严重创伤1092例急救及护理

目的:探讨江门市中心城区严重创伤患者的发生规律、临床特点及急救措施、效果。方法:对2005年11月～2009年11月我院收治的1 092例AIS≥3分的严重创伤患者的急诊抢救进行回顾性分析。结果:本资料显示受伤人群以青壮年为主,受伤原因排第一的是道路交通伤,受伤部位及病死率最高的是颅脑外伤和多发伤,存活出院1 007例,死亡85例;对严重创伤患者进行有效救治后,争取救治时间,可避免严重的并发症,提高抢救成功率。结论:改进急诊救治模式,创建生命绿色通道,形成高效快捷的急救路径,对颅脑外伤和多发伤等实施紧急的专业化治疗和护理,可缩短检查和术前准备时间,争取救治时间,提高抢救成功率。     

以腹部创伤为主的多发伤的急诊救治

目的总结以腹部创伤为主的多发伤的急诊救治经验,探讨如何改进救治方案,降低病死率。方法回顾性分析作者2007年8月至2009年6月参加急诊救治的以腹部创伤为主的严重多发伤典型病例50例的临床诊治资料。所有患者ISS评分在19～24之间,平均值22。结果本组患者抢救成功46例（其中痊愈出院44例,由于各种原因放弃后续治疗2例）,成功率92%;死亡4例,病死率8%。结论快速诊断、抗休克治疗、减少急诊手术准备及手术时间是提高抢救成功率的关键;要求急诊医生技术知识全面,反应迅速,合理地统筹安排整个救治过程。     

MDT对严重多发伤患者行早期干预创伤控制性手术的临床研究

目的:总结急诊科采用多学科诊疗模式(MDT)对严重多发伤患者早期行干预创伤控制性手术的临床效果,以提高严重多发伤的抢救成功率。方法:以2018年3月至2019年3月未采用MDT小组救治的严重多发伤患者30例为对照组,给予常规处理,以2019年4月至2020年3月应用MDT小组救治的严重多发伤患者30例为实验组,给予早期行干预创伤控制性手术处理。比较两组患者急诊停留时间、急诊抢救至手术时间、早期漏诊误诊率、早期死亡率和抢救成功率。结果:实验组急诊停留时间、急诊抢救至手术时间明显短于对照组(P均0.05);实验组早期漏诊误诊率、早期死亡率略低于对照组,抢救成功率稍高于对照组,但无统计学差异(P均0.05)。结论:急诊科采用MDT有利于提高严重多发伤患者早期行干预创伤控制性手术的疗效,缩短急诊停留时间和抢救至手术时间,提高早期诊断准确率及抢救成功率,建议推广应用。     

院前院内一体化救治模式在多发伤患者的应用

目的 探讨院前院内一体化救治模式对多发伤患者救治效果.方法 从院前急救、院内急诊、损伤控制外科手术、急诊重症监护治疗,我中心通过院前院内一体化救治模式成功救治158例多发伤患者.结果 救治多发伤158例.接诊时心搏、呼吸停止6例,处于濒死状态11例.其余大部分处于休克状态.其中7例在急诊室复苏急救未成功.105例行急诊手术治疗(包括48例行损伤控制外科手术),死亡5例.53例在急诊科经初步救治后转入专科病房.死亡11例.结论 院前院内一体化救治模式明显提高了多发伤抢救的成功率.     

不同急救模式在严重多发伤救治中的应用

目的:探讨传统专科专治救治模式和一体化创伤急救模式对严重多发伤患者救治效果的影响。方法:回顾性分析我院采用创伤一体化救治的患者132例,并与传统专科专治救治的患者115例进行比较,观察两组患者入院病情确诊时间、ICU住院天数、总住院天数及预后。结果:与传统专科专治救治模式比较,采用创伤一体化救治模式能明显提高严重多发伤患者救治成功率,缩短ICU住院天数及总住院天数,多器官功能衰竭及病死率亦明显降低,差异具有统计学意义。结论:对严重多发伤患者实行一体化创伤救治模式能够提高患者生存率及生存质量,改善其预后。     

多发伤135例急诊救治分析

目的探讨多发伤急诊救治策略，提高患者的生存率。方法对我院2006年10月至2009年3月以来135例多发伤患者的救治过程进行回顾性分析。结果本组135例患者抢救成功107例，抢救成功率为79．3％；28例死亡，病死率20．7％。结论早期迅速诊断、保持呼吸道通畅及积极有效的抗体克治疗措施，急诊抢救室-手术室-重症监护室（ICU）一体化模式缩短了多发伤患者救治的中间环节，提高了多发伤患者抢救成功率。     

2004-2006郑州市创伤流行病学分析

目的研究最近3年郑州市创伤流行病学现状和不同创伤急救模式对创伤救治的效果。方法统计2004年1月至2006年12月郑州市紧急救援中心的急诊流行病学资料和急救车出诊情况,比较自主型模式急救站和通道型模式急救站的创伤救治效果。结果郑州市紧急救援中心2004年、2005年和2006年派出的创伤出诊例次分别占当年急诊出诊总例次的45．3％、44．7％和45．8％。26家急救站中自主型模式1个,以内科为主的半自主型模式8个,通道型模式17个。严重多发伤在自主型模式急救站进行确定性手术治疗,明显缩短了受伤到手术的时间和降低死亡率。结论创伤是急诊出车原因的第一位。布局合理的急救站为急诊患者提供了快捷的院前急救,迅速转运严重创伤患者到自主型模式急救站可提高抢救成功率。     

突发群体伤患者的一体化急救护理管理

目的 探讨一体化急救模式下的护理管理在群体伤救治中的作用.方法 对14起突发群体创伤的救护采用与急救一体化模式相适应的护理管理措施,包括调整急救创伤中心的布局与设施,完善应急预案,规范抢救程序,抢救人员定位、定责,注重抢救的时效性,优化人力资源,加强护士业务培训等.结果 院前急救反应时间、检伤分类时间、按区分流时间明显缩短,急诊救治满意度、严重创伤患者救治成功率明显提高.结论 利用医院内急救一体化模式的优势,不断完善急救护理管理,提供准确、及时、有效的现代急救护理,保障了绿色通道的畅通,促进了突发群体伤患者的救治.     

基层医院救治严重多发伤分析

目的总结急诊严重多发伤的救治经验。方法回顾性分析我院近5年收治的32例严重多发伤患者的临床资料。结果本组32例患者经急诊抢救,死亡6例,收入病房26例;入院后死亡4例,抢救成功率为68.7%。结论急诊多发伤的抢救必须及时、迅速,并应与相关科室合作,强调时间是抢救重症多发伤的关键之关键"黄金一小时"的概念。     

126例严重多发伤的急诊救治

目的 探讨严重多发伤急诊科救治的重要性.方法 回顾性分析总结2003年3月至2007年6月4年多126例严重多发伤病人急诊救治的过程及要点.结果 本组126例抢救成功109例,成功率80.2%;死亡17例,死亡率19.8%.结论 多发伤在复苏、抗休克的同时尽可能的快速作出诊断,缩短中间环节,快速启动救命的手术程序,是提高抢救成功率的关键.     

急救绿色通道在严重多发伤救治中的作用

目的:探讨绿色通道急救模式在严重多发伤救治中的作用和意义。方法:回顾性分析2006年6月-2009年6月以绿色通道急救模式救治的120例多发伤患者的效果,并与2003年6月—2006年5月收治的106例非绿色通道组患者的救治效果进行比较。结果:2组患者在性别、年龄、致伤原因、ISS及伤后至入院时间等指标差异无统计学意义(P0.05);绿色通道组死亡率(4.2%)明显低于对照组死亡率(13.2%)(P0.05);绿色通道组在急诊室滞留时间、特殊检查时间、出急诊室至手术室时间及入院至手术时间均较对照组明显缩短(均P0.01)。结论:绿色通道急救模式缩短了严重多发伤患者的救治时间,降低了死亡率,提高了抢救成功率,是一种值得推广的急救模式。     

交通事故致严重多发伤的程序化急救处理

目的探讨提高交通事故致严重多发伤救治成功率的临床应用价值。方法交通事故致严重多发伤患者139例，随机分为治疗组和对照组（治疗组79例，对照组60例）。治疗组采取ABCDE制医生、护士抢救配合分工程序图程序化操作救治；对照组未采取ABCDE制医生、护士抢救配合分工程序图程序化操作救治。观察两组观察抢救成功率、诊断正确率、漏误诊率、并发症率。结果治疗组79例，抢救成功率89．57％，诊断正确率95．23％，漏误诊率19．00％，并发症率31．65％，治疗组抢救成功率明显高于对照组（t分别=10．52、11.43、12．72、11.32，P均〈0．05）。结论严重多发伤救治时制定了ABCDE制医生、护士抢救配合分工程序图进行程序化操作，可以使参加抢救的医护人员有序分工、紧密协作、迅速作出诊断、及时进行救治，可提高严重多发伤抢救成功率，减少了漏误诊率和并发症发生率，有一定的临床推广价值。     

严重多发伤在ICU的监护与治疗

目的探讨外科重症监护室（ICU）在多发伤监护及治疗上的作用。方法总结2005年1月至2009年7月接受ICU监护和治疗的145例严重多发伤患者的临床资料,分析严重多发伤在ICU处理中的几个关键问题如复苏、外科病情变化的监护及重要脏器的功能支持;并提出预防及治疗对策。结果本组发生急性呼吸窘迫综合征（ARDS）14例（9.66%）,多器官功能障碍综合征（MODS）17例（11.72%）,应激性溃疡伴出血38例（26.2%）;其治愈率分别为71.42%（10/14）、47.06%（8/17）、84.21%（32/38）。全组总存活率为90.34%（131/145）,病死率为9.66%（14/145）。结论在ICU能对一些危重患者可能发生的器官、系统衰竭的征象进行及时、系统、连续地严密监测和处理,以防止致命性并发症的出现,从而为专科治疗赢得宝贵时间。ICU治疗在严重多发伤的抢救治疗过程中具有非常重要的作用;强调严重多发伤抢救建立在重症监护平台上的多科室共同协作的抢救模式。     

雪灾春运期大型综合医院紧急医疗救援分析

目的 探讨雪灾春运时大量密集人群长期滞留的紧急医学救援方法.方法 回顾性分析2008年1月22日至2月6日雪灾春运期各类急诊患者20 966例的临床资料,对医学救助现场医疗中各系统疾病的构成比,院前急救的特点以及院内急诊门诊和危重病急救情况与日常情况进行对比分析.结果 现场医疗中以呼吸道疾病(57.3%)、消化道疾病(25.5%)和外伤(6.2%)为主,院前急救中以外伤、晕厥、昏迷、抽搐的呼叫为主,但空车率高达30.3%,院内急诊与现场医疗情况相似,外伤中以四肢外伤(56%)和头部外伤(24%)发病率最高,在严重创伤患者中,高处坠落伤的发生率较高(35.7%),外伤致死的2例中,1例因踩踏死亡,另1例为高处坠落伤并电击烧伤.结论 大型综合医院足城市灾害医疗救援中的主体,应把医院应对群体性灾害的能力列入医院质量考核指标,只有认真做好防灾,减灾的准备,才能高效地进行紧急医疗救援,将灾害带来的损失降到最低.     

严重多发伤的院内分期救治

目的：探讨严重多发伤的院内分期救治策略。方法：回顾性分析我科2008-01-2012-12收治的204例严重多发伤患者的临床资料。本研究将病例分为3组：组1,以胸伤腹伤为主的病例107例（52.5%）;组2,以四肢骨盆脊柱骨折为主的病例79例（38.7%）;组3,以胸伤腹伤四肢骨盆脊柱骨折均严重的18例（8.8%）。采用分期救治的策略,即按照严重多发伤在不同治疗阶段（手术复苏期、脏器功能支持期、创伤修复期和功能康复期）的特点,对伤者进行救治的方法。主要分析了手术复苏期各种急诊手术的复苏方式,心肺肝肾等各个主要脏器的功能支持手段以及创伤修复的方式。结果：全组204例,存活190例,存活率93.1%;死亡14例,死亡率6.9%。其中以胸伤腹伤为主的107例病例中,存活100例（93.5%）,死亡7例（6.5%）;以四肢骨盆脊柱骨折为主的79例病例中,存活77例（97.5%）,死亡2例（2.5%）;以胸伤腹伤四肢骨盆脊柱骨折均严重的18例病例中,存活13例（72.2%）,死亡5例（27.8%）。全组病例在手术复苏期死亡8例,占死亡总数的57.1%,死亡原因：创伤失血性休克3例,急性肺挫裂伤呼吸功能衰竭2例,弥散性血管内凝血（DIC）2例,急性脂肪栓塞并肺栓塞1例;在脏器功能支持期死亡4例,占死亡总数的28.6%,死亡原因：急性呼吸窘迫综合征（ARDS）2例,严重脓毒血症并发多器官功能障碍综合征（MODS）2例;在创伤修复期死亡2例,占死亡总数的14.3%,死亡原因：迟发型肠坏死和创伤后脓胸全身感染各1例。结论：从接诊严重多发伤的第一刻起,特别是胸伤腹伤或合并骨盆脊柱损伤,即应主动、有计划地实施分期救治。掌握手术复苏期合理的手术复苏方式、加强重要脏器的功能支持以及选择最佳的创伤修复方式,是提高救治成功率、实施多发伤分期救治一体化模式的重要途径。     

急救护理在严重创伤失血性休克患者中的应用体会

目的探讨急救护理在严重创伤失血性休克患者中的应用效果。方法选取2018年7月至2019年1月本院收治的20例严重创伤失血性休克患者为研究对象,回顾性分析其急救处理方法及效果。结果 20例严重创伤失血性休克患者经过有效急救护理后,好转18例、无变化1例、恶化1例,其中19例患者的失血性休克得到有效纠正,18例血压、心率恢复正常已康复出院,1例因创伤严重实质性脏器破裂性出血而死亡。本组患者的临床好转率为90.0%。结论对创伤失血性休克患者要采取迅速、及时、有效的急救措施,有助于提高临床救治成功率,降低死亡率。     

气道内固定治疗连枷胸

在收治的246例严重多发伤病人中，合并连枷胸52例，占21．1％。采用呼吸机通气气道内固定和胸带包扎外固定术治疗后，死亡率为7．7％。其疗效可靠，方法简单，提高了对严重胸部创伤的治愈率。     

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

Introduction

Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.

Methods

This multicenter prospective observational study involved 24,293 patients. All patients were older than 15 years of age, had sustained blunt or penetrating trauma and had an Injury Severity Score (ISS) higher than 15. All of the patient data were recorded between 2004 and 2011 in the Japan Trauma Data Bank, which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with a physician or ground emergency services.

Results

A total of 2,090 patients in the sample were transported by helicopter, and 22,203 were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared to 5,765 patients (26.0%) transported by ground emergency services. Patients transported by helicopter had higher ISSs than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, sex, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate and respiratory rate), ISS and prehospital treatment (including intubation, airway protection maneuver and intravenous fluid). In the propensity score–matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression, after adjusting for prehospital treatment (including intubation, airway protection maneuver and intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).

Conclusions

Among patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared to ground emergency services after controlling for multiple known confounders.     

Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care.

OBJECTIVE: The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients. METHODS: In a retrospective study, 81 blunt trauma patients treated prehospitally by a physician-staffed helicopter emergency medical service were compared with 77 patients treated before the era of the helicopter emergency medical service. The data were collected in the prehospital and hospital files and a questionnaire was sent to the survivors 3 years after the trauma. RESULTS: The physicians treated the patients more aggressively (gave drugs, intubated and cannulated) and had the patients transported directly to a university hospital. The given treatment did not delay arrival at the hospital. No statistically significant difference was found, but a trend (P = 0.065) to lower survival in the helicopter emergency medical service group. Almost half of the deaths in the helicopter emergency medical service group and none in the control group, however, occurred in the emergency department. No difference was found 3 years later between the groups in the health-related quality of life or decrease in the income owing to the accident. CONCLUSION: The physicians treated the patients more aggressively, but it did not delay the arrival at the hospital. A beneficial effect of this aggressive treatment or direct transport to a university hospital could not be seen in the immediate physiological parameters or later health-related quality of life. The physician-staffed helicopter emergency medical service was not beneficial to blunt trauma patients in this setting.     

The Rapid Impact on Mortality Rates of a Dedicated Care Team Including Trauma and Emergency Physicians at an Academic Medical Center

Background: Trauma center designation can result in improved patient outcomes after injuries. Whereas the presence of trauma teams has been associated with improved trauma patient outcomes, the specific components, including the role of emergency medicine (EM)-trained, board-certified emergency physicians, have not been defined. Objective: To assess the outcomes of patients before and after the establishment of a dedicated trauma team that incorporated full-time EM-trained physicians with trauma specialists at a Level I trauma center at an academic institution. Methods: Secondary analysis of prospectively collected trauma registry data was performed to compare mortality rates of all treated trauma patients before and after this intervention. Results: The establishment of a dedicated specialty trauma team incorporating full-time EM presence including EM-trained, board-certified emergency physicians was associated with a reduction in overall non-DOA (dead on arrival) mortality rate from 6.0% to 4.1% from the time period preceding (1999–2000) to the time period after (2002–2003) this intervention (1.9% absolute reduction in mortality, 95% confidence interval [CI] 0.7%–3.0%). Among patients who were most severely injured (Injury Severity Score [ISS] ≥ 25), mortality rates decreased from 30.2% to 22.0% (8.3% absolute reduction in mortality, 95% CI 2.1%–14.4%). In comparison, there was minimal change in national mortality rates for patients with ISS ≥ 25 during the same time period (33% to 34%). Conclusions: The implementation of a dedicated full-time trauma team incorporating both trauma surgeons and EM-trained, board-certified or -eligible emergency physicians was associated with improved mortality rates in trauma patients treated at a Level I academic medical center, including those patients presenting with the most severe injuries.