Biewener Achim, Aschenbrenner Ulf, Rammelt Stefan, Grass René, Zwipp Hans
Department of Trauma and Recontructive Surgery, University Hospital Dresden, Germany.
J Trauma. 2004 Jan;56(1):94-8. doi: 10.1097/01.TA.0000061883.92194.50.
Despite numerous studies analyzing this topic, specific advantages of helicopter transport of blunt polytrauma patients as compared with ground ambulances have not yet been identified unequivocally.
Four possible pathways in 403 polytrauma patients (Injury Severity Score [ISS] > 16) who were in reach of the helicopter emergency medical service (HEMS) Dresden were analyzed as follows: HEMS-UNI group (n = 140), transfer by HEMS into a university hospital; AMB-REG group (n = 102), transfer by ground ambulance into a regional (Level II or III) hospital; AMB-UNI group (n = 70), transfer by ground ambulance into the university hospital; and INTER group (n = 91), transfer by ground ambulance into a regional hospital, followed by transfer to the university hospital. Scores used were the ISS and the TRISS. Tests used for statistical analysis included chi2 and Fisher's tests. Statistical significance was set at p > 0.05.
Age, gender, and mean ISS (range, 33.3-35.6) revealed extensive homogeneity of the groups. Mortality of the AMB-REG group was almost doubled (41.2%) compared with HEMS-UNI (22.1%) patients (p = 0.002). The AMB-UNI group displayed the lowest mortality (15.7%, p = not significant). TRISS analysis (PRE-Chart) revealed identical outcome for AMB-UNI and HEMS-UNI patients. Rescue time averaged 90 +/- 29 minutes for HEMS-UNI patients, 68 +/- 25 minutes for AMB-UNI patients, and 69 +/- 26 minutes for the AMB-REG group.
Primary transfer by HEMS into a Level I trauma center reduces mortality markedly. In principle, this benefit can be attributed to superior preclinical therapy, primary admission to a Level I trauma center, or both. However, the identical probability of survival of the AMB-UNI and HEMS-UNI groups in this and comparable studies does not confirm generally better survival rates on account of a more aggressive on-site approach.
尽管有大量研究分析了这个话题，但与地面救护车相比，直升机转运钝性多发伤患者的具体优势尚未得到明确认定。
对德累斯顿直升机紧急医疗服务（HEMS）覆盖范围内的403例多发伤患者（损伤严重度评分[ISS]>16）的四种可能转运途径进行了如下分析：HEMS-UNI组（n = 140），由HEMS转运至大学医院；AMB-REG组（n = 102），由地面救护车转运至地区（二级或三级）医院；AMB-UNI组（n = 70），由地面救护车转运至大学医院；INTER组（n = 91），由地面救护车转运至地区医院，随后再转运至大学医院。使用的评分是ISS和TRISS。用于统计分析的检验包括卡方检验和费舍尔检验。统计学显著性设定为p>0.05。
年龄、性别和平均ISS（范围为33.3 - 35.6）显示各组具有广泛的同质性。AMB-REG组的死亡率（41.2%）几乎是HEMS-UNI组（22.1%）患者的两倍（p = 0.002）。AMB-UNI组的死亡率最低（15.7%，p = 无显著性差异）。TRISS分析（预图表）显示AMB-UNI组和HEMS-UNI组患者的结果相同。HEMS-UNI组患者的救援时间平均为90±29分钟，AMB-UNI组为68±25分钟，AMB-REG组为69±26分钟。
由HEMS直接转运至一级创伤中心可显著降低死亡率。原则上，这种益处可归因于卓越的院前治疗、直接入住一级创伤中心，或两者兼而有之。然而，在本研究及类似研究中，AMB-UNI组和HEMS-UNI组相同的生存概率并未证实因更积极的现场处理方式而总体生存率更高。
