王斌　陈昕昳　胡培阳

[摘要] 目的 探討县城医院严重创伤一体化救治模式的应用效果。 方法 回顾性分析我院采取一体化救治模式前（2015年6月～2016年5月，对照组，n=38）及采取后（2016年6月～2017年5月，观察组，n=43）收治的81例严重创伤患者临床资料。比较两组患者围抢救期基本情况[急诊科停留时间、术前检查时间、手术时间、输血量、术后住重症监护病房（ICU）例数、术后住院时间]、救治效果、术后1周时生活质量[生活质量综合评定问卷（GQOLI-74）]、家属满意度[中文版危重患者家属满意度量表（C-CCFSS）]及1周内并发症发生情况差异。 结果 观察组患者急诊科停留时间、术前检查时间、手术时间、输血量、术后住ICU例数、术后住院时间均明显少于对照组（P均<0.05），而救治有效率明显高于对照组（P<0.05）。术后1周时，观察组患者GQOLI-74各项评分及总分均明显高于对照组（P均<0.05）；观察组家属C-CCFSS各项评分及总分均明显高于对照组（P均<0.05）。术后1周内，观察组患者并发症发生率明显低于对照组（P均<0.05）。 结论 县城医院对严重创伤患者采取一体化救治模式可获得较为理想的应用效果，具有一定临床推广价值。

[关键词] 县城医院；严重创伤；一体化；救治模式

[中图分类号] R640 [文献标识码] B [文章编号] 1673-9701（2018）12-0095-04

Discussion on integrated treatment of severe trauma in county hospital

WANG Bin CHEN Xinyi HU Peiyang

Department of Traumatic Surgery，Tiantai People 's Hospital of Zhejiang Province，Tiantai 317200，China

[Abstract] Objective To explore the application effect of integrated treatment mode of serious trauma in county hospital. Methods A retrospective analysis of the clinical data of severe trauma patients admitted before the adoption of integrated treatment mode（from June 2015 to May 2016 ，control group， n=38） and after adoption（from June 2016 to May 2017， observation group， n=43） was conducted. Comparing basic situation[emergency department stay time， preoperative examination time， operation time， blood transfusion， number of postoperative intensive care unit （ICU）cases， postoperative hospital stay]， treatment effect， quality of life of postoperative 1 week[living quality comprehensive assessment（QOL-74）]， family satisfaction [Chinese family critical care family satisfaction scale（C-CCFSS）] and complications within 1 week of the two groups of patients during the rescue period. Results The length of stay， the time of preoperative examination， the time of operation， the volume of blood transfusion， the number of postoperative ICU patients and the postoperative hospital stay in the observation group were significantly less than those in the control group（all P<0.05）， while the effective rate of treatment was significantly higher in the control group（P<0.05）. At 1 week after operation， the score and total score of GQOLI-74 in the observation group were significantly higher than those in the control group（all P<0.05）. The score and total score of C-CCFSS in the observation group were significantly higher than those in the control group（P<0.05）. Within one week after operation， the complication rate in observation group was significantly lower than that in control group（all P<0.05）. Conclusion Taking an integrated treatment mode in county hospital for patients with severe trauma can obtain a more satisfactory effect with a certain clinical value.

[Key words] County hospital； Severe trauma； Integration； Treatment mode

随着市场经济的不断发展，建筑与交通行业日益繁荣，加之工业化机械应用领域广泛，严重创伤发病率呈现逐年增长的趋势。我国当前针对严重创伤的救治尚未形成规模式化、规范化的方法，尤其县城医院医疗条件不足，医用设备老化陈旧，患者家属思想观念保守，加之医护救助团队存在流动性大、指挥调度可行性低、业务能力缺乏等救护体系不健全特征，抢救成功率常不容乐观[1-3]。有关调查报告[4-6]认为，半数以上严重创伤患者在受伤后1 h内死亡，而30%左右患者则会死于受伤后2～4 h，有“白金1 h，黄金4 h”的急救医学概念，因而加强患者圍抢救期工作效率迫在眉睫。一体化救治模式属于涵盖多学科的团队密切协作模式，旨在通过建立明确的创伤救治系统与运行机制，强化各个急救环节的统一组织管理，以增强区域内创伤急救质量。……