目的 探讨损伤控制式急救模式结合全面干预在海水淹溺伤伴吸入性肺损伤患者急救中的应用效果.方法 选取2008年1月至2020年12月由北戴河康复疗养中心收治的130例海水淹溺伤伴吸入性肺损伤患者作为研究对象进行研究,按照急救和护理干预方法的不同将其分为对照组和研究组,每组65例.对照组患者给予传统急救方法及常规护理干预,研究组患者则给予损伤控制式急救模式联合全面护理干预.比较两组患者的急救效果、生活质量评分和护理服务满意度等指标.结果 ①研究组患者急救成功率显著高于对照组,肺部并发症发生率显著低于对照组,住院时间显著短于对照组,急性肺损伤评分显著低于对照组,比较差异均有统计学意义(P＜0.05).②干预后两组患者血气分析动脉血氧分压[p(O2)]较干预前明显升高,动脉血二氧化碳分压[p(CO2)]较干预前明显降低,且研究组与对照组比较差异有统计学意义(P＜0.05).③研究组患者及家属对整体救治水平和护理干预满意度较对照组显著升高,比较差异有统计学意义(P＜0.05).④干预后两组患者圣乔治呼吸问卷(SGRQ)各维度评分及总评分较干预前均显著降低,且干预后研究组患者的评分均显著低于对照组(P＜0.05).结论 损伤控制式急救模式结合全面干预能提高海水淹溺伤伴吸入性肺损伤患者急救成功率,降低肺部并发症发生率,改善患者血气状况,缩短住院时间,改善其预后和生活质量,同时提升患者对护理质量的满意度.

Objective To observe the changes of the autonomic nervous function disturbances in multiple trauma patients.Methods 30 multiple trauma patients were divided into three groups according to the injury severity score(ISS):slight injury group(ISS≤16),moderate injury group(16<ISS≤25),and severe injury group(ISS>25).To collect the ECG data from 8am to 10am at 1,7,14 d after the injury.Power spectral analysis was used to evaluate short time(5 minutes)heart rate variability (HRV).Results Low-frequency(LF)and high-frequency(HF)decreased to(111.2±49.9) ms~2/Hz and(42.7±27.0)ms~2/Hz in moderate injury group respectively(P<0.01),and(44.0±33.7) ms~2/Hz and(8.0±4.4) ms~2/Hz in severe injury group(P<0.01).LF/HF increased to 3.3±1.4 in moderate injury group and 6.1±3.6 in severe injury group(P<0.05).The decrease of LF and HF and the increase of LF/HF indicated sympathetic activity was superior in early phase of injury,and these changes were related to the severity of injury.During the convalescence,HF and LF increased and LF/HF decreased gradually,the balance between sympathetic activity and parasympathetic activity recov- ered.Conclusion The function of autonomic nervous system was obviously abnormal in multiple trauma patients,and the lasting time and degree of the disorder were related to the severity of injury.Power spec- tral analysis of HRV may indicate the state of illness and outcome in multiple trauma patients.

我院急救中心于2001年10月23日收治1例因急性心肌梗死导致呼吸心跳骤停的患者.在心肺复苏期进行了静脉溶栓治疗,救治成功,报告如下.