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目的探讨严重多发伤的急诊科急救处理方法,为后续治疗赢得时间、创造有利条件,提高治愈率。方法将1999年10月至2009年10月收入院的491例严重多发伤患者分为A、B两组。A组:1999年10月至2004年10月入院,189例;B组:2004年11月至2009年10月入院,302例。B组在A组的基础上,强调延时液体复苏、气管插管解除呼吸道梗阻、请相关专科急会诊以决定治疗方案(包括是否直接进手术室急诊手术或收入院进一步处理)等。结果①A、B两组入、出院诊断符合率分别为65.1%和97.4%,病死率分别为25.9%和14.2%,治愈率分别为74.1%和85.8%,多器官功能障碍综合征(MODS)发生率分别为25.3%和17.5%,两组比较差异有统计学意义(P<0.05)。②患者急诊就诊后急诊手术进入手术室平均时间:A组85 min/例,B组55 min/例,可为严重多发伤患者争取30 min的宝贵时间。结论强调延迟液体复苏、气管插管解除呼吸道梗阻、选择适当的影像学检查、请相关专科急会诊共同决定治疗方案(包括是否直接进手术室行急诊手术或收入院进一步处理)等急诊科抢救模式,可为后续治疗赢得时间、创造有利条件,提高治愈率。
Objective To explore the emergency department emergency treatment method for severe multiple trauma, gain time for subsequent treatment, create favorable conditions and improve the cure rate. Methods A total of 491 cases of severe multiple trauma from admission hospital from October 1999 to October 2009 were divided into A and B groups. Group A: 189 patients were admitted from October 1999 to October 2004; Group B: 302 patients admitted from November 2004 to October 2009. On the basis of group A, group B emphasizes delayed liquid resuscitation and endotracheal intubation to relieve airway obstruction. Please refer to the relevant specialist emergency consultation to decide on the treatment plan (including whether to go directly to the operating room emergency surgery or to receive further treatment at the income center). Results ① The coincidence rates of diagnosis and discharge in group A and group B were 65.1% and 97.4%, respectively. The case fatality rates were 25.9% and 14.2% respectively. The cure rates were 74.1% and 85.8% respectively. Multiple organ dysfunction syndrome (MODS) Rates were 25.3% and 17.5%, respectively, with significant differences between the two groups (P <0.05). ② The mean time of emergency operation entering the operating room after emergency treatment of patients was 85 minutes in group A and 55 minutes in group B, which could save 30 minutes for patients with severe multiple trauma. Conclusion The emphasis on delayed liquid resuscitation, endotracheal intubation to relieve airway obstruction, select the appropriate imaging examination, please relevant specialist emergency consultation jointly decide the treatment plan (including whether directly into the operating room emergency surgery or income hospital for further treatment) and other emergency department rescue mode , For the follow-up treatment to win time, create favorable conditions and improve the cure rate.