降阶梯思维在老年颅脑损伤患者急救中的应用效果研究

目的　探讨降阶梯思维在老年颅脑损伤患者急救中的应用效果。方法　选取2015年7月—2016年7月南通大学附属医院收治的老年颅脑损伤患者67例为常规组，行常规急救干预；选取2016年8月—2017年8月收治的老年颅脑损伤患者65例为研究组，行降阶梯思维的急救干预。比较两组急诊救治时间、急救效果、存活预后效果及满意度情况。结果　研究组急诊救治时间短于常规组（t=21.843，P<0.05）；研究组存活率高于常规组，总病死率低于常规组（χ2=6.453、6.872，P<0.05）；研究组存活患者的格拉斯哥昏迷量表评分高于常规组（t=7.924，P<0.001）；研究组急救总满意率高于常规组（χ2=14.678，P<0.001）。结论　老年颅脑损伤患者急救中应用降阶梯思维方式可明显缩短急诊救治时间，降低病死率，改善预后效果，提高急救满意度，值得临床推广。

De-escalation Strategies for Emergency Treatment of Elderly Patients with Craniocerebral Injury

Objective　To explore the effect of de-escalation strategies for emergency treatment of elderly patients with craniocerebral injury.Methods　The participants were 132 elderly patients with craniocerebral injury，including 67 enrolled from July 2015 to July 2016 treated by the conventional emergency treatment（conventional group），and 65 enrolled from August 2016 to August 2017 treated by emergency treatment with de-escalation strategies（research group）．The emergency treatment duration，outcome（survival rate，mortality，status of recovery of the survivals，prevalence of developmental disabilities） and patient satisfaction with emergency treatment were compared between the two groups.Results　Compared with the conventional group，the research group had much shorter emergency treatment duration（t=21.843，P<0.05），significantly higher survival rate（χ2=6.453，P<0.05），and notable lower case fatality rate（χ2=6.872，P<0.05），higher score of Glasgow coma scale（t=7.924，P<0.001），but substantially lower prevalence of severe developmental disabilities（χ2=8.786，P<0.05），and much higher level of patient satisfaction with emergency treatment（χ2=14.678，P<0.001）．Conclusion　De-escalation strategies used in the emergency treatment of elderly patients with craniocerebral injury can significantly shorten the emergency treatment duration，reduce the case fatality rate，improve the prognosis as well as the patient satisfaction with emergency treatment，so it is worthy of clinical promotion.