标题：骨髓腔穿刺输液在基层医院创伤失血性休克院前急救中的应用

      作者：鄢涛 1，谢雯雯 2，刘小琴 1，姜伟 1，汪红霞 1，邓艳华 1，杨勇 1，余函阳 1，李芝霖 1，阳毅 1，唐一男 1    (1.德阳市人民医院急诊科，四川 德阳 618000；2.绵阳市第三人民医院，四川 绵阳 621000)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨骨髓腔穿刺输液在基层医院创伤失血性休克院前急救中的应用效果。方法 回顾性分析 2016年 6月至 2018年 6月期间德阳市人民医院收治的 104例创伤失血性休克患者的临床资料，其中48例患者采用骨髓腔输液(观察组)，56例患者采用深静脉置管输液(对照组)。对两组患者的通道建立时间、加压输液速度、血压回升时间、抢救救室停留时间、死亡率、通道并发症等主要指标和操作者调查问卷、通道费用等次要指标进行比较。结果 观察组患者的骨髓腔输液通道的建立时间和抢救室停留时间分别为(2.51±0.55) min和(24.78±3.93) min，明显低于对照组的(8.52±3.54) min和(30.64±7.83) min，差异均具有统计学意义(P<0.05)；而加压输液速度、血压回升时间、死亡率和通道并发症发生情况两组比较差异均无统计学意义(P>0.05)。调查问卷显示骨髓腔穿刺操作比深静脉穿刺更简便、快捷。骨髓腔穿刺收费是深静脉穿刺的3倍多(1 575：475)。结论 在基层医院院前急救中，骨髓腔输液技术具有快速、高效、易操作、易携带特点，是抢救创伤失血性休克患者外周静脉输液通道建立失败时的一种有效替代方法，提高了院前急救效率。
      【关键词】 骨髓腔穿刺输液；深静脉穿刺输液；创伤失血性休克；院前急救；基层医院
      【中图分类号】 R605.971 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2863—03

Application of intraosseous infusion in pre-hospital first aid to patients with traumatic hemorrhagic shock inprimary hospitals.
YAN Tao 1, XIE Wen-wen 2, LIU Xiao-qin 1, JIANG Wei 1, WANG Hong-xia 1, DENG Yan-hua 1, YANGYong 1, YU Han-yang 1, LI Zhi-lin 1, YANG Yi 1, TANG Yi-nan 1. 1. Department of Emergency, the People's Hospital ofDeyang, Deyang 618000, Sichuan, CHINA; 2. The Third People's Hospital of Deyang, Deyang 621000, Sichuan, CHINA
【Abstract】 Objective To study the effect of intraosseous infusion application in pre-hospital first aid to pa-tients with traumatic hemorrhagic shock in primary hospitals. Methods The data of patients with traumatic hemorrhag-ic shock admitted to the People's Hospital of Deyang from June 2016 to June 2018 was collected. A total of 48 patientstreated with intraosseous infusion were selected as the observation group, and a total of 56 patients treated with deep ve-nous puncture infusion were selected as the control group. The main indicators, including the infusion setting time, pres-sure infusion speed, blood pressure recovery time, rescue room stay time, mortality rate and infusion complications, andthe secondary indicators (including operator questionnaires and operating costs) were compared and analyzed betweenthe two groups. Results The infusion setting time and the rescue room stay time of patients with intraosseous infusiontreatment were (2.51±0.55) min and (24.78±3.93) min, which were significantly lower than (8.52±3.54) min and (30.64±7.83) min of patients with deep vein infusion treatment (P<0.05). There was no significant difference between the twogroups in the pressure infusion speed, the blood pressure recovery time, mortality and complications (P>0.05). The ques-tionnaires showed that the operation of intraosseous infusion was more convenient and quicker than deep vein punctureinfusion, which costs more than three times as much as deep vein puncture infusion (1 575：475). Conclusion In thepre-hospital first aid of the primary hospitals, intraosseous infusion treatment has the advantages of fast, high efficiency,easy operation and easy carryover, which is an effective alternative method to rescue patients with traumatic hemorrhag-ic shock who suffered failure of peripheral venous infusion. It improves the efficiency of pre-hospital first aid.
      【Key words】 Intraosseous infusion; Deep vein puncture infusion; Traumatic hemorrhagic shock; Pre-hospitalfirst aid; Primary hospitals·论 著·doi:10.3969/j.issn.1003-6350.2018.20.016基金项目：四川省教育厅资助项目(编号：SWFZ16)