探讨群组化即时通信管理在危重烧伤患者救治中的临床应用效果。

整群抽样解放军总医院第四医学中心烧伤整形医学部烧伤科2016年6月至2021年12月收治的危重烧伤患者，依据纳入与排除标准共纳入73例。根据单双日收治分为对照组(n＝43)和实验组(n＝30)。对照组患者按照解放军总医院规章制度采取主诊医师负责制的三级岗位检诊制度进行医疗活动；实验组患者除采取对照组的措施外，同时对患者开展群组化即时通信管理，即通过微信平台建立群组，实时发送和回应相关信息。比较2组患者的病情处置情况(病情报告次数、病情报告时限、病情处置时限、主诊医师指示次数)，医护人员对患者的病情掌握情况，患者转归(特级护理时间、并发症发生率、救治成功率)情况。数据分析采用t检验、Mann-Whitney U检验和χ²检验。

实验组患者的病情报告次数、主诊医师指示次数分别为15.1(14.3, 17.1)、1.9(1.5, 2.7)次，均高于对照组[1.60(1.1, 2.9)、1.07(0.8, 1.4)次]，差异均有统计学意义(Z＝－36.421、－26.676，P<0.05)。实验组患者病情报告时限、病情处置时限分别为3.4(2.8, 4.1)、7.0(6.2, 7.7) min，均低于对照组[8.8(7.8, 9.3)、18.3(15.9, 20.6) min]，差异均有统计学意义(Z＝－35.698、－34.241，P<0.05)。实验组的医护人员对患者的病情完全掌握率为86.7%(156/180)，明显高于对照组[20.9%(54/258)]，差异有统计学意义(χ²＝30.801，P<0.05)。实验组特级护理时间、并发症发生率分别为(29.1±12.5) d、3.3%(1/30)，明显低于对照组[(40.4±15.9) d、23.3%(10/43)]，差异均有统计学意义(t＝17.255、χ²＝48.558，P<0.05)；实验组救治成功率为96.7%(29/30)，明显高于对照组[83.7%(36/43)]，差异有统计学意义(χ²＝6.650，P＝0.036)。

群组化即时通信管理有利于实施精准医疗和精细化护理，缩短危重烧伤患者的病情报告时限和处置时限，提高医护人员对病情的掌握程度，缩短特级护理时间，降低并发症发生率和提高救治成功率，并对青年医护人员的临床教学实践有积极作用，其在临床危重烧伤患者救治过程中的应用值得推广。

To explore the application effect of group-based instantaneous communication in the management of critical burned patients.

Critical burned patients admitted to the Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital from June 2016 to December 2021 were selected by cluster sampling. According to the inclusion and exclusion criteria, a total of 73 patients were included. The patients were divided into the control group (n=43) and the experimental group (n=30) based on odd-and even-day admissions. Patients in the control group were treated with medical activities according to the rules and regulations of Chinese PLA General Hospital, who adopted the three-level post examination system of attending physician responsibility system. In addition to the measures of the control group, the patients in the experimental group were treated with group instant communication management, that is, the group was established through wechat platform, and relevant information was sent and responded in real time. The condition management (frequency of condition report, time limit of condition report, time limit of condition management, and the number of instructions given by the attending physician), medical staff′s mastery rate of the patients′ condition, and patients′ outcome (intensive care time, incidence of complications, success rate of treatment) were compared between the two groups. The data were processed with t test, Mann-Whitney U test and chi-square test.

The frequency of condition report and the number of instructions given by the attending physician in the experimental group were 15.1(14.3, 17.1), 1.9(1.5, 2.7) times, respectively, which were higher than those in the control group [1.60(1.1, 2.9), 1.07(0.8, 1.4) times], the differences were statistically significant (Z=-36.421, -26.676; P< 0.05). The time limit of condition report and the time limit of condition management in the experimental group were 3.4(2.8, 4.1), 7.0(6.2, 7.7) min, respectively, which were lower than those in the control group [8.8(7.8, 9.3), 18.3(15.9, 20.6) min], the differences were statistically significant (Z=-35.698, -34.241; P< 0.05). The medical staff′s mastery rate of the patients′ condition in the experimental group was 86.7% (156/180), which was higher than that in the control group [20.9% (54/258)], the difference was statistically significant (χ²=30.801, P< 0.05). The intensive care time and the incidence of complications in the experimental group were (29.1±12.5) d, 3.3%(1/30), which were lower than those in the control group [(40.4±15.9) d, 23.3%(10/43)], and the differences were statistically significant (t=17.255, χ²=48.558; P< 0.05). The success rate of treatment in the experimental group was 96.7% (29/30), which was higher than that in the control group [83.7% (36/43)], and the difference was statistically significant (χ²=6.650, P=0.036).

Group-based instantaneous communication is conducive to the implementation of precise medical treatment and refined nursing care service, should shorten the time limit of condition report and the time limit of condition management of the critical burned patients, raise the medical staff′s mastery rate of the patients′ condition, shorten the intensive care time, reduce the incidence of complications and improving the successful rate. In addition, it can be helpful in the teaching and training for the younger healthcare professionals. Therefore, it is of great value to promote the application of group-based instantaneous communication in the management of critical burned patients.