损伤控制策略下一体化急救模式在危重症院前院内急救中的应用实践

目的探讨损伤控制策略下一体化急救模式在危重症院前院内急救中的应用效果。方法回顾性分析创伤危重症患者82例的临床资料,将2010年10月-2012年3月采取常规急救模式进行急救的40例患者设为对照组,将2012年4月-2013年9月采取损伤控制策略下一体化急救模式进行急救的42例患者设为观察组,比较2组治疗效果。结果观察组体温恢复时间、乳酸清除时间及PT、APTT恢复时间(8.8 h±1.3 h、11.3 h±4.2 h、13.2 h±4.7 h、28.9 h±3.2 h),均短于对照组(分别为14.7 h±3.6 h、32.3 h±7.5 h、29.6 h±17.5 h、39.3 h±4.2 h),差异有统计学意义(P<0.01)。2组患者手术时间及术中出血量比较差异无统计学意义(P>0.05);住院时间(27.6 d±8.6 d)、ICU监护时间(10.3 d±5.7 d)均明显多于对照组(分别为21.4 d±7.9 d、8.4 d±5.1 d),观察组抢救成功率高于对照组(92.86%vs.82.50%),术后并发症发生率(21.43%)均明显低于对照组(47.50%)(P<0.01)。结论在危重症院前院内急救中应用损伤控制策略下一体化急救模式,可显著改善生理状态,降低病死率及术后并发症,提高抢救成功率,是一种值得推广应用的危重症救治模式。

Application of damage control strategy guiding first aid of pre-hospital and in-hospital model in critically ill patients

Objective To explore the integration of emergency damage control mode , the effect of the policy applied in critically ill patients in the pre-hospital/in-hospital.Methods Retrospective analysis of 82 patients critically ill trauma clinical data.From Oct,2010 to Mar,2012,patients were took regular first aid emergency mode is set to the control group （ n =40）,from Apr,2012 to Sep,2013,patients were took damage control mode integrated emergency first aid strategy were set as observation group （ n =42）,comparing two groups＆#39;treatment effect.Results Temperature recovery time of the observation group, lactate clearance time and PT, APTT recovery time（8.8 h ±1.3 h,11.3 h ±4.2 h,13.2 h ±4.7 h,28.9 h ±3.2 h）, are shorter than the control group （14.7 h ±3.6 h, 32.3 h ±7.5 h, 29.6 h ±17.5 h, 39.3 h ±4.2 h）, the difference was statistically significant （ P 〈0.01）.2 groups＆#39;operative time and blood loss in patients showed no statistically significant differences （ P 〉0.05）;hospital stay （27.6 d ±8.6 d）, ICU monitoring time （10.3 d ±5.7 d） were significantly shorter than the control group （21.4 d ±7.9 d, 8.4 d ±5.1 d）,the success rate higher in the observation group （92.86% vs. 82.50%）, postoperative complication rate （21.43%） were significantly lower than the control group （47.50%, P 〈0.01）. Conclusion Critically ill patients pre-hospital/in hospital emergency first aid in damage control mode integration strategy can significantly improve the physiological state , reduce mortality and complications , improve the success rate .