Hilbert P, Hoeller J, Wawro W, Zur Nieden K, Ruppmann B, Koch R, Braunschweig R, Hofmann G O, Stuttmann R
Klinik für Anästhesiologie, Intensiv- und Notfallmedizin BG-Kliniken Bergmannstrost Halle.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2005 Dec;40(12):720-5. doi: 10.1055/s-2005-921036.
In the treatment of the seriously injured patient, time is crucial. Clarke et al. showed that in the hypotensive patient with blunt abdominal trauma and bleeding a delay in the surgical treatment over 90 min increases mortality of 1 % every 3 minutes. So called trauma algorithms are used as systematic approach to the seriously injured patient that can be easily reviewed and practiced. One impact of this algorithm is to shorten time in the emergency room and may improve outcome of the patient. The patient outcome is directly related to the length of time between the injury and the beginning to proper definitive care.
Are improvements still necessary and possible in the care of the seriously injured patient? New technical developments like multislice-CT are able to shorten time until definitive care. The practicability of an multislice-CT orientated treatment algorithm was evaluated.
After integration of an multislice-CT into the emergency room the treatment of the seriously injured patient (ISS >16) was changed. Therefore an algorithm which puts the CT diagnostics in the first minutes of the clinical care was developed.
50 patients were treated following the new algorithm. The time in the emergency room decreased from 87 min to 36 min.
This algorithm requires a differing from previous surgical standards, but it proved to be timesaving, effective and practicable. It makes the beginning of the definitive care possible within the first 40 min after patient arrival in the emergency room.
在救治重伤患者时，时间至关重要。克拉克等人表明，对于腹部钝性创伤并出血的低血压患者，手术治疗延迟超过90分钟，每3分钟死亡率就会增加1%。所谓的创伤治疗流程被用作救治重伤患者的系统方法，这种方法易于回顾和实施。该流程的一个作用是缩短在急诊室的时间，并可能改善患者的治疗结果。患者的治疗结果与受伤至开始接受适当确定性治疗之间的时间长度直接相关。
在重伤患者的救治方面是否仍有必要且有可能进行改进？像多层螺旋CT这样的新技术发展能够缩短直至确定性治疗的时间。对一种以多层螺旋CT为导向的治疗流程的实用性进行了评估。
将多层螺旋CT整合到急诊室后，对重伤患者（损伤严重度评分>16）的治疗方式进行了改变。因此，制定了一种在临床护理的最初几分钟就进行CT诊断的流程。
按照新流程治疗了50例患者。在急诊室的时间从87分钟减少到了36分钟。
该流程需要不同于以往的手术标准，但事实证明它节省时间、有效且可行。它使得患者到达急诊室后的前40分钟内就能够开始进行确定性治疗。
