摘要
目的结合目前国内在颅脑外伤救治中存在的问题探讨区域创伤中心建设的重点内容及关注点。方法收集2015年8月至2017年7月泰州市人民医院收治的颅脑外伤急诊手术病例共171例。根据患者入院时GCS评分(Glasgow Coma Scale)分为4组。术后根据其出院时的GCS评分对其预后进行评价,分为死亡,4~5分,6~8分,9~12分,13~15分5个类别。结果共有171例患者纳入本研究中,按照入院GCS评分分为4组(3~5分,6~8分,9~12分,13~15分),其病死率分别是48.15%,20.59%,4.76%,8.57%。在3~5分组中入院1 h内手术的组内死亡率与1~2 h及大于2 h相比(17.95%,38.96%,43.59%)差异有统计学意义(P<0.05),在6~8分组入院1 h内手术的组内死亡率与1~2 h及大于2 h相比(0,42.86%,57.14%)差异有统计学意义(P<0.05),另外两组(9~12分,13~15分)死亡率组间比较差异无统计学意义(P>0.05)。针对上述数据,结合国内及国际颅脑创伤救治现状分析,目前颅脑外伤救治中存在院前救治与院内救治衔接不畅、院内救治流程繁琐、各个环节之间脱节、院内转运距离远、时间长等问题。结论区域性创伤中心建设的重点是以信息化为基础,强化各个环节的有效衔接,进行诊治流程再造、优化资源的时间和空间配置,缩短伤情发生到得到有效救治的时间,提高颅脑外伤患者救治的效率。
Objective Combined with the current problems in treating traumatic brain injury(TBI),we discussed the actual contents and concerns of the construction of regional trauma centres.Methods We collected 171 TBI cases who took emergency surgery in our hospital from August 2015 to July 2017.The patients were divided into 4 groups according to the GCS score at admission.Each patient was admitted to the hospital with surgical indications for emergency surgery.After the operation,the prognosis was evaluated in 5 categories according to the GCS score at discharge(death,4~5 points,6~8 points,9~12 points,and 13~15 points).Results A total of 171 patients were enrolled in this study,according to the GCS score were divided into 4 groups(3~5 points,6~8 points,9~12 points,13~15 points),the mortality rate was 48.15%,20.59%,4.76%,8.57%.In the group whose GCS was 3~5,the mortality rate in <1 hour group compared to the 1~2 hours and more than 2 hours was lower(17.95%,38.96%,43.59%),P<0.05.In the group whose GCS was 6~8,the result of the mortality rate is the same as above(0,42.86%,57.14%),P<0.05.In the other two groups(9~12,13~15).There was no statistical significance in mortality and treatment time(P>0.05).According to the analysis of the above data,combined with the analysis of the current situation of the treatment of TBI at home and abroad,there are some problems such as poor connection between pre-hospital treatment and in-hospital treatment,cumbersome in-hospital treatment process,disconnection between various links,long distance and time of in-hospital transfer in the current treatment of craniocerebral trauma.Conclusion The focus of the construction of regional trauma centres is to strengthen the effective link of each link,to re-engineer the consultation and treatment process,to optimize the time and space allocation of the resources,to shorten the time of the injury to get the effective treatment and to improve the efficiency of the treatment of the TBI patients.
作者
霍红月
降建新
HUO Hongyue;JIANG Jianxin(Medical clinical science and technology development fund of Jiangsu University,Dalian 116044,China;Department of Neurosurgery,Taizhou People's Hospital,Taizhou 225300,China)
出处
《中华灾害救援医学》
2022年第3期143-147,共5页
Chinese Journal of Disaster Medicine
基金
泰州市第五期“311工程”第二层次培养对象拟资助科研项目(RCPY202129)
浦东新区科技发展基金事业单位民生科研专项(PKJ2021-Y09)。
关键词
颅脑外伤
有效救治时间
区域创伤中心
建设重点
traumatic brain injury
adequate treatment time
regional trauma center
focus of construction
