创伤评分在急诊救治中的应用与分析

目的 创伤评分(trauma score,TS)是根据患者的解剖、生理指标进行量化表达,对创伤进行综合判断,以便快速完成急诊接诊程序,提高救治质量,从而探讨,TS在创伤患者快速救治中的价值.方法 通过采用TS对上海交通大学附属第六人民医院金山分院的1568例创伤患者进入和离开急诊抢救室的创伤严重程度进行评估,同时进行必要影像学等检查和救治.结果 TS分值越低表示伤情越严重,但对以颅脑伤为主的伤员,TS敏感性差,仍以GCS评分更为有价值,本组1568例创伤患者入急诊抢救室时TS分值≥10分者1135例,占72.39%,＜10分者443例,占27.61%;经救治离开急诊室时,TS分值≥10分者1435例,占91.52%,＜10分者133例,占8.41%;两者比较差异均具有统计学意义(P＜0.01).TS分值越低,在救治中出现低血压、休克等严重并发症的发生率越高.液体需要与TS分值有明显相关性,TS分值越低,液体需要量越大.结论 TS使用简便快速,易掌握,能较好地反映创伤患者伤情,便于院前、急诊科医生尽早掌握伤情,尽快完成急诊接诊程序和采取有效救治措施.尤其对创伤、失血性休克患者,在受伤后"黄金1小时"内,迅速补充1500 mL以上液体十分必要.

Application and analysis of traunm score in emergency care

Objective To explore the value of trauma seore(TS)in emergency care according to anatomy,physiological parameters of patients in order to improve the efficiency of emergency care.Method The injury severity of 1568 patients with trauma admitted to Emergency Department was assessed with TS,and complieations were recorded in Jinshan Branch of Sixth Municipal Hospital Affiliated Shanghai Jiaotong University.The interventions,monitoring and imaging examinations started immediately after admission.Results The lower the TS,the poorer the patient's condition.However,the sensitivity of TS was low in the patients with brain injury,whereas the Glasgow coma score (GCS)was more valuable.The patients with score of 10 or above accounted for 72.39% of patients while 27.61% patients had score of 10 or below.Alout 91.52%patients who had TS above 10 and 8.41% patients who had TS 10 or below survived and were discharged from Emergency Department(both P＜0.001).The patients with score of 10 or below had a higher rate of severe complications including hypotension,shock,abnormal respiration and cardiac arrest.The lower the TS,the larger the volume of fluid resuscitation reqired.Conclusions TS is an objective valuein assessing the seriousness of the oatient's condition,which can help doctors quickly deal with the injured patients.Rapid administration of more than 1500 mL of fluid,is especially necessary for the trauma patients with hemontlagic shock in the period of"golden one hour"after injury.