摘要
目的分析不同年龄组严重创伤的临床特征和救治结果,以提高严重创伤的急诊救治水平。方法1997年10月至2004年10月7年间共救治严重创伤患者2069例,分为儿童组(＜13岁)106例,少年组(13～18岁)128例,青壮年组(18～40岁)1518例,中年组(40～60岁)215例,老年组(＞60岁) 102例。入选病例按损伤严重程度评分(ISS)标准进行评估,所有患者ISSl≥16。结果各组男性患者均多于女性,青年组、中年组和老年组男性严重创伤比例显著高于儿童组和少年组(P＜0．01)。交通伤是首要致伤原因,儿童组、少年组和中年组高于青壮年和老年组(P＜0．01)；第二位致伤原因坠落伤在儿童组,械斗与工伤在少年组、青壮年组和中年组,跌伤在老年组中显著增高(P＜0．01)。儿童组和老年组以颅脑损伤为主；而少年组、青壮年组和中年组在四肢和(或)脊柱的损伤中显著增高(P＜0．05)。老年组腹部损伤显著减少(P＜0．01)。总病死率为11．9%(246/2 069),老年组创伤＜24 h病死率(20．6%,21/102)较≥24 h病死率(7．8%,8/102)显著增高(P＜0．01)。各组的急诊滞留时间,在抢救脱险病例和死亡病例之间比较,差异具有统计学意义(P＜0．01)。结论各年龄组严重创伤患者在性别构成、致伤原因和致伤部位的发病率及其特点是不同的,老年患者在遭受严重创伤后死亡率明显增高；观念上要重视“黄金1小时”,“白金10分钟”,缩短急诊滞留时间；早期实施手术抢救；应用损伤控制性手术。
Objective To analyze the clinical characteristics and the outcome of severe trauma of various ages in emergency department, to improve the therapeutic effect of emergency rescuing. Methods Two thousand and sixty nine patients of severe trauma were treated during a seven - year period from October 1997 to October 2004. The studied patients were divided into 5 groups： （1） adolescent group （Group A, 〈 13 years old, n = 106） ; （2） juvenile group （Group B, 13-18 years old , n = 128） ; （3） youth group （Group C, 18-40 years old, n = 1518） ; （4） middle age group （Group D, 40-60 years old, n = 215） ; and （5） elderly group （Group E, 〉 60 years old, n = 102） . All the patients were evaluated with Injury Severity Score （ISS）, and the result was≥ 16 in all of the studied patients. Results The incidence of severe trauma in male in all 5 groups was higher than that in female, and it was significantly higher in Group C, Group D and Group E when compared with that in the other groups （ P 〈 0.01 ）. Traffic accident was the leading cause of injury, and its incidence in Group A, Group B and Group D was higher than that in other groups （ P 〈 0.01 ）. However, injury caused by falling from high places was the second cause of injury, being significantly increased in Group A, while armed fighting and injury during work being significantly increased in Group B, Group C and Group D , slip fall injury being significantly increased in Group E （ P 〈 0.01）. Head injury was mainly found in Group A and Group E, extremities injury and/or spinal injury were increased markedly in Group B, Group C and Group D （ P 〈 0.05） , abdominal injury was significantly decreased in Group E （ P 〈 0.001）. The total mortality was 11.9% （246/2069）. The mortality within 24 hours （20.6%, 21/102） was significantly higher than that beyond 24 hours （7.8%, 8/102） in Group E （ P 〈 0.01）. The time of staying in the emergency department differed significantly between the survived patients and those died in all 5 groups （ P 〈 0.01 ）. Conclusion The gender, the incidence and the characteristics of the injury causes and injury sites differed bemeen severely injured patients of various ages. Mortalit） in the elderly is significantly increased following severe trauma. The idea of ＂golden one hour＂ and ＂platinum ten minutes＂, measures of shortening the time of staying in the emergency clinic , early definite operation and damage control operation should be emphasized.
出处
《中华急诊医学杂志》
CAS
CSCD
2006年第12期1075-1078,共4页
Chinese Journal of Emergency Medicine
关键词
不同年龄
严重创伤
特点
救治
Various ages
Severe trauma
Characteristics
Rescue
