芦山地震与汶川地震骨科伤员伤情比较分析
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摘要
目的:分析芦山地震和汶川地震伤员损伤特点,探讨地震伤员的救援及治疗方法。方法:以华西医院骨科收治的汶川地震和芦山地震骨科伤员为对象,分析比较伤员的年龄、性别、致伤原因、损伤部位、就医时间以及伤员转运速度等信息。结果:两次地震伤员的年龄分布及性别构成比差异没有统计学意义。芦山地震伤员从受伤到入院平均2.1天,收治高峰出现早、持续时间短,而汶川地震伤员从受伤到入院平均8.3天,收治高峰出现晚且持续时间长。汶川地震挤压综合征、截肢、气性坏疽、血管损伤及多器官功能衰竭的发生率高于芦山地震。汶川地震以倒塌建筑及滚落山石砸伤/掩埋为主,占所有受伤原因的79.6%,而芦山地震砸伤/掩埋占所有受伤原因的39.2%,低于高坠伤和跌伤(56.8%)的发生率。芦山地震足部、脊柱骨折及多发骨折的发生率高于汶川地震,而开放性骨折、小腿骨折的发生率低于汶川地震。结论:快速的现场救援和病员转运是救治成功的关键,早期救援和病员转运可以显著降低创面感染、挤压综合征、多器官功能衰竭及截肢的发生率,而正确的地震应急避难知识的普及有利于降低因地震而盲目跳楼、逃跑等逃生引起的损伤。
Objective:To systematically analyze and compare the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquake,so as to provide useful references for future earthquakes injury rescue.Methods:Based on the orthopedic inpatients in Lushan and Wenchuan earthquakes,the data of the age,gender,injury causes,body injured parts and speed of transport were classified and compared.Results:The duration of patients admitted to hospital lasted long and the peak appeared late in Wenchuan earthquake,which is totally opposed to Lushan earthquake.There was no significant difference in the patient's age and gender between the two earthquakes.However,the occurrence rate of crush syndrome,amputation,gas gangrene,vascular injury and multiple organ dysfunction syndrome(MODS) in Wenchuan earthquake was much higher than that in Lushan earthquake.Blunt traumas or crush-related injuries(79.6%) are the major injury cause in Wenchuan earthquake,however,high falling injuries and falls(56.8%) are much higher than blunt trauma or crush-related injuries(39.2%)in Lushan earthquake.The incidence rate of foot fractures,spine fractures and multiple fractures in Lushan earthquake was higher than that in Wenchuan earthquake,but that of open fractures and lower limb fractures was lower than that in Wenchuan earthquake.Conclusion:The rapid rescue scene is the cornerstone of successful treatment,early rescue and transport obviously reduce the incidence of the wound infection,crush syndrome,MODS and amputation.Popularization of correct knowledge of emergency shelters will help to reduce the damage caused by blindly jumping or escaping while earthquake happens.
Objective:To systematically analyze and compare the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquake,so as to provide useful references for future earthquakes injury rescue.Methods:Based on the orthopedic inpatients in Lushan and Wenchuan earthquakes,the data of the age,gender,injury causes,body injured parts and speed of transport were classified and compared.Results:The duration of patients admitted to hospital lasted long and the peak appeared late in Wenchuan earthquake,which is totally opposed to Lushan earthquake.There was no significant difference in the patient's age and gender between the two earthquakes.However,the occurrence rate of crush syndrome,amputation,gas gangrene,vascular injury and multiple organ dysfunction syndrome(MODS) in Wenchuan earthquake was much higher than that in Lushan earthquake.Blunt traumas or crush-related injuries(79.6%) are the major injury cause in Wenchuan earthquake,however,high falling injuries and falls(56.8%) are much higher than blunt trauma or crush-related injuries(39.2%)in Lushan earthquake.The incidence rate of foot fractures,spine fractures and multiple fractures in Lushan earthquake was higher than that in Wenchuan earthquake,but that of open fractures and lower limb fractures was lower than that in Wenchuan earthquake.Conclusion:The rapid rescue scene is the cornerstone of successful treatment,early rescue and transport obviously reduce the incidence of the wound infection,crush syndrome,MODS and amputation.Popularization of correct knowledge of emergency shelters will help to reduce the damage caused by blindly jumping or escaping while earthquake happens.
引文
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[11]Peek-Asa C,Ramirez M,Seligson H,et al.Seismic,structural,and individual factors associated with earthquake related injury[J].Inj Prev,2003,9(1):62-66.
[12]Djalali A,Khankeh H,Ohlén G.Facilitators and obstacles in prehospital medical response to earthquakes:a qualitative study[J].Scand J Trauma Resusc Emerg Med,2011(19):30.
[13]Aoki N,Demsar J,Zupan B,et al.Predictive model for estimating risk of crush syndrome:a data mining approach[J].J Trauma,2007,62(4):940-945.
[14]Otani Y,Ando T,Atobe K,et al.Comparison of two large earthquakes:the 2008 Sichuan earthquake and the 2011 east Japan earthquake[J].Keio J Med,2012,61(1):35-39.
[2]裴福兴.1410名地震伤员早期救治体会[J].中国矫形外科杂志,2008,16(20):1523-1524.
[3]易敏,裴福兴,宋跃明,等.汶川地震骨科伤员伤情分析[J].中华外科杂志,2008,46(24):1853-1855.
[4]Lebel E,Blumberg N,Gill A,et al.External fixator frames as interim damage control for limb injuries:experience in the 2010 haiti earthquake[J].J Trauma,2011,71(6):128-131.
[5]姜洁,李幼平,王觅也,等.玉树与汶川地震医疗救援比较[J].中国循证医学杂志,2010,10(5):550-554.
[6]杜明奎,樊毫军,杨炯,等.玉树地震伤与汶川地震伤临床特点比较[J].中国急救复苏与灾害医学杂志,2010,5(12):1103-1105.
[7]张雪梅,张咏梅,白晟遥,等.海地地震中的孕妇救治[J].中国急救复苏与灾害医学杂志,2010,5(3):203-205.
[8]石应康,郑尚维,邓绍林.从汶川经验到玉树医疗救援[J].中国循证医学杂志,2010,10(4):373-375.
[9]Green GB,Modi S,Lunney K,et al.Generic evaluation methods for disaster drills in developing countries[J].Ann Emerg Med,2003,41(5):689-699.
[10]Liang NJ,Shih YT,Shih FY,et al.Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan[J].Ann Emerg Med,2001,38(5):549-555.
[11]Peek-Asa C,Ramirez M,Seligson H,et al.Seismic,structural,and individual factors associated with earthquake related injury[J].Inj Prev,2003,9(1):62-66.
[12]Djalali A,Khankeh H,Ohlén G.Facilitators and obstacles in prehospital medical response to earthquakes:a qualitative study[J].Scand J Trauma Resusc Emerg Med,2011(19):30.
[13]Aoki N,Demsar J,Zupan B,et al.Predictive model for estimating risk of crush syndrome:a data mining approach[J].J Trauma,2007,62(4):940-945.
[14]Otani Y,Ando T,Atobe K,et al.Comparison of two large earthquakes:the 2008 Sichuan earthquake and the 2011 east Japan earthquake[J].Keio J Med,2012,61(1):35-39.
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