Georgescu V, Tudorache O, Nicolau M, Gugonea G, Strambu V
Department of Anaesthesia and Intensive Care, "Carol Davila" Nephrology Hospital, Bucharest, Romania.
Department of Anaesthesia and Intensive Care, "Agrippa Ionescu" Emergency Hospital, Bucharest, Romania.
J Med Life. 2015 Oct-Dec;8(4):527-32.
Severe trauma has become the most frequent cause of death in industrialized countries and, for this reason, the fastness of a diagnostic approach and the precocity of the proper treatment are both essential and best influenced by the trauma team collaboration and the existence of a specific algorithm in which each specialist has a definite place and role. In the first stage time of a proposed specific algorithm, the vital stage, which covers the primary survey, the trauma team has not more than 5 min. (ideally) to complete airway, breathing, circulation lesions with vital potential. The ultrasound exam is placed in this stage, which is nothing more than a completion of the primary survey maneuvers, which are exclusively clinical. Two groups of patients were compared in our study; one which was named A, represented by severe traumatized patients admitted between January 2003 and December 2006 and the other one which was named B, with severe traumatized patients admitted between January 2007 and December 2012. The second group was treated by using the modified algorithm. Although the differences were not statistically significant because of the small number of survivors, the modified algorithm was evidently superior in patients with and without cardiac arrest. If we take into account that 48 of the 261 patients survived a cardiac arrest event (although only 9 of them were discharged), the advantages of this type of algorithm are even more obvious. In lot A, 21 patients survived a cardiac arrest, of whom only 4 were discharged. Performing an ultrasound examination during the first step of the algorithm used in the study is essential regardless of trauma causes, particularly hypovolemia. For both groups of patients with and without cardiac arrest, the percentage of patients who received ultrasound increased in the group that received a modified algorithm.
在工业化国家，严重创伤已成为最常见的死亡原因。因此，诊断方法的快速性和恰当治疗的及时性至关重要，而创伤团队协作以及存在特定算法（其中每位专家都有明确的位置和作用）对此影响最大。在所提议的特定算法的第一阶段即关键阶段（涵盖初级评估），创伤团队完成气道、呼吸、循环等具有生命危险的损伤评估的时间（理想情况下）不超过5分钟。超声检查在此阶段进行，它不过是对仅靠临床操作的初级评估动作的补充。在我们的研究中比较了两组患者；一组名为A组，由2003年1月至2006年12月收治的严重创伤患者组成，另一组名为B组，由2007年1月至2012年12月收治的严重创伤患者组成。第二组采用改良算法进行治疗。尽管由于幸存者数量少差异无统计学意义，但改良算法在有或无心脏骤停的患者中明显更具优势。如果考虑到261名患者中有48人经历了心脏骤停事件后存活（尽管其中只有9人出院），这种算法的优势就更加明显。在A组中，21名患者经历心脏骤停后存活，其中只有4人出院。在研究中使用的算法的第一步进行超声检查至关重要，无论创伤原因如何，尤其是低血容量情况。对于有和没有心脏骤停的两组患者，接受改良算法的组中接受超声检查的患者百分比都有所增加。
