摘要
目的:探讨互助型创伤急救模式下确定性救命手术的规律及其现实意义。方法:建立由急救医师以“白金十分钟”的理念对病人进行链式流程复苏、由专科医师实行确定性救命手术的互助型创伤小组工作模式,总结分析1993年-2005年2428例中等严重度以上的急诊创伤病例。结果:伤员构成:男1882例,女546例,男女比例为3．45:1;年龄30．5±17．2岁(4-86岁);创伤评分(TS)11．5±3．5、CRAMS评分7．46±2．4;严重度:中度(ISS≤13)1250例(51．5％)、重度(ISS≥13-25)838例(34．5％)、极重度(ISS≥25)40(14．0％)。合并伤:复合伤29例(1．2％),多发伤687例(28．3％),休克1076例(44．3％),其中创伤性休克767(31．6％),失血性休克309 (12．7％);死亡197例(8．1％),其中主要引起死亡的原因按脏器分类:脑140例(71．1％),腹45例(22．8％),胸8例(4．1％),大血管4例(2．0％);抢救互助情况:急救部完成急救手术481例,急救部+专科手术1440例,急救部+SICU完成507例。结论:互助型创伤急救模式在当前城市创伤救治中仍具有普遍意义,加强急救与专科的密切协作是救治成功关键。
Objective:To explore the rule and significance of emergency definitive operation under the cooperative type of trauma care. Methods: Setting up the cooperative team of trauma care consisted of emergency doctors conducting trauma flow-chain resuscitation and surgeons performing emergency definitive operation. The data of 2428 trauma patients with middle severity from 1993-2005 were collected and analyzed. Results: 1882 male cases and 546 female cases were adopted, the proportion of male/female was 3. 45:1;the average age was 30. 5 17. 2(4-86); trauma score was TS (TS) 11. 5±3. 5, CRAMS 7. 46±2. 4; the severity was divided: middle 1250 cases (51.5%), high 838 cases(34. 5%) , very high 340 cases (14. 0%) , combined injures 29 cases(1.2%), multiple injures 687 cases(28. 3%), shock 1076 cases(44. 3%), including traumatic shock 767 cases(31. 6%)and hemorrhagic shock 309 cases(12. 7%). 197 cases(8. 1%)died off, including 140 cases of brain injures(71. 1%), 45 cases (22. 8%)of abdomen injures, 8 cases(4. 1%)of chest wall injures,and 4 cases(2. 0%)of major blood vessel injures. During the cooperation of trauma care, 481 cases were performed operations by emergency doctors, 1440 cases by emergency doctors and surgeons, and 507 cases by emergency doctors and SICU surgeons. Conclusion: The treatment of cooperative type possesses an important and prevalent significance in community trauma care. Enhancing the cooperation between critical care and surgery plays the main role in successful trauma care.
出处
《感染．炎症．修复》
2006年第1期30-33,共4页
Infection Inflammation Repair
