早期集束化急救策略对严重多发伤患者的临床价值

摘要

目的探讨早期集束化急救策略对严重多发伤患者的临床价值.方法回顾性分析2007年1月至2010年6月经治的严重多发伤患者320例资料,按就诊时间分成两组：对照组160例,经急诊采取一般的生命体征监测,开通输液,据病情行影像学等检查,入住ICU后再决定是手术或保守治疗；集束组160例,入急诊后即予重症监护,联合快速床旁血气、电解质、乳酸、血红蛋白测定,积极保证氧供充足,维持有效的血流动力学指标,创造条件在心电血压监护下首选多部位CT检查,紧急时联合B超、X线等检查,据病情决定是否手术.结果集束组患者血气变化、乳酸(Lac)、血红蛋白(Hb)值与对照组比较差异均有统计学意义(均P<0.05)；与对照组比较急诊手术率(83.75%)明显提高(70.0%,P<0.05),检查花费时间(0.48±0.22)h、平均住ICU时间(18.09±6.38)d、漏诊率(4.38%)及病死率(11.32%)显著减少[(0.77±0.24)h,(25.27±5.65)d,11.25%和30.63%,均P<0.01或0.05].结论重症监护下的早期集束化干预可以显著提高严重多发创伤的抢救成功率.%Objective To evaluate the early bundle therapy for patients with severe multiple trauma. Methods Three hundred and twenty patients with severe multiple trauma, admitted from January 2007 to June 2010, were divided into control group (160 cases) and bundle group (160 cases) in chronological order, and the data were analyzed retrospectively. The patients in control group were checked for vital signs and the routine fluid therapy, imaging examination were performed in the emergen-cy;the decision of operation was made according to the condition in ICU. The patients in bundle group were given intensive care as soon as admission. The blood gas, electrolytes, lactate and hemoglobin were measured and adequate oxygen supply was given, effective hemodynamic Index was maintained. Under the ECG and blood pressure monitoring, multi-body-part imaging and B-type ultrasound scanning were taken when needed. The decision of operation was made promptly according to the pa-tient's condition. Results The inspection time, blood gas changes, levels of lactic acid and hemoglobin in bundle group were significantly more favorable compared to control group (P<0.05). Compared to control group the misdiagnosis rate (4.38% vs 11.25%, P<0.01), the average inspection time (0.48±0.22h vs 0.77±0.24h, P<0.05), the average ICU duration (18.09±6.38d vs 25.27±5.65d, P<0.05) and the mortality rate (13.12%vs 30.63%, P<0.01) in bundle group were significantly lower;while the e-mergency operation rate (83.75%) in bundle group was significantly higher than that in control group (70.0%, P<0.05). Conclu-sion The early bundle therapy can significantly increase the rescue efficiency for patients with severe multiple trauma under the intensive care.