Wright K D, Knowles C H, Coats T J, Sutcliffe J C
Department of Neurosurgery, Royal London Hospital, London, UK.
Injury. 1996 Dec;27(10):719-21. doi: 10.1016/s0020-1383(96)00119-2.
Patients with intracranial haematoma following head injury may have little primary brain injury, but sustain a secondary brain injury that can often be minimized by early evacuation of the haematoma. Rapid intervention by a neurosurgeon with early evacuation of the haematoma gives a better outcome. The timing of treatment in 403 patients with severe head injuries, admitted to the Royal London Hospital between January 1991 and December 1994 was examined. All cases had been transported directly from the accident scene by the Helicopter Emergency Medical Service because the local hospital did not have neurosurgical facilities. The median time to medical intervention was 15 min (95 per cent, confidence interval (CI) 14-16) and the median time to neurosurgery was 177 min (95 per cent, CI 171-195). As secondary interhospital transfer of patients with head injuries is known to increase the time to neurosurgical intervention and is a time of great risk of secondary insult to the brain, transfer direct from the scene of the accident to an appropriate centre allows a process of care that has been shown to be associated with a better outcome.
头部受伤后发生颅内血肿的患者可能原发性脑损伤较轻，但会遭受继发性脑损伤，而早期清除血肿通常可将这种损伤降至最低。神经外科医生进行快速干预并早期清除血肿可带来更好的治疗效果。对1991年1月至1994年12月间收治于皇家伦敦医院的403例重度头部受伤患者的治疗时机进行了研究。所有病例均由直升机紧急医疗服务直接从事故现场转运而来，因为当地医院没有神经外科设施。医疗干预的中位时间为15分钟（95%置信区间（CI）14 - 16），神经外科手术的中位时间为177分钟（95% CI 171 - 195）。由于已知头部受伤患者的二次院间转运会增加神经外科干预的时间，且是脑部遭受二次损伤的高风险时期，直接从事故现场转运至合适的中心可实现一种已被证明与更好治疗效果相关的护理流程。
