深圳市院前急救创伤患者流行病学特征与急救结局研究

发布时间：2018-01-05 02:29

本文关键词：深圳市院前急救创伤患者流行病学特征与急救结局研究　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:1、分析院前急救创伤患者的流行病学特征,为制定科学的创伤防控措施提供依据;2、探讨影响严重道路交通伤院前急救效果的危险因素,为完善创伤院前救治体系提供依据;3、通过对院前、急诊、院内创伤死亡病例综合分析,探寻每个急救阶段所存在的缺陷,为改善创伤整体救治体系和优化流程提供参考依据。方法:1、收集深圳市急救中心2011—2015年所有创伤患者调度出车及院前电子病历数据,导入SPSS 19.0进行描述性统计分析;2、回顾性分析2011-2015年深圳市严重道路交通伤患者120调度出车及院前急救病历数据共488例,通过多因素Logistic回归分析,得出可导致严重道路交通伤患者院前急救无效的影响因素;3、通过急救死亡病例调查收集整理2014年深圳市急救网络医院创伤患者急救3天内死亡患者资料,综合运用与2004年数据纵向比较、可预防性死亡多因素Logistic回归分析及专家评价分析等方法寻找院前、急诊、院内病房各个阶段存在的主要缺陷。结果:1、5年间院前创伤患者逐年增加,在纳入的79 480例创伤患者中,20～49岁青壮年占76.5%。一年中,以10—12月份创伤患者较多,二月份最少;一天中,以夜间20:00-22:00点较多,凌晨4:00-6:00点较少。救护车到达现场时间中位数为9.12 min,救护车到达医院时间中位数为23.31 min,各区急救反应时间不均衡。致伤原因前3位为交通伤、斗殴伤、跌倒伤,交通伤占42.74%,55岁之前的致伤原因前3位均为交通伤、斗殴伤、跌倒,56岁之后顺位改变为跌倒、交通伤和斗殴伤,跌倒居首位,占39.51%;下肢和脊柱受伤比例随年龄增长而增高;重伤原因以交通伤、高处坠落伤、刀砍刺伤、斗殴伤、酗酒致伤为主。2、488例严重道路交通伤患者中,院前急救无效347例(71.1%)。多因素Logistic回归分析提示受伤部位、昏迷、PHI、救援到达时间长、院前急救非规范化措施是决定院前急救无效的危险因素。3、2014年创伤患者中院前死亡构成比73.44%,2014年到达现场致死率92.71%;急诊死亡患者中,2014年会诊医师30分钟到场率58.62%;院内病房死亡病例中,会诊医师30分钟到场率、30分钟开始输血率及手术率均有不同程度下降,均在30%以下。创伤可预防性致死率达27.7%,可预防性相关影响因素有受伤地点、受伤机制、是否转院、死亡地点、死亡原因,不包括医院等级。急救死亡病例专家评价中,急诊死亡病例问题出现率最高,50.37%,流程问题占95.59%;系统问题在院内病房病例最多见,占50%。结论:1、深圳院前创伤患者的流行病学特点与其移民城市的性质密切相关,深圳市急救资源的配置仍然不均衡,老龄人创伤的流行病学分布不同于其他人群,值得重视。2、严重道路伤患者的受伤部位、PHI和是否发生昏迷,是院前急救效果的重要影响因素。缩短救援到达时间、规范院前急救措施有助于提高院前急救有效率,从而改善严重创伤的预后。3、院前死亡构成比、到达现场致死率均较高,应重视现场自救互救。可预防性死亡发生率高于发达国家,创伤院前急救--急诊--院内病房急救服务绿色通道实施仍未到位,急救措施缺乏标准化。总之,深圳创伤救治体系需要重新规划。
[Abstract]:Objective: 1, analysis of the epidemiological characteristics of trauma patients in pre hospital emergency, provide the basis for making scientific trauma prevention and control measures; 2, to explore the effect of risk factors affecting serious road traffic injury in pre hospital emergency, provide the basis for the improvement of pre hospital treatment system; 3, the emergency of pre hospital, comprehensive analysis of death cases in hospital in exploring the defects of each trauma, emergency stage, to provide reference for improving the overall trauma treatment system and optimize the process. Methods: 1, collect the emergency center of Shenzhen city from 2011 to 2015 and the pre hospital trauma patients out of the bus scheduling electronic medical records data into SPSS 19 descriptive statistical analysis; 2, retrospective analysis of emergency medical records the data of Shenzhen city a total of 488 cases of severe traffic injury patients and 120 out of the bus scheduling hospital in 2011-2015, through Logistic regression analysis, it can lead to serious road traffic injury patients Influence factors of emergency invalid; 3, the emergency death cases survey collected in 2014 in Shenzhen city emergency network hospital emergency trauma patients died within 3 days of data, comprehensive application and data of 2004 longitudinal comparison, can prevent the death of method of multivariate Logistic regression analysis analysis and expert evaluation for pre hospital emergency, the main defects of hospital in the ward for each stage. Results: 1,5 years of pre hospital trauma patients increased year by year, in 79480 cases of trauma patients in 20 ~ 49 year-old young adults accounted for 76.5%. in a year, from 10 to December in trauma patients more, at least in February; during the day, at night 20:00-22:00 points more, less 4:00-6:00 in the morning. The ambulance arrived at the scene for a median of 9.12 min, the ambulance arrived at the hospital time was 23.31 min, the emergency response time is not balanced. The causes of injury before the 3 traffic accidents, fights, or Fall injury, traffic injuries accounted for 42.74%, 55 years before the top 3 causes of injury were traffic accident, fighting, fall, after the age of 56 cis position change to fall, traffic accidents and fights, fall in the first place, accounting for 39.51%; lower limb and spine injury rate increased with age; for the injured in the traffic accident, falling injury, knife stabbed, fighting, drinking injury.2488 cases of severe traffic injury patients, 347 cases of pre hospital emergency care (71.1%). Multivariate Logistic regression analysis showed that the site of injury, coma, PHI, rescue time, pre hospital emergency non standardized measures is decided prehospital hospital risk factors.32014 trauma patients invalid death before 73.44% of 2014, arrived at the scene 92.71% mortality rate; death of emergency patients, the consultant in 2014 30 minutes was 58.62%; cases in hospital ward died, the consultant arrived 30 minutes rate, 30 points The clock began to blood transfusion rate and operation rate were decreased, were below 30%. The trauma of preventable death rate of 27.7%, cause of preventable factors related to injury site, injury mechanism, whether referral, place of death, death, not including the rank of the hospital. Emergency death cases of expert evaluation, the highest rate of emergence, 50.37% emergency death cases, process problems accounted for 95.59%; the system problems in the hospital ward were the most common, accounting for 1. Conclusion: 50%. is closely related to nature of epidemiological characteristics of trauma patients before the Shenzhen Institute and immigration city, Shenzhen emergency resource allocation is still not balanced, the elderly trauma epidemiology distribution different from other people, worthy of attention.2 injuries in patients with severe injury of the road, and PHI is unconscious, is an important factor influencing the effect of pre hospital emergency rescue. Shorten the arrival time, measures of pre hospital emergency Help to improve the first-aid efficiency, so as to improve the prognosis of.3 in severe trauma, prehospital death proportion, arrived at the scene of death rate is higher, should pay attention to the field of self-help and mutual aid. Preventable death incidence was higher than that of developed countries, emergency hospital emergency ward - service Easy Access implementation is not yet in place of pre hospital trauma emergency first aid measures, lack of standardization. In short, Shenzhen trauma system need to be re planning.

【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R459.7

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