四川大学华西医院在汶川地震和芦山地震中收治的伤员伤情对比分析
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摘要
目的了解不同震级的地震对地震医学救援中三甲医院所收治伤员伤情的差异,为地震医学救援决策的制定和医疗资源的配置提供参考。方法回顾性分析2008年"5 12"汶川地震和"4 20"芦山地震中四川大学华西医院收治的住院地震伤员的临床资料,比较两次地震伤员的性别、年龄、来院时间、受伤机制、伤情分类和治疗转归。结果共纳入汶川地震伤员1 856例,其中男974例、女882例,年龄(45.8±22.7)岁;芦山地震伤员316例,其中男174例、女142例,年龄(43.0±23.1)岁。两次地震伤员的性别与年龄差异均无统计学意义(P>0.05)。但汶川地震伤员来院的高峰明显后移,持续时间明显延长;汶川地震中,重物砸伤和掩埋伤所占比例明显高于芦山地震,伤情也明显较重,住院死亡率明显较高;与汶川地震伤员相比,芦山地震伤员中胸外、颅脑外伤的患者比例明显较高,四肢外伤的比例有所下降。结论 (1)地震时地质物理破坏程度将会对地震伤员的受伤机制产生明显影响,高震级的地震,重物砸伤和掩埋伤的患者比例将会明显增高,相应的,高处坠落伤和跌伤的患者比例会下降,导致患者病情更重,死亡率更高。(2)地震时地质物理破坏程度将会明显影响到地震伤员的后送,越高震级的地震后,伤员来院的高峰会越往后推迟,甚至无明显的高峰出现,但病员流的时间会明显延长,对医院工作的影响较持久。相应的,在伤员后送影响不大的较低震级地震中,伤员来院的高峰会明显提前,病员流的持续时间不会太长,对医院日常工作的影响持续较短。(3)伤员后送的障碍将会影响到患者的及时处理,从而影响到胸外、颅脑外伤患者的预后,最后影响到到院伤员胸外和颅脑外伤的构成比例。与震级较高的地震相比,在较低震级的地震后,应更加加强胸外科、神经外科的救治力量,以保证对此类伤员的及时救治。
Objective To assess the impact of earthquake magnitude scale on injury characteristics of patients admitted to an earthquake rescue hospital,and provide references for rescue strategy formulation and medical resource allocation.Methods We retrospectively analyzed clinical data of patients injured in 2008"5 12"Wenchuan earthquake and 2013"4 20"Lushan earthquake who were admitted to West China Hospital of Sichuan University.Patient gender,age,time of admission,mechanisms,types and severity of injury and their prognosis were compared between the 2 groups.Results A total of 1 856 patients who were injured in Wenchuan earthquake,including 974 male and 882 female patients with their age of 45.8±22.7 years,and 316 patients who were injured in Lushan earthquake,including 174 male and 142 female patients with their age of 43.0±23.1 years,were enrolled in our study.No significant difference was found in gender or age between these 2 groups(P > 0.05).Peak time of admission of Wenchuan earthquake patients was significantly later than that of Lushan earthquake patients,and transfer duration of Wenchuan earthquake patients was significantly longer than that of Lushan earthquake patients.The percentage of patients with crash injury of heavy objects or buried trauma of Wenchuan earthquake patients was significantly higher than that of Lushan earthquake patients.Injury severity and in-hospital mortality of Wenchuan earthquake patients were significantly higher than those of Lushan earthquake patients.The proportion of patients with chest or cerebral injury of Lushan earthquake patients was significantly higher than that of Wenchuan earthquake patients.Conclusions Earthquake magnitude scale has a significant influence on mechanisms,types and severity of injury of patients injured in earthquakes,as well as their timely transfer,management and prognosis.In earthquakes with a comparatively lower magnitude scale,more thoracic surgeons and neurosurgeons are needed to ensure timely management for patients with chest or cerebral injury.
Objective To assess the impact of earthquake magnitude scale on injury characteristics of patients admitted to an earthquake rescue hospital,and provide references for rescue strategy formulation and medical resource allocation.Methods We retrospectively analyzed clinical data of patients injured in 2008"5 12"Wenchuan earthquake and 2013"4 20"Lushan earthquake who were admitted to West China Hospital of Sichuan University.Patient gender,age,time of admission,mechanisms,types and severity of injury and their prognosis were compared between the 2 groups.Results A total of 1 856 patients who were injured in Wenchuan earthquake,including 974 male and 882 female patients with their age of 45.8±22.7 years,and 316 patients who were injured in Lushan earthquake,including 174 male and 142 female patients with their age of 43.0±23.1 years,were enrolled in our study.No significant difference was found in gender or age between these 2 groups(P > 0.05).Peak time of admission of Wenchuan earthquake patients was significantly later than that of Lushan earthquake patients,and transfer duration of Wenchuan earthquake patients was significantly longer than that of Lushan earthquake patients.The percentage of patients with crash injury of heavy objects or buried trauma of Wenchuan earthquake patients was significantly higher than that of Lushan earthquake patients.Injury severity and in-hospital mortality of Wenchuan earthquake patients were significantly higher than those of Lushan earthquake patients.The proportion of patients with chest or cerebral injury of Lushan earthquake patients was significantly higher than that of Wenchuan earthquake patients.Conclusions Earthquake magnitude scale has a significant influence on mechanisms,types and severity of injury of patients injured in earthquakes,as well as their timely transfer,management and prognosis.In earthquakes with a comparatively lower magnitude scale,more thoracic surgeons and neurosurgeons are needed to ensure timely management for patients with chest or cerebral injury.
引文
1 石应康,郑尚维.区域性国家级医院在汶川地震医疗救援中的战略支撑作用.中国循证医学杂志,2008,8(6):380-382.
2 陈运泰,刘瑞丰.地震的震级.地震地磁观测与研究,2004,25(6):1-12.
3 Sever MS,Vanholder R.Management of crush victims in mass disasters:highlights from recently published recommendations.Clin J Am Soc Nephrol,2013,8(2):328-335.
4 He Q,Wang F,Li G,et al.Crush syndrome and acute kidney injury in the Wenchuan Earthquake.J Trauma,2011,70(5):1213-1217.
5 Shorr RM,Crittenden M,Indeck M,et al.Blunt thoracic trauma.Analysis of 515 patients.Ann Surg,1987,206(2):200-205.
6 Stevens RD,Sutter R.Prognosis in severe brain injury.Crit Care Med,2013,41(4):1104-1123.
7 LoCicero J.3rd,Mattox KL.Epidemiology of chest trauma.Surg Clin North Am,1989,69(1):15-19.
2 陈运泰,刘瑞丰.地震的震级.地震地磁观测与研究,2004,25(6):1-12.
3 Sever MS,Vanholder R.Management of crush victims in mass disasters:highlights from recently published recommendations.Clin J Am Soc Nephrol,2013,8(2):328-335.
4 He Q,Wang F,Li G,et al.Crush syndrome and acute kidney injury in the Wenchuan Earthquake.J Trauma,2011,70(5):1213-1217.
5 Shorr RM,Crittenden M,Indeck M,et al.Blunt thoracic trauma.Analysis of 515 patients.Ann Surg,1987,206(2):200-205.
6 Stevens RD,Sutter R.Prognosis in severe brain injury.Crit Care Med,2013,41(4):1104-1123.
7 LoCicero J.3rd,Mattox KL.Epidemiology of chest trauma.Surg Clin North Am,1989,69(1):15-19.
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