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中国临床研究英文版:2023,36(4):576-580
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新冠疫情下严重创伤救治时间轴管理对创伤救治质量的影响
(苏州大学附属第一医院急诊医学科,江苏 苏州 215006)
Management along axis of time for severe trauma treatment on the quality of trauma treatment under the COVID-19 epidemic
(Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China)
摘要
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Received:July 14, 2022   Published Online:April 20, 2023
中文摘要: 目的 探讨新冠疫情下通过时间轴管理、流程优化和技能提升对创伤救治质量的影响。 方法 收集苏州大学附属第一医院新院创伤中心2019年1月1日至2020年12月31日收治抢救的严重创伤患者[创伤严重程度评分(ISS)≥16分]共492例为研究对象,根据新冠疫情发生的时间节点将2019年1月1日至12月31日收治的219例作为对照组,采用传统的流程和方法进行创伤救治;将2020年1月1日至12月31日收治的273例作为观察组,根据疫情防控需求优化预检分诊流程,加强临床、检验、放射人员互通合作,制定完备的急救和急诊手术应急预案,并通过时间轴管理持续改进相应流程,加强各级医师的技能优化实施抢救,比较新冠疫情前后两组患者在ISS评分、团队启动时间、建立静脉通路时间、输第一袋血时间、气管插管时间、送CT检查时间、送急诊手术时间、抢救室滞留时间及死亡率等质控指标的差异。 结果 观察组与对照组的ISS评分、相近,差异无统计学意义(P>0.05);观察组、启动创伤团队时间、建立静脉通路的时间输第一袋血时间、气管插管时间及送CT检查时间、送急诊手术时间和抢救室滞留时间缩短,差异有统计学意义(P<0.05)。死亡率略减低,但差异无统计学意义(P>0.05)。 结论 通过信息化时间轴管理系统对严重创伤抢救流程进行优化和改进,结合疫情防控流程优化,可减少新冠疫情对抢救质量和效率的影响,有利于提升创伤中心抢救能力。
Abstract:Objective To explore the influences of time axis management, process optimization and skill improvement on the quality of trauma treatment under the COVID-19 epidemic. Methods A total of 492 severe trauma patients [Injury Severity Score(ISS)≥ 16 points] rescued in the Trauma Center of the First Affiliated Hospital of Soochow University from January 1, 2019 to December 31, 2020 were selected as the research subjects. According to the time points of COVID-19 epidemic, 219 cases admitted from January 1 to December 31, 2019 were enrolled as control group, treated with traditional processes and methods for trauma care. Another 273 patients admitted from January 1 to December 31, 2020 were selected as observation group, in which the following measures were implemented, including pre-triage screening, cooperation in clinical, laboratory and radiological staff, formulating a complete emergency plan for first aid and emergency surgery, improving continuouly the corresponding process through time axis management and improving the skills of doctors at all levels to optimize the implementation of rescue. ISS scores, team start-up time, establishing venous access time, start-time of blood transfusion, endotracheal intubation time, sending time for CT examination, sending time for emergency-surgery, length of emergency room stay and mortality were compared between two groups of patients before and after the COVID-19 epidemic. Results ISS score, was similar in two groups(P>0.05). The team start-up time, establishing venous access time start-time of blood transfusion, endotracheal intubation time and sending time for CT examination, sending time for emergency-surgery and emergency room stay in observation group were statistically shortened compared with those in control group(P<0.05). The mortality was slightly lower in observation group, but there was no statistical difference in it between two groups(P>0.05). Conclusion Optimizing and improving the rescue process of severe trauma through the information-based time axis management system, combined with the optimization of epidemic prevention and control process, can reduce the impact of COVID-19 epidemic on the rescue quality and efficiency, which is conducive to improving the rescue capacity of the trauma center.
文章编号:     中图分类号:R641    文献标志码:B
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