Mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries
10.3760/cma.j.issn.1001-8050.2009.02.31
- VernacularTitle:移动监护与急救手术前移在严重胸部创伤急救中的应用
- Author:
Dingyuan DU
;
Lingwen KONG
;
Xingji ZHAO
;
Yuankang TAN
;
Hongjie SU
;
Weimin ZHANG
;
Pingjun CAI
- Publication Type:Journal Article
- Keywords:
Multiple trauma;
Thoracic injuries;
Pre-hospital care
- From:
Chinese Journal of Trauma
2009;25(2):107-111
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the feasibility, safety and effectiveness of mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries so as to further improve success rate of treatment of severe thoracic trauma. Methods A retrospective study was done on the clinical data of 72 patients with severe thoracic injuries (AIS≥3) treated by surgeons from Chongqing Emergency Medical Center (CEMC) from April 1998 to August 2008. The patients were divided into pre-hospital group (n = 36) and in-hospital group (n = 36) according to the time that the definite surgery performed. Results (1) There was no significant statistical difference upon arrival time from scene to primary hospital between two groups (P > 0.05). For patients in pre-hospital group, the time to receive definite surgery was (3.9±4.1) hours, which was significant shorter than (9.6±8.2) hours in in-hospital group (P < 0.05). (2) There were no statistical significant differences upon blood loss volume and blood transfusion volume between two groups (P > 0.05). (3) There was no significant statistical difference upon ISS value between two groups (P > 0.05), but the RTS value of pre-hospital group was significantly lower than that of in-hospital group (P < 0.05). The incidence rate of shock in pre-hospital group was 86.1%, which was significantly higher than 41.7% in in-hospital group (P < 0.05). (4) The percentage of patients who received thoracic close drainage in pre-hospital group was 16.7%, which was significantly higher than 5.6% in in-hospital group. There was no significant statistical difference upon thoracic close drainage plus thoracotomy, thoracic close drainage plus laparotomy and thoracic close drainage plus other operations between two groups. However, the operative rate of thoracic close drainage plus thoracotomy for penetrating injury was 4.8 times higher than that for blunt injury in pre-hospital group, and 1.9 times higher than that for blunt injury in-hospitai group. The operative rate of thoracic close drainage plus laparotomy for blunt injury was 5 times higher than that for penetrating injury in prehospital group, and 4.5 times higher than that for penetrating injury in in-hospital group. The overall survival rate was 95.8% (69/72). Five of eight moribund patients were saved in pre-hospital group, the prevented death rate accounted for 13.9% (5/36) in this group. Conclusions It is flexible, safe and effective to implement mobile intensive care and definite lifesaving surgical interventions for patients with severe thoracic injuries in primary hospitals. After the condition of the patient is stabilized, a quick transportation of the patients to a higher level trauma centers (hospitals) for further treatment may reduce the pre-hospital death rate.
