应用压疮评估系统对创伤并发急性压疮患者进行预见性护理

预防手术创伤并发急性压疮是手术护理工作中的重点之一。近年来,笔者采用急性压疮危险因素评估系统,对入科实施大手术患者进行压疮相关因素分析,以定量的分值预见性地指导具体的护理措施,在手术中进行有效的护理干预,主动避免可控诱因与潜在危险因素,取得了较好的效果,现报道如下。     

良性肿瘤手术患者发生术中急性压疮的危险因素分析

【摘要】 目的 分析探讨良性肿瘤手术患者发生术中急性压疮的危险因素。 方法 选取 2020 年 5 月至2022 年 5 月河南科技大学第一附属医院收治的202例良性肿瘤手术患者作为研究对象, 收集患者性别、年龄、体重指数、基础体温、术中有无应用防压疮措施、手术持续时间、既往有无压疮史以及术后 6 d 内压疮 (即术中急性压疮) 发生情况等资料, 并根据是否发生术中急性压疮将其分为急性压疮组和无急性压疮组, 多因素 Logistic回归分析良性肿瘤手术患者发生术中急性压疮的相关危险因素。结果 202 例良性肿瘤手术患者发生术中急性压疮 (均为Ⅰ期) 28例 (13.86%),设为急性压疮组; 未发生术中急性压疮 174 例 (86.14%), 设为无急性压疮组。单因素分析结果显示, 急性压疮组体重指数>25.0 kg / m2、基础体温>36.5 ℃、术中未应用防压疮措施、手术持续时间>180 min 的患者比例均明显高于无急性压疮组 (χ2 = 110.092、6.542、7.393、76.579, P<0.001、P=0.011、P= 0.007、P < 0.001); 多因素 Logistic 回归分析结果显示, 体重指数> 25.0 kg / m2、手术持续时间>180 min是良性肿瘤手术患者发生术中急性压疮的独立危险因素 (95%CI为1.137 ~ 2.569、1.332 ~ 5.871, P 均<0.001)。结论 良性肿瘤手术患者术中急性压疮的发生与体重指数、手术持续时间密切相关, 临床应在术前对患者术中急性压疮发生情况进行风险评估, 及时给予相应措施干预, 以降低术中急性压疮的发生风险。     

创伤严重度评分法评估创伤死亡250例资料分析

创伤严重度评分（ISS），最早出Baker提出[1]，是目前最常用的评分方法，尤其是改进后的AIS－90版[2]较早期的AIS各版有明显优越性。但我们在临床应用中仍发现有许多不足[3，4]。近年来不少作者在应用ISS评价创伤伤员时都提到了死亡率和伤情严重度划分问题，但尚无关于专门的死亡病例分析。为了进一步验证ISS法对创伤救治水平评价的准确性，将我院1975～1992年因创伤死亡的250例病历进行回顾性评估分析。现报告如下。1临床资料1．1一般情况男196例，女54例。年龄6～88岁，平均36．2岁。交通事故伤164例，坠落伤36例，跌碰伤24例，挤…     

FTTO体系救治管理新模式在严重创伤患者中的应用研究

目的 探讨四线制、三岗位、二层轨及一轴化的体系管理(FTTO体系管理)救治新模式在严重创伤患者救治中的应用。方法 回顾性分析2019年8月—2021年8月山东第一医科大学附属青州医院急诊医学科收治的严重创伤患者410例,男性258例,女性152例;年龄18～71岁,平均47.1岁。以FTTO体系救治管理新模式(2020年8月—2021年8月)处理的患者210例为观察组;以急诊分流专科辅助管理救治模式(2019年8月—2020年7月)处理的患者200例为对照组。比较两组患者交班问题、转出交接问题发生率,交班所耗时间,转出交接所耗时间,开始抢救时间,CT检查时间及滞留时间,出院好转率,不良事件发生率以及抢救成功率等指标。结果 观察组医护人员交班问题发生率(14.7%)低于对照组(22.5%),交班所耗时间(16.2±5.2)min短于对照组(27.4±6.0)min,组间比较差异有统计学意义(P<0.05)。观察组转出交接问题发生率(9.1%)低于对照组(16.0%),交接所耗时间(10.0±5.0)min短于对照组(18.3±4.0)min,组间比较差异有统计学意义(P<0....     

严重创伤患者ARDS预后相关影响因素探讨

急性呼吸窘迫综合征(ＡＲＤＳ)是以严重低氧血症、极度呼吸困难和窘迫为特征的急性进行性呼吸衰竭,是严重创伤后的常见危重并发症。笔者对我院ＩＣＵ收治的24例严重多发伤并发ＡＲＤＳ病例的临床资料进行回顾性分析,旨在探讨影响严重创伤后伴发ＡＲＤＳ的预后的相关因素。资料与方法1991年1月～1998年1月我院ＩＣＵ共收治严重创伤(ＩＳＳ≥16)伴发ＡＲＤＳ病例24例,其中交通事故伤11例,高处坠落伤9例,刀伤、挤压伤各2例。男性17例,女性7例,年龄16～79岁,平均(4025±1691)岁。死亡14例,存活10例,其中18例为急诊手术后转入。病人受伤部位以胸…     

重型颅脑损伤患者发生压疮的危险因素分析

目的 分析探讨重型颅脑损伤患者发生压疮的危险因素。方法 选取2017年1月至2020年1月河南科技大学第一附属医院收治的188例重型颅脑损伤患者作为研究对象,收集患者性别、年龄、体重指数(BMI)、是否合并糖尿病、是否合并高血压、有无高度水肿、有无大小便失禁、是否合并营养不良、入院时格拉斯哥昏迷评分(GCS)、入院时Braden压疮风险评估量表(简称Braden)评分、是否留置尿管、是否留置胃管、卧床时间等资料,并根据患者是否发生压疮将其分为压疮组和无压疮组,单因素分析各指标与重型颅脑损伤患者发生压疮的相关性,多因素Logistic回归分析重型颅脑损伤患者发生压疮的危险因素。结果 188例重型颅脑损伤患者中出现压疮62例,设为压疮组;未出现压疮126例,设为无压疮组。单因素分析结果显示,压疮组年龄>60岁、BMI> 24 kg/m²、有高度水肿、有大小便失禁、合并营养不良、入院时GCS评分<8分、入院时Braden评分≤12分、卧床时间≥15 d的患者比例明显高于无压疮组(χ²=26.082、20.033、4.707、4.2...     

严重老年胸伤患者临床流行病学特征与救治结局分析

目的 进一步提高严重老年胸部创伤患者的救治水平.方法 对重庆市急救医疗中心1995年6月-2005年5月救治的148例严重老年胸部创伤(年龄≥65岁,AIS≥3)(高龄组)病例资料进行回顾性分析,以同期<65岁严重胸部创伤患者1669例作为对照(AIS≥3)(低龄组).结果 (1)高龄严重胸伤致伤机制以钝性伤为主(124/148,83.8%),较低龄组高(1 157/1 669,69.3%)(P<0.01);致伤原因依次为交通伤、跌倒伤和坠落伤,其中高龄组交通伤及跌倒伤构成比(98/148,66.2%;22/148,14.9%)明显高于低龄组(845/1 669,50.6%;52/1 669,3.1%)(P<0.01).(2)两组ISS、RTS及GCS比较差异无统计学意义(P=0.518;P=0.419;P=0.525).(3)高龄组与低龄组院前时间比较差异无统计学意义(P=0.884).(4)高龄组病死率(23/148,15.5%)显著高于低龄组(109/1 669,6.5%)(P<0.01).(5)高龄组主要并发症发生率(38/148,25.7%)显著高于低龄组(174/1 669,10.4%)(P<0.01).(6)有并发症患者病死率,高龄组(51.7%)较低龄组(26.7%)显著增高(P<0.01),而无并发症患者两组间病死率(6.7%:3.5%)差异无统计学意义(P=0.069).结论 年龄和并发症是预测创伤后救治结局相对独立的因素;加强对高龄老人创伤后危险性的认识,强调并发症的处理与器官功能支持治疗是提高高龄严重胸部创伤患者生存率的关键.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

诺顿评分在预防及护理压疮中的应用

目的通过对高危患者的护理，降低压疮的发生率。方法将诺顿评分应用于压疮危险度的评估与护理。结果提高了对高危患者的压疮发生预见性，减少了压疮的发生率。结论诺顿评分用于临床护理中，可以指导护理工作有重点的进行，从而降低了压疮的发生率。     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

胸部创伤严重度评价与救治结局探讨

目的探讨以简明损伤定级标准（AIS）为基础的ISS与胸部创伤救治结局的关系。方法采用AIS-98最新修订本对我院1995年1月-2005年6月救治的3057例胸部创伤病例资料进行回顾性分析。结果总治愈率93．8％（2866／3057），病死率6．2％（191／3057）。死亡组ISS、GCS、修正创伤评分（RTS）、国人创伤严重度特征评分[ASCOT_CHINA]_生存概率（Ps）、创伤与损伤严重度评分（TRISS）_Ps、ASCOT_Ps与生存组比较，差异具有统计学意义（P〈0．01）。穿透伤病死率11．4％（75／655），显著高于钝性伤4．8％（116／2402）（P〈0．01），穿透伤组ISS值显著高于钝性伤组，但穿透伤组TRISS_Ps、ASCOT_Ps和ASCOT_CHINA_Ps明显低于钝性伤组。ISS值越高，RTS值越低，ASCOT_CHINA_Ps越低，病死率越高。ISSt〉20，病死率高达7．2％-28．8％；RTS≤6，病死率高达52．7％以上。TRISS和ASCOT准确性、特异性高，生存误判低，而ASCOT-CHINA灵敏度高，死亡误判低。结论以AIS-98为基础的ISS、TRISS、ASCOT、ASCOT_CHINA_Ps等方法评价胸部创伤或胸伤合并多发伤的严重度及其结局预测是可行的，TRISS、ASCOT和ASCOT_CHINA_Ps的各项预测性指标以及误判性指标趋于合理。     

严重创伤并急性胆囊炎1例报告

严重创伤、灼伤或与胆囊无关的大手术后有可能并发急性胆囊炎。本病来势凶险，确诊早期较困难．死亡率高。国内文献报导较少。现就我们所治一例报告如下。