A Retrospective Study of Effectiveness of Non-operative management for High-grade Blunt Hepatic and Splenic injury in a First Aid Responsibility Hospital in Middle Taiwan

• Main Authors: MEI-FEN DENG, 鄧梅芬
• Other Authors: YUEH-CHIH CHEN
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/a4dr32

碩士 === 弘光科技大學 === 護理研究所 === 104 === Background：Ministry of Health and Welfare (former Department of Health, 2011) in the Republic of China 98 years, have blunt hepatic and splenic injuries to accept operative or non-operative management of the recording and analysis, are listed on First Aid responsibility hospital care quality assessment project. Objective：（1）to understand the Taiwan a First Aid responsibility hospital in High-grade blunt hepatic and splenic injuries pedestrian clinical effectiveness of non-operative management; (2) the relevant factors affecting the clinical effectiveness, such as patient characteristics, to the hospital situation, trauma severity , hospital emergency medical capabilities; (3) the role of nurse practitioners in major trauma care capabilities. Methods: In this study, the Commission agreed China Medical University＆Hospital Research Ethics Committee (number CMUH103-REC3-096), Retrospective research trauma registry of First Aid responsibility hospital in Taiwan, admitted to high-grade blunt hepatic and splenic injuries (AAST-OIS≧3, N=184). Using SAS 9.0 statistical software package version, be High-grade blunt hepatic and splenic injury from descriptive statistics and chi-square test or independent sample T test for patient characteristics, arrive satuation, injury status, hospitals emergency medical capabilities, explore the operative and nonoperative treatment, receiving successful non-operative management and failure, if there is a significant difference between them. Result：High-grade blunt hepatic and splenic injuries (AAST-OIS≧3, N=184)﹐men accounted for 66%, less than 40 years old is the highest (65%), 86% prompted by a car accident, injury severity score (ISS) an average of 22 points. Under the premise of stable vital signs, High-grade blunt hepatic and splenic injuries (AAST-OIS≧3) underwent operative accounted for 26.1% (n = 31/184), the non-operative management (NOM) accounted for 153 (73.9%), wherein the successful non- operative management (sNOM) accounted for 88.9% (n = 136/153), failure non-operative management (fNOM) accounted for 11.1% (n = 17/153), the overall survival rate of treatment 91.8% (n = 167 / 184).To hospital when systolic blood pressure, drunk driving, degree of hepatic and splenic injury, Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), start trauma team, emergency endotracheal tube disposal, emergency ultrasound, angiography and embolization, undergo operative or non-operative management (NOM), showing statistically significant ( p<.05); age, GCS, degree of hepatic and splenic injury, Trauma and Injury Severity Score (TRISS), has accepted emergency ultrasound, intubation disposal, undergo successful non-operative management(sNOM) and failure (fNOM), showing statistically significant (p <.05) .In the length of stay, underwent operative of ICU stay is 13.1±12.8 and length stay is 25.9 ± 25. 6, non-operative management of ICU stay is 5.5 ± 7. 2 and length days is 15.3 ± 22. 6, all showed statistically significant (p <. 05). Conclussion：High-grade blunt hepatic and splenic injuries (AAST-OIS≧3) with non-operative management(NOM), First Aid responsibility hospital must both foot emergency medical capabilities, including computer tomography scans, angiography and embolization, Intensive care unit（ICU）and 24 hours standby manpower and equipment of emergency surgery to improve patient survival. Now Nurse practitioner should be actively integrated interdisciplinary team care communication and coordination care, and to develop Clinical pathway or Clinical practice guidelines, together to improve care for major trauma quality. Keyword﹕High-grade blunt hepatic and splenic injuries﹐Non-operative management﹐First Aid responsibility hospital﹐Nurse practitioner.