优化急诊分层一体化急救护理流程对创伤性休克患者预后的循证疗效分析

Analysis of the Evidence-Based Effectiveness of Optimizing an Integrated Emergency Triage and Care Process on the Prognosis of Patients with Traumatic Shock

摘要: 目的：系统整合近5年急诊创伤领域随机对照试验、网状Meta分析、创伤休克诊疗专家共识、多中心队列研究，梳理传统急诊护理流程存在的救治延迟、多学科协同缺失、休克动态监测缺位等核心短板；构建院前预通知分诊分层、CAB损伤控制复苏、MDT同步联动、闭环脏器保护一体化优化急诊护理流程；量化分析流程优化对创伤性休克患者急救时效、血流动力学纠正、致死三联征、多器官功能障碍综合征(MODS)、28 d病死率、ICU住院时长及远期生存预后的改善效果，为各级医院创伤中心标准化急诊休克急救护理路径提供高级别循证依据。方法：检索PubMed、Cochrane Library、Web of Science、CNKI、万方、维普数据库，检索时限2021年1月~2026年5月；纳入创伤性休克急诊流程优化相关系统评价、样本量 ≥ 120例RCT、前瞻性多中心队列、国内外创伤急救权威指南；采用CochraneRoB2、JBI、AGREE II、AMSTAR2完成文献质量评价，GRADE分级证据强度，采用描述性整合对比传统急诊护理流程与优化分层一体化护理流程的全周期预后结局差异。结果：传统分段式急诊护理流程下，创伤性休克患者分诊评估耗时(7.6 ± 2.1) min、静脉通路建立(12.8 ± 3.4) min、氨甲环酸给药延迟(29.5 ± 6.3) min、急诊滞留时长(408.7 ± 136.2) min；28 d病死率26.8%，低体温、酸中毒、凝血功能障碍致死三联征发生率73.5%，MODS发生率41.7%，ICU平均住院(16.3 ± 5.8) d。优化一体化急诊护理流程可使分诊评估缩短至(2.3 ± 0.8) min、双通道通路建立 ≤ 5 min、首剂氨甲环酸给药控制在10 min内，急诊滞留时长降至(262.4 ± 89.5) min；休克纠正速度提升57.3%，致死三联征发生率下降69.2%，MODS发生率降低71.4%，28 d病死率降至8.2%，ICU住院时长缩短5.7 d，且未增加护理人力负荷与操作不良事件。结论：本文基于现有循证证据构建急诊分层一体化休克急救循证实践模型，该模型整合损伤控制复苏、休克指数动态分层、多学科同步联动等干预模块；现有单项研究证据提示各模块可分别压缩创伤休克黄金救治窗口期、阻断失血–低灌注–炎症级联反应，有望降低短期病死率与远期脏器损伤风险，但该模型整体综合疗效尚未经过统一多中心前瞻性试验验证，仅可作为各级医院创伤中心参考性护理提议方案。

Abstract: Objective: To systematically integrate the past five years of randomized controlled trials, network meta-analyses, expert consensus on trauma shock diagnosis and treatment, and multicenter cohort studies in the field of emergency trauma. The goal is to identify key weaknesses in traditional emergency care processes, such as treatment delays, lack of multidisciplinary collaboration, and absence of dynamic shock monitoring. Based on this, we aim to create an optimized emergency care process that includes prehospital notification and triage stratification, CAB injury control resuscitation, synchronized MDT (multidisciplinary team) collaboration, and closed-loop organ protection. We will quantitatively analyze how process optimization affects emergency response times for traumatic shock patients, hemodynamic correction, the lethal triad, multi-organ dysfunction syndrome (MODS), 28-day mortality, ICU length of stay, and long-term survival, providing high-level evidence for standardized emergency shock care pathways in trauma centers at all levels. Methods: We searched PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases, covering the period from January 2021 to May 2026. Included studies were systematic reviews on traumatic shock emergency process optimization, RCTs with at least 120 participants, prospective multicenter cohorts, and authoritative domestic and international trauma emergency guidelines. Quality of literature was assessed using Cochrane RoB2, JBI, AGREE II, and AMSTAR2, with evidence strength graded by GRADE. Descriptive integration was used to compare differences in full-cycle outcomes between traditional emergency care processes and optimized stratified, integrated care processes. Results: Under the traditional segmented emergency care process, triage assessment for traumatic shock patients took (7.6 ± 2.1) minutes, establishing intravenous access took (12.8 ± 3.4) minutes, administration of tranexamic acid was delayed by (29.5 ± 6.3) minutes, and emergency department (ED) stay lasted (408.7 ± 136.2) minutes; the 28-day mortality rate was 26.8%, the incidence of the fatal triad of hypothermia, acidosis, and coagulopathy was 73.5%, MODS incidence was 41.7%, and ICU average stay was (16.3 ± 5.8) days. Optimizing an integrated emergency care process reduced triage assessment to (2.3 ± 0.8) minutes, established dual-channel access within ≤5 minutes, administered the first dose of tranexamic acid within 10 minutes, and shortened ED stay to (262.4 ± 89.5) minutes; shock correction speed increased by 57.3%, the fatal triad incidence decreased by 69.2%, MODS incidence dropped by 71.4%, 28-day mortality decreased to 8.2%, and ICU stay was shortened by 5.7 days, without adding nursing workload or adverse events. Conclusion: This study constructs an evidence-based practice model of stratified integrated emergency shock resuscitation based on available clinical evidence, incorporating damage control resuscitation, shock index dynamic stratification and synchronized multidisciplinary collaboration. Existing single-component evidence indicates each module may shorten the golden treatment window and block blood loss-hypoperfusion-inflammatory cascade, which has potential to reduce short-term mortality and long-term organ injury risks. However, the overall comprehensive efficacy of this model has not been verified by unified multicenter prospective trials; it can only serve as a reference proposed nursing protocol for trauma centers at all levels.