| Objective: To evaluate the role of emergency surgeon-assisted emergency bedside ultrasound E-FAST regimen in the treatment of multiple trauma patients by comparing the results of ultrasound diagnosis of E-FAST with the ultrasound surgeon and conventional ultrasound surgeons,And by comparing the ultrasound guidance and traditional body surface positioning for central venipuncture effect of differences,to guide the clinical operation.Methods: The order was collected in December 2015-December 2016 in Hebei Medical University,the second hospital emergency surgical hospital patients with a total of 47 cases of multiple injuries,patients were randomly assigned to emergency surgeon using emergency bedside ultrasound group(group A)and ultrasound surgeon using conventional ultrasound group(group B).A group of 28 patients with multiple trauma by the emergency surgeon E-FAST examination,B group of 19 patients with multiple trauma by ultrasound surgeon routine ultrasound examination,comparing the two groups of ultrasound positive rate,and recorded ultrasound check the time from admission.According to the needs of the disease,A group of 23 patients with multiple trauma under ultrasound guidance for central venipuncture;B group of15 patients using conventional conventional surface positioning method for central venipuncture,comparison of A,B two groups of central venipuncture of a needle success rate,total success rate,incidence of complications,puncture time and other related indicators.Results:1 Patient general situationThere was no significant difference in gender,age,trauma type and new injure severity score(NISS)between the two groups of patients with multiple trauma(P> 0.05).2 Clinical resultsAmong the patients enrolled,35 patients had confirmed thoracic and abdominal organ injuries by surgery and CT(Computer Tomography),including 32 cases of thoracic and abdominal organs rupture.30 cases of surgical treatment,conservative treatment of 5 patients.Among the 35 patients,there were 45 lesions in the injured patients,including 11 lesions in the liver,18 in the spleen,1 in the pancreas,4 in the kidney,2 in the bladder and9 in the gastrointestinal tract.Combined with injury: liver and spleen combined injury in 2 cases,3 cases of liver and intestinal injury,liver and kidney combined injury in 1 case,spleen and kidney combined injury in 2 cases,2cases of splenomegaly combined injury,bladder and bladder joint injury in 1case,pancreas intestine joint injuries in 2 cases.3 Ultrasound examination3.1 The accuracy of ultrasonographyThe E-FAST examination performed by an emergency surgeon and the ultrasonography performed by a conventional ultrasound surgeon were confirmed to be 71.4% and 63.1%,respectively,according to the patient’s spiral CT or surgical findings.The difference between the two groups was 71.4% and63.1% Statistical significance(P> 0.05),false negative patients in 3 cases,CT confirmed that the 3 patients with solid organ damage,free fluid volume less,after conservative treatment improved condition.3.2 Complete the time to complete the ultrasound examinationPatients with multiple trauma were 8 to 25 minutes for an E-FAST examination by an emergency surgeon and 15.3 ± 4.9 minutes for an average of 23 to 45 minutes for an ultrasound surgeon.The average age was 37.1 ± 6.0minutes,the difference between the two groups was statistically significant(P<0.05).4 Central venipuncture results4.1 The success rate of central venipunctureA group of patients undergoing ultrasound-guided central venous puncture in 23 cases,of which a successful needle in 21 patients,the successrate of 91.0%,the total success rate of 100%;B group using conventional conventional body surface positioning Methods 15 patients with central venipuncture were enrolled in this study.The success rate was 60.0% and the total success rate was 86.7%.There was significant difference between the two groups(P <0.05).4.2Central venipuncture complicationsOnly one of the patients who underwent central venovenous puncture in group A had a complication in the infarcted arteries with a complication rate of 4.3%.Group B was treated with conventional body surface localization for central venipuncture There were 6 patients with complications,of which 5patients were stabbed into the arteries of the needle,1 patient had pneumothorax,the incidence of complications as high as 40%.There was significant difference between the two groups(P <0.05).4.3Central venipuncture timeA group of ultrasound positioning using central venipuncture time for 5to 13 minutes,the average time of 8.4 ± 1.9 minutes.Group B using conventional body surface positioning method for central venipuncture time used for 14 to 26 minutes,the average time for 18.9 ± 3.4 minutes.The difference between the two groups was statistically significant(P <0.05).Conclusion:1 For patients with multiple trauma,the emergency ultrasound(E-FAST)examination performed by the emergency surgeon was compared with the conventional ultrasound examination performed by the surgeon,and there was no significant difference in the diagnostic efficacy between the two patients,but the bed was performed by an emergency surgeon Ultrasound examination is time-consuming for the rescue of multiple trauma patients.2 There was significant difference in the success rate,total success rate,complication rate and time of puncture using central venipuncture under the guidance of ultrasound and central venous puncture.The difference was statistically significant in ultrasound guidance Under the implementation of central venipuncture overall effect is better than conventional body surfacepositioning method.3 Emergency surgeon-led emergency bedside ultrasound E-FAST technology,in patients with multiple trauma assessment,central venipuncture and other aspects of a significant advantage,especially for the need for emergency treatment of hemodynamic instability of the thoracic and abdominal trauma patients,In order to obtain definitive treatment to win valuable time,improve the success rate of rescue effect is significant.Help patients with multiple injuries and treatment,should be vigorously promote the use of emergency surgery. |
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