“5G”应急管理模式在创伤急救中的应用

李林; 王恩召; 李来春; 周洁浩; 宋坤

doi:10.16766/j.cnki.issn.1674-4152.003961

“5G”应急管理模式在创伤急救中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003961

1.
阜阳市人民医院急诊外科，安徽阜阳 236000
2.
阜阳市人民医院普外科
3.
阜阳市人民医院医务科

基金项目:

安徽省阜阳市卫健委科研课题 FY2021-141

工业和信息化部5G+急诊救治项目工信厅联通信函〔2020〕270号

详细信息

通讯作者:
宋坤，E-mail：1215904195@qq.com

中图分类号: R64 R197.323.2
计量
- 文章访问数: 0
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-08-13
- 网络出版日期: 2025-06-30

Application of "5G" emergency management model in trauma emergency treatment

1.
Department of Emergency Surgery, Fuyang People' s Hospital, Fuyang, Anhui 236000, China

摘要

摘要: 目的探讨“5G”应急管理模式在创伤救治中的应用效果，分析影响抢救成功率的因素。方法回顾性分析2021年1月—2023年8月阜阳市人民医院救治的198例创伤患者的病历资料，根据抢救模式的不同分为观察组(采用5G应急管理模式救治，90例)和对照组(采用常规创伤中心抢救流程救治，108例)，比较2组患者抢救效果。根据是否抢救成功，将患者分为有效组和无效组，进行单因素和多因素logistic回归分析，明确影响抢救成功的危险因素，并据此建立对应的预警模型。结果相较于对照组，观察组的检查完成时间、会诊完成时间、初诊确定时间、输血等待时间、手术等待时间均较短(P＜0.05)，入住ICU率和死亡率均较低(P＜0.05)；相较于有效组，无效组受伤至入院时间明显偏长，治疗前损伤严重度评分(ISS)较高，不同部位简略损伤量表(AIS)head、AIS chest评分≥3分的比例较大(P＜0.05)。Logistic回归分析显示，治疗前ISS评分高、AIS≥3分、受伤至入院时间长均是影响创伤患者救治效果的危险因素(OR＞1，P＜0.05)，而采用“5G”应急管理模式则是提高创伤患者救治效果的保护因素(OR＜1，P＜0.05)。基于ISS评分、AIS评分、受伤至入院时间、抢救管理模式4个因子构建的预警模型，对创伤患者抢救效果有较高的预测效能，模型AUC为0.861。结论 ISS评分、AIS评分、受伤至入院时间是影响创伤患者救治效果的因素，采用“5G”应急管理模式能够提高抢救效率和成功率，根据影响因素构建的预警模型对创伤患者的救治效果有较好的预测效能。
- 创伤 /
- 救治效果 /
- 互联网+
Abstract: Objective To explore the effect of the "5G" emergency management model in trauma treatment, and analyze the factors influencing the success rate of resuscitation. Methods A total of 198 trauma patients treated in Fuyang People' s Hospital from January 2021 to August 2023 were retrospectively analyzed. According to the different rescue models, they were divided into observation group (90 cases, treated using 5G emergency management model) and control group (108 cases, treated using routine trauma center rescue process). The rescue effect of the two groups were compared. According to whether the rescue was successful, the patients were divided into an effective group and an ineffective group. Univariate and Multivariate logistic regression analysis were performed to identify the risk factors affecting the success of the rescue, and based on this, a corresponding early warning model was established. Results Compared with the control group, the observation group had shorter examination completion time, consultation completion time, first diagnosis confirmation time, blood transfusion waiting time, and surgery waiting time (P < 0.05), the ICU admission rate and mortality rate were low (P < 0.05). Compared with the effective group, the time from injury to admission in the ineffective group was significantly longer, the injure severity score (ISS) score before treatment was higher, and the proportion of patients with abbreviated injury scale (AIS) head and AIS chest scores ≥3 was larger (P < 0.05). Logistic regression analysis showed that high ISS score before treatment, AIS≥3 score and long time from injury to hospital admission were risk factors affecting the treatment effect of trauma patients (OR > 1, P < 0.05), while adopting the "5G" emergency management model was a protective factor to improve the rescue effect of trauma patients (OR < 1, P < 0.05). Early warning model constructed by four factors, including ISS score, ASI score, time from injury to admission, and rescue management model, had high early prediction power on the rescue effect of trauma patients, with ROC-AUC of 0.861. Conclusion ISS score, ASI score, and time from injury to admission are factors that affect the treatment effect of trauma patients. Adopting the "5G" emergency management model can improve the rescue efficiency and success rate. The early warning model built based on the influencing factors has good predictive effectiveness for the treatment effect of trauma patients.
- Trauma /
- Treatment effect /
- Internet +

HTML全文

图 1 5G应急管理模式构成示意图

Figure 1. Schematic diagram of 5G emergency management mode

下载: 全尺寸图片幻灯片

图 2 多因子联合预警LogP模型构建及ROC曲线

Figure 2. Construction of a multi-factor combined early warning LogP model and ROC curve analysis

下载: 全尺寸图片幻灯片

表 1 观察组和对照组急性创伤患者基线资料比较

Table 1. Comparison of baseline data between the observation and control group

组别	例数	性别[例(%)]		年龄(x±s，岁)	受伤机制[例(%)]			受伤至入院时间(x±s，min)
组别	例数	男性	女性	年龄(x±s，岁)	交通事故	高处坠落	其他各种类型受伤	受伤至入院时间(x±s，min)
对照组	108	73(67.59)	35(32.41)	45.93±10.05	30(27.78)	25(23.15)	53(49.07)	54.31±8.92
观察组	90	59(65.56)	31(34.44)	47.01±9.73	26(28.89)	23(25.56)	41(45.56)	54.80±9.12
统计量		0.092^a		0.764^b	0.267^a			0.390^b
P值		0.762		0.446	0.875			0.697
注：^a为χ²值，^b为t值；受伤至入院时间为检查完成时间、会诊完成时间、初诊确定时间、输血等待时间、手术等待时间5个时间的综合，但不等于其加和，因为5个时间互有一定的交叉重叠。

下载: 导出CSV

表 2 观察组和对照组急性创伤患者救治相关指标比较

Table 2. Comparison of relevant indexes between the observation and control groups in acute trauma patients

组别	例数	检查完成时间(x±s，min)	会诊完成时间(x±s，min)	初诊确定时间(x±s，min)	输血等待时间(x±s，min)	手术等待时间(x±s，min)	入住ICU[例(%)]	死亡[例(%)]
观察组	90	13.27±3.24	13.27±1.35	22.09±3.78	18.22±3.02	30.34±14.24	12(13.33)	5(5.56)
对照组	108	20.75±5.31	17.58±1.59	35.92±5.46	35.06±5.26	54.26±18.34	28(25.93)	16(14.81)
统计量		5.457^a	9.843^a	16.914^a	17.047^a	22.726^a	4.829^b	4.439^b
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.028	0.035
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 3 有效组和无效组急性创伤患者基线资料比较

Table 3. Comparison of general information between the effective and ineffective groups in acute trauma patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	受伤机制[例(%)]			受伤至入院时间(x±s，min)
组别	例数	男性	女性	年龄(x±s，岁)	交通事故	高处坠落	其他各种类型受伤	受伤至入院时间(x±s，min)
有效组	177	116(65.54)	61(34.46)	45.71±9.86	49(27.68)	41(23.16)	87(49.15)	54.01±9.13
无效组	21	16(76.19)	5(23.81)	52.40±10.47	7(33.33)	7(33.33)	7(33.33)	58.60±9.71
统计量		0.959^a		2.921^b	2.002^a			2.175^b
P值		0.327		0.004	0.368			0.031
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 4 有效组和无效组急性创伤患者临床指标比较

Table 4. Comparison of clinical data between the effective and ineffective groups in acute trauma patients

组别	例数	采用“5G”应急管理模式[例(%)]	治疗前ISS评分(x±s，分)	AIS head≥3分[例(%)]	AIS chest≥ 3分[例(%)]	AIS abdomen≥ 3分[例(%)]	AIS extremity≥ 3分[例(%)]
有效组	177	85(48.02)	13.80±3.09	25(14.12)	21(11.86)	39(22.03)	16(9.04)
无效组	21	5(23.81)	15.43±3.66	10(47.62)	7(33.33)	6(28.57)	2(9.52)
统计量		4.439^a	2.240^b	12.263^a	5.468^a	0.160^a	0.108^a
P值		0.035	0.026	＜0.001	0.019	0.689	0.743
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 5 创伤患者救治效果影响因素的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of factors influencing treatment effect in trauma patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
ISS评分	0.110	0.043	6.425	0.011	1.116	1.026~1.214
AIS评分	0.820	0.235	12.194	＜0.001	2.271	1.432~3.599
受伤至入院时间	0.051	0.023	4.947	0.026	1.052	1.006~1.101
未采用“5G”应急管理模式	0.545	0.195	7.831	0.005	1.725	1.177~2.527

下载: 导出CSV

参考文献(16)

[1]	何颖, 蒲川, 王秋婷, 等. 重庆市院前急救创伤患者的流行病学特征与救治结局研究[J]. 创伤外科杂志, 2023, 25(11): 849-855. HE Y, PU C, WANG Q T, et al. Epidemiological characteristics of pre-hospital emergency trauma patients and treatment outcomes in Chongqing City[J]. Journal of Traumatic Surgery, 2023, 25(11): 849-855.
[2]	熊飞, 邵小平, 芮碧宇. 基于多学科协作的创伤性老年髋部骨折诊疗与护理模式的实施和效果评价[J]. 中华全科医学, 2023, 21(12): 2156-2159. doi: 10.16766/j.cnki.issn.1674-4152.003312 XIONG F, SHAO X P, RUI B Y, et al. Implementation and evaluation of a multidisciplinary team-based model for managing and caring for elderly patients with traumatic hip fractures[J]. Chinese Journal of General Practice, 2023, 21(12): 2156-2159. doi: 10.16766/j.cnki.issn.1674-4152.003312
[3]	梁钟琴, 吴月峰. 优化急诊护理流程对急性脑梗死患者急救效果的研究[J]. 中华全科医学, 2019, 17(4): 682-685. doi: 10.16766/j.cnki.issn.1674-4152.000766 LIANG Z Q, WU Y F. Study on the effect of optimizing emergency nursing procedure on emergency treatment of patients with acute cerebral infarction[J]. Chinese Journal of General Practice, 2019, 17(4): 682-685. doi: 10.16766/j.cnki.issn.1674-4152.000766
[4]	ZHURAVLEV S V, KOLODKIN A A, MAKSIMOV D A, et al. The organization of registration of rate, capacity and effectiveness of first aid measures[J]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med, 2020, 28(4): 616-620.
[5]	杜哲, 黄伟, 王志伟, 等. 多学科协作诊疗模式在严重创伤患者救治中的应用[J]. 北京大学学报(医学版), 2020, 52(2): 298-301. DU Z, HUANG W, WANG Z W, et al. Application of multidisciplinary team (MDT) in the treatment of severe trauma[J]. Journal of Peking University(Health Sciences), 2020, 52(2): 298-301.
[6]	孙浩, 高惠, 王骅, 等. 创伤中心在严重多发伤患者救治中的作用研究[J]. 中国急救复苏与灾害医学杂志, 2022, 17(5): 580-584. SUN H, GAO H, WANG H, et al. The role of trauma center in the treatment of patients with severe multiple injuries[J]. China Journal of Emergency Resuscitation and Disaster Medicine, 2022, 17(5): 580-584.
[7]	KWON J, LEE M, KIM Y, et al. Trauma system establishment and outcome improvement: a retrospective national cohort study in South Korea[J]. Int J Surg, 2023, 109(8): 2293-2302. doi: 10.1097/JS9.0000000000000481
[8]	郭程, 俞晔, 谢仁国, 等. 5G智慧医疗院前急救模式探讨[J]. 中国卫生质量管理, 2021, 28(1): 61-63. GUO C, YU Y, XIE R G, et al. Discussion on pre-hospital first-aid mode of 5G smart medical treatment[J]. Chinese Health Quality Managem, 2021, 28(1): 61-63.
[9]	ADENUGA A, ADEYEYE A. Injury severity score as a predictor of mortality in patients with abdominal trauma at a tertiary Nigerian hospital[J]. Niger J Clin Pract, 2023, 26(2): 223-228. doi: 10.4103/njcp.njcp_559_22
[10]	MAHAJAN C, SENGUPTA D, KAPOOR I, et al. Evaluation of the GCS-Pupils Score for prognosis in traumatic brain injury: the COMA study[J]. Brain Inj, 2023, 37(9): 1041-1047. doi: 10.1080/02699052.2023.2227943
[11]	BASAK D, CHATTERJEE S, ATTERGRIM J, et al. Glasgow coma scale compared to other trauma scores in discriminating in-hospital mortality of traumatic brain injury patients admitted to urban Indian hospitals: a multicentre prospective cohort study[J]. Injury, 2023, 54(1): 93-99.
[12]	TOIDA C, MUGURUMA T, GAKUMAZAWA M, et al. Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study[J]. BMJ Open, 2023, 13(2): e062619. DOI: 10.1136/bmjopen-2022-062619.
[13]	赵明阶, 魏婧, 徐华, 等. 创伤严重度评分法在创伤患者院内急救及护理管理中的应用效果[J]. 中西医结合护理(中英文), 2023, 9(10): 151-153. ZHAO M J, WEI J, XU H, et al. Application effect of injury severity score in hospital first aid and nursing management of trauma patients[J]. Journal of Clinical Nursing in Practice, 2023, 9(10): 151-153.
[14]	JEONG T S, CHOI D H, KIM W K. The relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury[J]. Korean J Neurotrauma, 2022, 18(2): 169-177.
[15]	HATCHIMONJI J S, LUKS V L, SWENDIMAN R A, et al. Settling the score: injury severity score fails to capture nuances in pediatric trauma[J]. Pediatr Emerg Care, 2022, 38(2): e828-e832.
[16]	JIANG D S, CHEN T X, YUAN X Y, et al. Predictive value of the Trauma rating index in age, Glasgow coma scale, respiratory rate and Systolic blood pressure score (TRIAGES) and Revised trauma score (RTS) for the short-term mortality of patients with isolated traumatic brain injury[J]. Am J Emerg Med, 2023, 71: 175-181.