Buchmann B, Kaufmann M A, Scheidegger D, Gratzl O
Department of Anesthesia and Intensive Care, University of Basel/Kantonsspital, Switzerland.
J Trauma. 1992 Apr;32(4):459-63. doi: 10.1097/00005373-199204000-00009.
To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). The DNR and mortality rates within the first 48 hours (13%, 10%, 10%, respectively) as well as for the entire stay in the surgical intensive care unit (SICU) were comparable for the three groups. It has been pointed out that efficient resuscitation at the scene of the injury may, instead of improving overall outcome, increase morbidity and mortality rates because more severely injured patients now reach the hospital alive. We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.
为评估现场复苏与院内复苏对重型颅脑损伤患者“不要复苏”（DNR）决策及院内死亡率的影响，我们对561例患者进行了前瞻性研究。根据复苏最初发生在受伤现场（第1组）、转院前在地区医院（第2组）还是直接入住我们的神经外科中心后（第3组），对患者进行分组。三组患者在最初48小时内的DNR率和死亡率（分别为13%、10%、10%）以及在外科重症监护病房（SICU）的整个住院期间的情况均具有可比性。有人指出，受伤现场的有效复苏可能不会改善总体预后，反而会增加发病率和死亡率，因为现在更多重伤患者活着到达医院。然而，我们得出的结论是，受伤现场的积极初步治疗在48小时随访期内以及在SICU的整个住院期间，均未增加DNR率和院内死亡率。对长期预后的研究对于进一步确定这种方法的疗效很重要。
