目的:探讨循证治疗流程化管理对严重创伤患者救治的影响,为综合性医院高效救治严重创伤提供借鉴。方法选择2013年1月至2015年6月在南京医科大学附属苏州市立医院依照循证治疗流程化处理的严重创伤患者165例,作为研究组;2011年1月至2012年12月院内进行常规救治的严重创伤患者124例,作为对照组。比较两组在术前时间、早期漏诊率、早期死亡率、并发症发生率以及晚期死亡率等指标方面的差异。结果研究组患者院内术前时间、检验获得时间、CT完成时间较对照组明显提前[(52.1±10.2)min vs.(85.2±12.5)min;(40.3±5.2)min vs.(60.4±7.3) min;(24.2±8.3)min vs.(40.3±10.3)min;均P<0.01],损伤控制使用比例和氨甲环酸使用比例明显提高(46.1%vs.8.1%;55.3%vs.30.2%;均P<0.01),且研究组早期漏诊率、早期死亡率以及并发症发生率均较对照组患者显著降低(7.9%vs.16.6%;5.5%vs.11.8%;9.1%vs.18.3%;均P<0.01),但是患者晚期死亡率在两组之间差异无统计学意义(18.9%vs.19.3%,P>0.05)。结论循证治疗流程化管理可明显提高严重创伤的院内急救水平,有益于患者早期救治。
Objective To analyze the impact of the evidence-based treatment pathway checklist be used to guide clinical management on severe trauma treatment, in order to help general hospitals to develop effective strategy for treating severe trauma on the basis of emergency department. Methods The clinical data of 289 patients with severe trauma who were treated in the department of Emergency in Suzhou Municipal Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. The patients were divided to two groups, including the study group (n=165), who were treated by evidence-based treatment from Jan 2013 to Jun 2015, and the control group (n=124), who were treated by routine treatment from Jan 2011 to Dec 2012. The variation of several indicators between the study group and the control group, such as the preoperative time, early misdiagnosis, early and late mortality, and the incidence of complications were analyzed respectively. Results The preoperative time, the time of testing, and the time from hospital arrival to CT scan were improved significantly in study group than those in control group [(52.1±10.2)min vs. (85.2±12.5)min; (40.3±5.2)min vs. (60.4±7.3)min; (24.2±8.3)min vs.(40.3±10.3)min; all P<0.01], the usage of damage control surgery and tranexamic acid increased in study group than those in control group (46.1%vs. 8.1%;55.3%vs. 30.2%;all P<0.01), however the rate of early misdiagnosis, early mortality and the incidence of complications reduced dramatically in study group than those in control group (7.9%vs. 16.6%;5.5%vs. 11.8%;9.1%vs. 18.3%;all P<0.01). There was no statistically significant difference in late mortality between the two groups (18.9% vs. 19.3%, P>0.05). Conclusion The evidence-based treatment pathway checklist be used to guide clinical management can significantly improve the treatment of severe trauma in hospital.