目的 探讨便携式超声仪超声重点评估（e-FAST）技术在批量伤员军地联合院前救治中的应用效果。方法 抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员,均开展军地联合院前救治,按照治疗方案不同分为观察组和对照组,每组患者40例,其中对照组在救治现场行基于创伤严重程度（CRAMS）评分,进行常规急救处置,救护车返院后行CT检查并进行相应伤情治疗,观察组救治现场行CRAMS评分,进行常规急救处置,院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位,初步诊断后进行相应伤情治疗,对比两组患者治疗效果,两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果 观察组治疗有效率为95.0%,对照组为85.0%,对比差异无统计学意义（χ²=2.222,P=0.136）;观察组患者的诊断时间（13.56±2.36）min、初次医疗接触—进入手术室时间（30.42±8.99）min均短于对照组[（23.64±5.69）、（52.27±12.60）min],差异有统计学意义（t=10.349、8.928,P<0.05）;观察组患者入院诊断与出院时确定性诊断的符合为97.5%,对照组患者入院诊断与出院时确定性诊断的符合为95.0%,差异无统计学意义（χ²=0.346,P=0.556）;治疗后两组患者的CRAMS评分均升高,且观察组（9.87±2.62）分高于对照组（8.60±2.98）分,差异有统计学意义（t=2.024,P=0.046）;观察组患者CRAMS≤8分的抢救成功率为97.50%,对照组CRAMS≤8抢救成功率为85.00%,观察组患者CRAMS≤8分的抢救成功率高于对照组（χ²=3.914,P=0.048）。结论 本研究从军地联合救治批量伤员切入,瞄准部队医院军民融合战略发展路线,本文针对便携式超声仪e-FAST应用范围前移,明显地提高急救人员院前救治能力,提高抢救成功率,值得临床参考。

Objective To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals．Methods Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected,all of whom underwent military civilian joint pre hospital treatment．They were divided into an observation group and a control group according to different treatment plans,with 40 patients in each group．The control group received CRAMS scores at the treatment site for routine first aid treatment,CT scans after ambulance return to the hospital for corresponding injury treatment,the observation group received CRAMS scores at the treatment site for routine first aid treatment,and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process．After preliminary diagnosis,corresponding injury treatment was carried out．The treatment effects of the two groups of patients were compared,and the diagnosis time and initial diagnosis of the two groups of patients were compared．The time from medical contact to entering the operation room,the compliance rate of discharge and admission diagnoses,the CRAMS score before and after treatment,and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared．Results The effective rate of treatment in the observation group was 95.0%,while in the control group it was 85.0%,which difference was not statistically significant（χ²=2.222,P=0.136）．The time to diagnosis（13.56±2.36）min,time to the operating room（30.42±8.99）min were shorter than that in the control group[（23.64±5.69）,（52.27±12.60）min],with significant difference（t=10.349,8.928,P<0.05）．The consistency between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%,while the consistency of the control group patients was 95.0%．There was no significant difference between the groups（χ²=0.346,P=0.556）．After treatment,the CRAMS scores of both groups of patients increased,the observation group（9.87±2.62）was higher than that of the control group（8.60±2.98）（t=2.024,P=0.046）．The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%,while the success rate in the control group was 85.00%．The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group（χ²=3.914,P=0.048）．Conclusions This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces,aiming at the development path of military civilian integration strategy in military hospitals．The application scope of portable ultrasound e-FAST has been moved forward,which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue．It is worth clinical reference．

       目的   探讨、对比休克指数（SI）与血乳酸水平预测院前创伤性休克患者预后中的应用。方法   于2020年12月—2023年12月收治80例创伤性休克患者，均接受SI、乳酸水平的监测。结合监测的结果进行分组：乳酸正常组：乳酸水平在2 mmol/L以下，升高组：2 mmol/L以上；SI正常组：SI在0.9以下，升高组：SI在0.9以上。观察、记录患者入院7 d后的序贯性器官功能衰竭评分（SOFA），对多器官功能障碍综合征（MODS）情况进行评估。同时观察、记录机械通气、血管活性药物的使用和住院等情况。结果   乳酸水平升高组60例，正常组20组；SI升高组58例，正常组22例，女性乳酸水平、SI，与男性比较差异无统计学意义（P＞0.05）。是否发生多器官功能障碍者的年龄、性别、SI指数比较差异无统计学意义（P＞0.05）；格拉斯哥昏迷评分（GCS）评分［（4.22±1.53）分 vs （9.46±3.82）分，t=7.816，P＜0.001］、住院时间［（23.34±5.71）d vs （12.26±2.11）d，t=11.830，P＜0.001］、基础乳酸值［（4.75±2.36）mmol/L vs （2.04±1.11）mmol/L，t=6.721，P＜0.001］与发生MODS在组间对比差异有统计学意义。SI升高组的容量复苏收缩压＞80 mmHg（%）有27例，与乳酸水平升高组比较差异有统计学意义（P＜0.05）（46.55% vs 18.18%，χ ² =12.237，P＜0.001）。乳酸水平升高组中，11例患者接受机械通气，乳酸水平均升高（P＜0.05）；9例患者使用血管活性药物，乳酸水平均升高，比较差异无统计学意义（P＞0.05）；38例住院患者，24例乳酸水平升高（P＜0.05）。13例患者接受机械通气，12例SI升高，比较差异无统计学意义（P＞0.05）；11例患者接受血管活性物治疗，8例SI升高，比较差异无统计学意义（P＞0.05）；39例患者住院，SI升高22例，比较差异有统计学意义（P＜0.05）。结论   针对重症的创伤性休克患者，当血乳酸水平升高时会大大增加MODS发生的概率，乳酸水平在对重症创伤性休克患者预后进行预测时，应用价值更高。

       Objective  To explore and compare the application of shock index（SI）and  blood lactic acid level in predicting the prognosis of patients with pre-hospital traumatic shock．Methods  From December 2020 to December 2023，80 patients with traumatic shock were enrolled，and their SI and levels of lactic acid were monitored．Patients were grouped according to the monitoring results：normal group：lactic acid level below 2 mmol/L，increased group：above 2 mmol/L；normal group：SI below 0.9，and increased group：SI above 0.9．The sequential organ failure score（SOFA）was observed and recorded 7 days after hospitalization，and the situation of multiple organ dysfunction syndrome（MODS）was evaluated．At the same time，mechanical ventilation，the use of vasoactive substances and hospitalization were observed and recorded．Results  There were 60 cases in the group with increased lactic acid level and 20 cases in the normal group．There were 58 cases of increased SI and 22 cases of normal．The lactic acid level and SI index in women were higher than those in men，with no difference（P＞0.05）．There were no differences in age，sex，SI index and the incidence of MODS（P＞0.05）．GCS score（4.22±1.53 vs 9.46±3.82），hospitalization days（23.34±5.71 vs 12.26±2.11）d，basal lactate value（4.75±2.36 vs 2.04±1.11）mmol L-1 were significantly different from those of MODS（t=11.830，P＜0.001；t=6.721，P＜0.001，P＜0.05）．There were 27 cases with volume  resuscitation systolic blood pressure ＞ 80 mmhg（%）in the group with increased SI，which was different from that of SI and lactic acid（46.55% vs18.18%，χ ² =12.237，P＜0.001；P＜0.05）．Lactic acid increased group：11 patients received mechanical ventilation，and the lactic acid levels of all 11 patients increased（P＜0.05）．Nine patients used vasoactive substances，and their lactic acid levels all increased，with no significant difference（P＞0.05）．Of the 38 inpatients，24 cases had elevated lactic acid levels（P＜0.05）．Thirteen patients received mechanical ventilation，and 12 patients had elevated SI，with no statistical significance（P＞0.05）．Eleven patients were treated with vasoactive agents，and 8 patients had increased SI，with no difference（P＞0.05）．Among the 39 patients hospitalized，22 cases had increased SI，and the difference was statistically significant（P＜0.05）．Conclusions  For patients with severe traumatic shock，when the blood lactic acid level increases，the probability of MODS will be greatly increased．Compared with SI index，lactic acid level has higher application value in predicting the prognosis of patients with severe traumatic shock．

          目的   探讨便携式超声仪超声重点评估（e-FAST）技术在批量伤员军地联合院前救治中的应用效果。方法    抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员，均开展军地联合院前救治，按照治疗方案不同分为观察组和对照组，每组患者40例，其中对照组在救治现场行基于创伤严重程度（CRAMS）评分，进行常规急救处置，救护车返院后行CT检查并进行相应伤情治疗，观察组救治现场行CRAMS评分，进行常规急救处置，院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位，初步诊断后进行相应伤情治疗，对比两组患者治疗效果，两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果   观察组治疗有效率为95.0%，对照组为85.0%，对比差异无统计学意义（χ ² =2.222，P=0.136）；观察组患者的诊断时间（13.56±2.36）min、初次医疗接触—进入手术室时间（30.42±8.99）min均短于对照组［（23.64±5.69）、（52.27±12.60）min］，差异有统计学意义（t=10.349、8.928，P＜0.05）；观察组患者入院诊断与出院时确定性诊断的符合为97.5%，对照组患者入院诊断与出院时确定性诊断的符合为95.0%，差异无统计学意义（χ ² =0.346，P=0.556）；治疗后两组患者的CRAMS评分均升高，且观察组（9.87±2.62）分高于对照组（8.60±2.98）分，差异有统计学意义（t=2.024，P=0.046）；观察组患者CRAMS≤8分的抢救成功率为97.50%，对照组CRAMS≤8抢救成功率为85.00%，观察组患者CRAMS≤8分的抢救成功率高于对照组（χ ² =3.914，P=0.048）。结论    本研究从军地联合救治批量伤员切入，瞄准部队医院军民融合战略发展路线，本文针对便携式超声仪e-FAST应用范围前移，明显地提高急救人员院前救治能力，提高抢救成功率，值得临床参考。

       Objective  To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals．Methods  Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected，all of whom underwent military civilian joint pre hospital treatment．They were divided into an observation group and a control group according to different treatment plans，with 40 patients in each group．The control group received CRAMS scores at the treatment site for routine first aid treatment，CT scans after ambulance return to the hospital for corresponding injury treatment，the observation group  received CRAMS scores at the treatment site for routine first aid treatment，and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process．After preliminary diagnosis，corresponding injury treatment was carried out．The treatment effects of the two groups of patients were compared，and the diagnosis time and initial diagnosis of the two groups of patients were compared．The time from medical contact to entering the operation room，the compliance rate of discharge and admission diagnoses，the CRAMS score before and after treatment，and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared．Results  The effective rate of treatment in the observation group was 95.0%，while in the control group it was 85.0%，which difference was not statistically significant（χ ² =2.222，P=0.136）．The time to diagnosis（13.56±2.36）min，time to the operating room（30.42±8.99）min were shorter than that in the control group［（23.64±5.69），（52.27±12.60）min］，with significant difference（t=10.349，8.928，P＜0.05）．The consistency  between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%，while the consistency of the control group patients was 95.0%．There was no significant difference between the groups（χ ² =0.346，P=0.556）．After treatment，the CRAMS scores of both groups of patients increased，the observation group（9.87±2.62）was higher than that of the control group（8.60±2.98）（t=2.024，P=0.046）．The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%，while the success rate in the control group was 85.00%．The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group（χ ² =3.914，P=0.048）．Conclusions  This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces，aiming at the development path of military civilian integration strategy in military hospitals．The application scope of portable ultrasound e-FAST has been moved forward，which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue．It is worth clinical reference．