以创伤医师为主导的多学科协作模式对血流动力学不稳定骨盆骨折的早期救治效果评估

摘要
图/表
参考文献(20)
相关文章 (15)

全文: PDF (589 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要

目的探讨以创伤医师为主导的多学科协作（MDT）模式对血流动力学不稳定骨盆骨折的早期救治效果。方法选取2020 年7 月至2023 年7 月北京积水潭医院贵州医院收治的280 例血流动力学不稳定骨盆骨折患者作为研究对象，根据救治模式分为观察组（140 例）和对照组（140 例）。观察组实施创伤医师为指导的MDT 救治模式，对照组实施传统救治模式。比较两组死亡率、入院时及入院后生命体征、实验室指标、治疗情况及诊疗时间。结果两组入院后24 h 内死亡率比较，差异无统计学意义（P＞0.05）；两组入院时收缩压、心率、血红蛋白、血小板计数、血乳酸比较，差异无统计学意义（P＞0.05）；入院后6、24 h，观察组收缩压高于对照组，观察组心率低于对照组，差异有统计学意义（P＜0.05）；入院后24 h，观察组血红蛋白、血小板计数高于对照组，观察组血乳酸低于对照组，差异有统计学意义（P＜0.05）；观察组输血量低于对照组，ICU 住院时间、急诊通过时间、早期救治时间短于对照组，差异有统计学意义（P＜0.05）。结论创伤医师为主导的MDT 模式在血流动力学不稳定骨盆骨折的早期救治中，可有效提高患者生命体征的稳定性，缩短治疗相关时间。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：骨盆骨折, 血流动力学不稳定, 多学科协作模式, 创伤医师, 早期救治

Abstract：

Objective To explore the effectiveness of early treatment of hemodynamically unstable pelvic fractures led by trauma physicians using multidisciplinary team (MDT) approach.Methods A total of 280 patients with hemodynamically unstable pelvic fractures from July 2020 to July 2023 admitted to Beijing Jishuitan Hospital Guizhou Hospital were selected as the study objects.They were divided into observation group (140 cases)and control group (140 cases).The observation group was treated with MDT model guided by trauma physicians,while the control group received traditional treatment.The mortality rate,vital signs at admission and after admission,laboratory indicators,treatment conditions,and diagnostic and treatment times were compared between the two groups.Results The mortality rates within 24 hours after admission between the two groups showed no significant statistical differences(P＞0.05).There were no significant differences in systolic blood pressure,heart rate,hemoglobin,platelet count,and blood lactate levels at admission between the two groups(P＞0.05).At 6 hours and 24 hours after admission,the systolic blood pressure of the observation group was higher than that of the control group,and the heart rate of the observation group was lower than that of the control group,and the differences were statistically significant (P＜0.05).At 24 hours after admission,the hemoglobin and platelet counts of the observation group were higher than those of the control group,and the blood lactate levels of the observation group were lower than those of the control group,and the differences were statistically significant (P＜0.05).The transfusion volume of the observation group was lower than that of the control group,and the ICU stay duration,emergency department throughput time,and early treatment time were shorter than those of the control group,and the differences were statistically significant (P＜0.05).Conclusion The MDT model led by trauma physicians can effectively improve the stability of vital signs in patients with hemodynamically unstable pelvic fractures and shorten related treatment times.

Key words： Pelvic fracture Hemodynamic instability Multidisciplinary team model Trauma physician Early treatment

通讯作者: 罗盛强（1995-），男，贵州遵义人，硕士；研究方向：急诊创伤。

作者简介:

引用本文:

周瑶；罗盛强. 以创伤医师为主导的多学科协作模式对血流动力学不稳定骨盆骨折的早期救治效果评估[J]. 中国当代医药, 2024, 31(12): 70-73转78.
ZHOU Yao LUO Shengqiang. Evaluation of early treatment effectiveness for hemodynamically unstable pelvic fractures led by trauma physicians using multidisciplinary team approach. 中国当代医药, 2024, 31(12): 70-73转78.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2024/V31/I12/70

[1]	刘丹，刘纪宁，朱伦刚，等.多学科联合急救系统在血流动力学不稳定骨盆骨折患者的临床应用[J].重庆医学，2021，50（15）：2606-2610.
[2]	方加虎.血流动力学不稳定骨盆骨折的致病因素和早期处理措施[J].创伤外科杂志，2021，23（5）：321-325.
[3]	韦功滨.严重骨盆骨折大出血治疗进展[J].重庆医学，2021，50（9）：1609-1612，1620.
[4]	周东生.严重血流动力学不稳定骨盆骨折早期急救的进展[J].中国骨伤，2022，35（4）：3305-3309.
[5]	郭剑，雷洁洁，章柏平，等.新型无创外固定装置在骨盆骨折院前急救中的临床应用[J].实用临床医药杂志，2020，24（3）：26-28，32.
[6]	Guillaume JM，Pesenti S，Jouve JL，et al.Pelvic fractures in children（pelvic ring and acetabulum）[J].Orthop Traumatol Surg Res，2020，106（1）：125-133.
[7]	Mi M，Kanakaris NK，Wu X，et al.Management and outcomes of open pelvic fractures：An update[J].Injury，2021，52（10）：2738-2745.
[8]	游建雄，王精兵，赵庆，等.动脉栓塞联合外固定术治疗不稳定性骨盆骨折伴出血性休克效果分析[J].介入放射学杂志，2021，30（5）：493-497.
[9]	中华医学会急诊医学分会创伤学组.血流动力学不稳定骨盆骨折急诊处理的专家共识[J].中华急诊医学杂志，2011，20（10）：1017-1018.
[10]	Lin SS，Zhou SG，He LS，et al.The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures[J].Chin J Traumatol，2021，24（2）：100-103.
[11]	Maruhashi T，Kashimi F，Kotoh R，et al.Novel transcatheter arterial embolization method for hemodynamical ly unstable pelvic fractures to prevent complications of gluteal necrosis[J].Eur J Trauma Emerg Surg，2020，46（5）：1129-1136.
[12]	张明照，李博，秦荣清，等.血管介入栓塞治疗骨盆骨折出血的止血效果[J].介入放射学杂志，2023，32（5）：431-435.
[13]	金翔赟，涂志朋，张超，等.骨盆骨折合并出血性休克早期止血方法[J].国际骨科学杂志，2022，43（6）：348-351.
[14]	Perumal R，S DCR，P SS，et al.Management of pelvic injuries in hemodynamically unstable polytrauma patients-Challenges and current updates[J].J Clin Orthop Trauma，2021，12（1）：101-112.
[15]	Anand T，El-Qawaqzeh K，Nelson A，et al.Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures[J].JAMA Surg，2023，158（1）：63-71.
[16]	汪洋，鲁厚清，邵仁德，等.三种休克指数对骨盆骨折伴休克患者预后的早期评估预测价值[J].皖南医学院学报，2022，41（3）：235-238.
[17]	Kim MJ，Lee SH，Jang JY，et al.Comparison of mortality among hemorrhage-control methods performed for hemodynamically unstable patients with traumatic pelvic fractures：A multi-center study[J].Asian J Surg，2023，46（1）：444-450.
[18]	王琦，李琳，于震，等.骨盆创伤知名血管损伤的紧急处理策略[J].骨科，2023，14（3）：207-214.
[19]	江吕泉，杨乐，郑建，等.损伤控制在严重胸部创伤合并四肢和骨盆骨折救治中的应用价值[J].武警医学，2020，31（5）：422-425.
[20]	赵丽.预见性干预结合信息化干预对创伤性骨盆骨折的急救影响[J].中国急救复苏与灾害医学杂志，2020，15（3）：225-229.