Ali J, Adam R, Stedman M, Howard M, Williams J I
Department of Surgery, University of Toronto, Ontario, Canada.
J Trauma. 1994 Mar;36(3):391-4. doi: 10.1097/00005373-199403000-00020.
Over a 9-year period (July 1981-December 1985--pre-ATLS period; January 1986-June 1990--post-ATLS period), the hospital charts of 813 trauma patients with ISS > or = 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The frequency of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access (i.v.), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for i.v., 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emergency room these frequencies (%) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for i.v., 11.0 vs. 97.1 for Foley, 3.2 vs. 95.9 for NG, and 3.9 vs. 95.2 for CT. The differences in the application of these life saving procedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except i.v. access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS > or = 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2% in ER). These differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS.(ABSTRACT TRUNCATED AT 250 WORDS)
在9年期间（1981年7月至1985年12月——ATLS之前的时期；1986年1月至1990年6月——ATLS之后的时期），回顾了813例创伤患者（损伤严重度评分[ISS]≥16）的医院病历（ATLS之前的时期有413例，ATLS之后的时期有400例），以评估ATLS方案的影响。通过Pearson卡方分析比较了气管插管（ET）、鼻胃管插入（NG）、静脉通路建立（i.v.）、膀胱留置导尿（Foley）和胸管插入（CT）的频率。总体而言，ATLS之前与之后的频率（%）分别为：ET为83.5%对65.3%，i.v.为97.3%对98.0%，Foley为74.6%对96.3%，NG为68.3%对91.3%，CT为18.4%对47.0%。在急诊室，这些频率（%）分别为：ET为26.1%对36.4%，i.v.为98.8%对98.7%，Foley为11.0%对97.1%，NG为3.2%对95.9%，CT为3.9%对95.2%。除了静脉通路建立在ATLS之前和之后的组间没有差异外，这些救命措施在ATLS之前和之后时期的应用差异具有统计学意义（p<0.05）。在严重胸部损伤（简明损伤定级[AIS]≥3）的患者中，ATLS之后有87.7%留置了胸管（在急诊室为94.4%），而ATLS之前为48.1%（在急诊室为3.2%）。这些差异与ATLS之后创伤患者的预后显著改善相关。我们得出结论，ATLS之后，尤其是在急诊室，救命干预的频率增加了。（摘要截短至250字）
