综合创伤一体化急救模式的临床应用研究

Clinical application effects of integrated trauma emergency care model

关键词:  创伤  急救模式  多系统损伤  并发症

Key words:  trauma  emergency care model  multisystem injury  complication

摘要:

目的评估在严重创伤急救中应用综合创伤一体化急救模式的临床效果。 方法回顾性分析2022年5月—2024年5月在广东省中西医结合医院急诊科就诊的104例严重创伤患者，按照实施综合创伤一体化急救模式的时间节点，将患者分为实施前组和实施后组，每组各52例。实施前组采用常规治疗模式，实施后组采用综合创伤一体化急救模式。分别比较综合创伤一体化急救模式实施前后患者在抢救成功率、抢救时间、各种并发症的发生率、血清炎症因子的表达等方面的差异。 结果综合创伤一体化急救模式实施后患者抢救成功率高于实施前(χ2=15.145，P＜0.05)，抢救时间(t=3.879，P＜0.05)、辅助检查时间(t=2.252，P＜0.05)和急诊接诊到手术时间(t=2.807，P＜0.05)均缩短，总并发症发生率(χ2=15.592,P<0.05)，包括感染(χ2=4.300，P=0.038)、失血性休克(χ2=6.190，P=0.013)、多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)(χ2=0.153，P=0.696)发生率均低于综合创伤一体化急救模式实施前。该模式实施后，患者各种炎症因子如C反应蛋白(C-reactire protein, CRP)、降钙素原(procalcitonin, PCT)的水平在治疗后明显下降(P＜0.05)。 结论综合创伤一体化急救模式在严重创伤的急救中疗效显著，能够提高患者的抢救成功率，节约抢救时间，降低并发症的发生率，值得在临床急救中推广应用。

Abstract:

ObjectiveTo investigate the effects of integrated trauma emergency care model in the emergency treatment of severe trauma. MethodsA total of 104 patients with severe trauma admitted to the Department of Emergency, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from May 2022 to May 2024, were enrolled as the study subjects. The patients were retrospectively analyzed and divided into a pre-implementation group and a post-implementation group based on the time point of the implementation of the integrated trauma emergency care model, 52 patients for each group. The pre-implementation group adopted the conventional treatment model, while the post-implementation group received an integrated trauma first aid model. The differences between two groups of patients in terms of rescue success rate, rescue time, incidence of various complications et al, and expression of serum inflammatory factors were compared, respectively. ResultsAfter the implementation of the integrated trauma emergency care model, the resuscitation success rate of patients was higher than before(χ2=15.145, P<0.05); the resuscitation time(t=3.879, P<0.05), auxiliary examination time(t=2.252, P<0.05) and the time from emergency department reception to surgery(t=2.807, P<0.05) were all shortened; the overall complication rate(χ2=15.592, P<0.05), including infection(χ2=4.300, P=0.038), hemorrhagic shock(χ2=6.190, P=0.013) and MODS(χ2=0.153, P=0.696) were all lower than those before the implementation of the model. After the implementation of integrated trauma emergency care model, the levels of various inflammatory markers(C-reactive protein, procalcitonin, et al) decreased more significantly after treatment(all P<0.05). ConclusionThe integrated trauma emergency care model is highly effective in treating severe trauma emergencies, it could improve the rescue success rate, reduce rescue time, and decrease the incidence of complications. This model is worth of being recommended for further application in emergency medicine service.