ICU management (38%) and the mean ICU stay was 6.55+/-5.65 days. Twenty patients (19%) needed a re-laparotomy for various reasons. The complication rate was 37% and the mortality rate was 20% (23% for firearms, 44% for blunt trauma and 4% for stabs). The mortality rate in patients with shock was 58% compared to 12% in those who were not shocked (p<0.0001). Mortality rate was 2, 23 and 63% for Injury Severity Score (ISS)20, respectively (group 1 versus group 2 p=0.015; group 1 versus group 3 p<0.0001 and group 2 versus group 3 p=0.001). Mortality rates for delay 6h were 28 and 9%, respectively (p=0.008). Associated injuries led to a higher mortality (3% versus 27%; p=0.006). Hospital stay was 11.27+/-12.09 days. CONCLUSIONS: Liver injuries occurred in 22% of abdominal injuries. Injury mechanism, delay before surgery, shock on admission, grade of injury, associated injury and ISS are significantly associated with outcome.     

Impact of obesity in the critically ill trauma patient: a prospective study

BACKGROUND: Obesity has risen at an epidemic rate over the past 20 years in the US. To our knowledge, there is an absence of data evaluating the impact of obesity in the critically ill trauma patient. METHODS: Prospective data were collected on 1,167 patients admitted to the ICU over a 2-year period. Obesity was defined as a body mass index (calculated as weight [kg]/height [m(2)]) of 30 or higher. Outcomes analyzed included infection rate, hospital and ICU length of stay, and mortality. Multiple logistic regression was used to evaluate outcomes between obese and nonobese patients for infection (infection versus noninfection) and mortality (deceased versus not deceased). Continuous outcomes such as hospital and ICU lengths of stay were evaluated using multiple linear regression analyses. RESULTS: Sixty-two of 1,167 (5.3%) patients were obese. The majority (71%) of injuries in the study cohort were blunt. Although the majority of patients were men (76%), women (10% versus 4%) were more likely to be obese (p < 0.001). Obese patients had a more than twofold increase in risk of acquiring a bloodstream, urinary tract, or respiratory infection, or being admitted to the ICU (p < 0.001), after statistically controlling for age and Injury Severity Score. When controlling for diabetes, gender, obesity, age, COPD, and Injury Severity Score, obese patients were 7.1 times (95% CI, 2.06-8.9) more likely to die in the hospital. CONCLUSIONS: Obesity is associated with a substantial increase in morbidity and mortality in the critically ill trauma patient. Future studies are warranted in both the prevention of infection and intensive care management of the obese trauma patient.     

The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay?

OBJECTIVES: To compare the New Injury Severity Score (NISS) and the Injury Severity Score (ISS) as predictors of intensive care unit (ICU) admission and hospital length of stay (LOS) in an urban North American trauma population and in a subset of patients with head injuries. METHODS: The study population consisted of 23,909 patients from three urban level I trauma centres in the province of Quebec, Canada. The predictive accuracies of the NISS and the ISS were compared using Receiver Operator Characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission and using r2 for the linear regression model of LOS. RESULTS: A total of 7660 (32%) patients were admitted to the ICU. Mean LOS was 8.2+/-2.5 days. In the whole sample, the NISS presented equivalent discrimination (area under ROC curve: NISS = 0.839 versus ISS = 0.843, p = 0.08) but better calibration (H-L statistic: 309 versus 611) for predicting ICU admission. In the subgroup patients with moderate to serious head injuries, the NISS was a better predictor of ICU admission in terms of both discrimination (area under ROC curve: NISS = 0.771 versus ISS = 0.747, p < 0.00001) and calibration (H-L statistic: 12 versus 21). The NISS explained more variation in LOS than the ISS for the whole sample (r2 = 0.254 versus 0.249, p = 0.0008) and in the sub-population with moderate to severe head injuries (r2 = 0.281 versus 0.263, p = 0.0002). CONCLUSIONS: The NISS is a better choice for case mix control in trauma research than the ISS for predicting ICU admission and LOS, particularly among patients with moderate to severe head injuries.     

Respiratorische Insuffizienz nach Brustwirbelfrakturen

BACKGROUND: Proper timing of stabilization for spinal injuries is discussed controversially. Whereas early repair of long bone fractures is known to reduce complications, few studies exist that investigate this issue in acute spinal trauma. In particular, the importance of coexisting lung injuries has to be determined, as it might influence clinical course and outcome. MATERIAL AND METHODS: We investigated retrospectively 30 severely injured patients who were stabilized dorsally for fractures of the thoracic and upper lumbar spine. The mean Injury Severity Score (ISS) was 41 points. Patients were divided into two groups: group I: acute trauma/stabilization <72 h and group II: acute trauma/stabilization >72 h. All patients in groups I and II presented radiological or clinical signs of lung contusion. RESULTS: The average duration of the procedures in group I was 199 min (115-312 min) and in group II 139 min (98-269 min). Intraoperative blood loss and P(a)O(2)/F(i)O(2)-ratio did not differ significantly between the two groups. The overall in ICU and hospital stay was significantly shorter in group I: 16 days (1-78 days) versus 24 days (7-86 days) in the late group II. Postoperative respirator therapy was necessary in group I for 15 days (0-79 days) and in group II for 19 days (4-31 days). The mortality rate was 10% in this series. CONCLUSION: Our data provide further evidence that early stabilization of spinal injuries is safe in severely injured patients, does not impair perioperative lung function, and results in a reduced overall ICU and hospital stay. Further prospective randomized investigations are warranted to prove these results.