| 赵海洋,郭红民,李晓明,王浩琪,连利超,于海昊,姚 蕾,刘立红,杨丽娟,祝乃强.骨科损伤控制联合多学科团队协作创伤急救模式在严重创伤骨折大出血救治中的应用[J].,2024,(13):2537-2541 |
| 骨科损伤控制联合多学科团队协作创伤急救模式在严重创伤骨折大出血救治中的应用 |
| Application of Damage Control Orthopaedics Combined with Multidisciplinary Team Collaboration Trauma First Aid Mode in the Treatment of Severe Traumatic Fracture with Massive Bleeding |
| 投稿时间：2024-01-12 修订日期：2024-01-31 |
| DOI：10.13241/j.cnki.pmb.2024.13.026 |
| 中文关键词: 骨科损伤控制 多学科团队协作 创伤急救 严重创伤 骨折 大出血 |
| 英文关键词: Damage control orthopaedics Multidisciplinary team collaboration Trauma first aid Severe trauma Fracture Massive bleeding |
| 基金项目:河北省2022年度自然科学基金项目（H2022406038） |
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| 中文摘要: |
| 摘要 目的：观察骨科损伤控制（DCO）联合多学科团队协作（MDT）创伤急救模式在严重创伤骨折大出血救治中的应用效果。方法：选取2023年1月~2023年9月我院收治的108例严重创伤骨折大出血患者，以随机数表法纳为观察组与对照组。对照组给予常规救治模式，观察组给予DCO联合MDT创伤急救模式。比较两组术前损伤严重度（ISS）评分、救治情况、围术期心率（HR）、收缩压、24 h尿量、凝血功能[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）]、炎症因子[肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、白介素-6（IL-6）]，并统计两组术后骨折愈合、并发症及死亡情况。结果：观察组休克控制时间、术中出血量及住院时间均较对照组少（P<0.05）。术后6 h两组患者HR较术前降低，且观察组较对照组低（P<0.05）。术后6 h两组收缩压、24 h尿量较术前增加，且观察组较对照组高（P<0.05）。术前与术后6 h两组患者PT、APTT水平比较差异不显著（P>0.05）。两组患者围术期TNF-α、IL-1、IL-6水平在重复测量方差分析的组间、时间及交互作用比较差异显著（P＜0.05），与术前比较术后3 d及7 d两组TNF-α、IL-1、IL-6水平均降低，且观察组更低（P＜0.05）。观察组院内死亡率低于对照组，且骨折愈合优良率高于对照组（P＜0.05）。两组术后并发症发生率比较差异不显著（P>0.05）。结论：DCO联合MDT创伤急救模式能减少严重创伤骨折大出血患者术中出血量、休克及住院时间，同时有助于改善患者围术期血流动力学与炎症反应，促进骨折愈合并降低死亡率。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the application effect of damage control orthopaedics (DCO) combined with multidisciplinary team collaboration (MDT) trauma first aid mode in the treatment of severe traumatic fracture with massive bleeding. Methods: A total of 108 patients with severe traumatic fracture and massive bleeding who were admitted to the hospital from January to September 2023 were selected. They were divided into an observation group and a control group using the random number table method. The control group was given conventional treatment, and the observation group was given DCO combined with MDT trauma first aid mode. The preoperative injury severity score (ISS), treatment outcomes, perioperative heart rate (HR), systolic blood pressure, 24-hour urine volume, coagulation function [prothrombin time (PT) and activated partial thromboplastin time (APTT)], and inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6)] were compared between the two groups. Postoperative fracture healing, the incidence rates of complications, and in-hospital mortality rates in both groups were recorded. Results: The shock control time, intraoperative blood loss and hospital stay of the observation group were less than those of the control group(P<0.05). Six hours after surgery, HR of both groups decreased, and HR of the observation group was lower than that of the control group (P<0.05). Six hours after surgery, systolic blood pressure and 24-hour urine volume of both groups increased. Systolic blood pressure and 24-hour urine volume of the observation group were higher than those of the control group (P<0.05). There was no significant difference in PT or APTT in the two groups before surgery and at 6 hours after surgery (P>0.05). Perioperative TNF-α, IL-1 and IL-6 levels showed significant differences in terms of inter-group effect, time effect and interaction effect(P<0.05). The levels of TNF-α, IL-1 and IL-6 in both groups on day 3 and day 7 after surgery were lower than preoperative levels, and the observation group were lower(P<0.05). Compared with the control group, the observation group had a lower in-hospital mortality rate and better fracture healing(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion: DCO combined with MDT trauma first aid mode can reduce intraoperative blood loss, shock duration and hospital stay of patients with severe traumatic fracture and massive bleeding. At the same time, it helps to improve perioperative hemodynamics and inflammatory response, promote fracture healing, and reduce mortality. |
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