昏迷患者院前急救干预策略分析

目的分析昏迷患者院前急救的临床干预策略。方法回顾性分析镇江辖市区九家医院自2017年6月至2018年5月收治的因昏迷呼叫的院前急救患者208例,其中男性116,女性92;年龄18~98岁,平均(54.5±8.5)岁。纳入标准病例(GCS评分在3~14分)的男性多于女性,发病年龄集中在45~65岁,以脑血管意外67例(23.93%)、严重创伤45例(21.63%)、心血管疾病28例(13.46%)、急性中毒33例(15.87%)、糖尿病合并各种并发症15例(7.21%)为主;以昏迷患者病情进展情况(临床好转、无变化、恶化、死亡)作为观察指标。综合临床资料(性别比例、年龄结构、院前诊断、治疗效果、病发因素、病情转归、文化程度、健康教育等)分析,积累临床经验、院前急救路径管理和健康宣教干预等措施。结果经现场急救,108例患者(51.92%)意识迅速恢复,169例(81.25%)稳定并安全转入院内救治,现场死亡37例(17.79%),途中死亡2例(0.96%),恶化13例(6.25%),无变化26例(12.50%),有效104例(50.00%),显效26例(12.50%),现场抢救成功率为81.25%。患者学历为大中专文化以上者80例(38.76%),中学以下者128例(61.24%)。未接受过健康教育26例(23.21%),曾接受个体化健康教育45例(21.63%),公众健康咨询103例(49.52%),两者均参34例(16.35%)。结论院前急救昏迷患者病因多为心脑血管疾病、严重创伤、急性中毒、糖尿病并发症及其他急症,通过积累临床经验、院前急救路径管理和健康宣教干预等措施,平战结合,对提高抢救成功率有所帮助,值得推广。

Pre-hospital emergency intervention for coma patients: strategy analysis

ObjectiveTo analyze the clinical intervention strategy of pre-hospital first aid for coma patients. MethodsA total of 208 cases of pre-hospital emergency patients called for coma from June 2017 to May 2018 in nine hospitals under the jurisdiction of Zhenjiang were analyzed retrospectively, including 116 males and 92 females, aged 18~98 years (54.5±8.5) years]. More males than females were included in the standard cases (GCS score of 3~14), and the onset age was concentrated in 45~65 years old, with 67 cases (23.93%) of cerebrovascular accidents, 45 cases (21.63%) of severe trauma, 28 cases (13.46%) of cardiovascular diseases, 33 cases (15.87%) of acute poisoning, and 15 cases (7.21%) of diabetes complications. The progress of coma patients (clinical improvement, no change, deterioration, and death) was taken as the observation index. Comprehensive clinical data (sex ratio, age structure, pre-hospital diagnosis, treatment effect, disease incidence factors, disease prognosis, education, health education, etc.) were analyzed to accumulate clinical experience, pre-hospital first-aid route management, health education intervention and other measures. ResultsThere were more males than females in the standard cases (GCS score ranged from 3 to 14). The age of onset was concentrated in 45 to 65 years. 67 cases of cerebrovascular accident (23.93%), 45 cases of severe trauma (21.63%), 28 cases of cardiovascular disease (13.46%), 33 cases of acute poisoning (15.87%) and 15 cases of diabetes mellitus complicated with various complications (7.21%) were the main cases. After on-site first aid, 108 cases (51.92%) were conscious. Rapid recovery, 169 cases (81.25%) were stable and safely transferred to hospital, 37 cases (17.79%) died on the site, 2 cases (0.96%) died on the way of transfer, 13 cases (6.25%) worsened, and 26 cases (12.50%) unchanged. 104 cases (50.00%) were effective, including remarkably effective in 26 cases (12.50%), and the success rate of rescue on the site was 81.25%; 80 cases (38.76%) had secondary school education or above from the investigated cases. 128 cases (61.24%) had their education below the secondary school; 26 cases (23.21%)did not accept any health education, 45 cases (21.63%) had individualized health education and 103 cases (49.52%) had public health consultation, and 34 cases (16.35%) had both. ConclusionsMost of the causes of pre-hospital emergency coma patients are cardiovascular and cerebrovascular diseases, severe trauma, acute poisoning, diabetic complications and other emergencies. If early measures can be taken, the mortality and disability rate can be reduced. By accumulating clinical experience, pre-hospital emergency path management and health education intervention, the combination of peace and war can help to improve the success rate of rescue and is worth promoting.