地震中儿童创伤的类型和救治要点
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摘要
肢体外伤在儿童地震创伤中最为常见。地震导致的颅脑外伤发生居多,而颅内损伤较少,但颅内损伤是地震创伤致死的首要原因。胸腹挤压伤易致内脏出血等危急情况,也是地震伤患儿主要致死原因之一。挤压综合征和骨筋膜室综合征常常并发急性肾脏功能衰竭。由于地震创伤出现时间集中,现场救援要遵循"救命第一,危重优先"的原则。条件允许时,伤员应及时转运。危重伤员治疗需采用多学科联合序贯方式,重视并发症的防治、康复治疗和心理疏导。
Limb trauma is the most common among pediatric victims in earthquake.Compared with traumatic brain injury,which is frequent in earthquake,intracranial injury is rare,but it is the leading cause of death from trauma in earthquake.Thoracoabdominal crush injury,which often causes such crises as visceral hemorrhage,is also one of the main causes of death among pediatric victims in earthquake.Crush syndrome and osteofascial compartment syndrome are often complicated by acute renal failure.Because trauma is emergent in earthquake,the principle of "life-saving first,critical injury priority" should be complied with during on-site rescue.The injured children must be transferred to the medical center as soon as possible.It is essential to treat the critically injured children by multidisciplinary cooperation,and much attention should be paid to prevention of complications,rehabilitation care,and psychological counseling.
Limb trauma is the most common among pediatric victims in earthquake.Compared with traumatic brain injury,which is frequent in earthquake,intracranial injury is rare,but it is the leading cause of death from trauma in earthquake.Thoracoabdominal crush injury,which often causes such crises as visceral hemorrhage,is also one of the main causes of death among pediatric victims in earthquake.Crush syndrome and osteofascial compartment syndrome are often complicated by acute renal failure.Because trauma is emergent in earthquake,the principle of "life-saving first,critical injury priority" should be complied with during on-site rescue.The injured children must be transferred to the medical center as soon as possible.It is essential to treat the critically injured children by multidisciplinary cooperation,and much attention should be paid to prevention of complications,rehabilitation care,and psychological counseling.
引文
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[15]王军,康斌,唐诗添,杨衡.四川汶川地震伤情统计与分析[J].实用骨科杂志,2008,14(12):731-732.
[2]杨策,钟河江,蒋电明,张连阳,王爱民,蒋东坡,等.533例汶川地震伤员感染流行病学分析与思考[J].中华创伤杂志,2008,24(8):587-590.
[3]曹豫江,李明,刘传康,覃佳强,罗聪,王忠良.109例汶川地震伤儿童创面或伤口感染及治疗情况分析[J].重庆医学,2010,39(12):3398-3399,3401.
[4]权毅,潘显明,邓冰,周劲松,邓少林,伍红桦,等.1070例地震伤救治情况报告[J].中华创伤骨科杂志,2008,10(6):510-512.
[5]Zhang L,Li H,Carlton JR,Ursano R.The injury profile after the2008 earthquakes in China[J].Injury Int J Care Injured,2009,40(1):84-86.
[6]Phalkey R,Reinhardt JD,Marx M.Injury epidemiology after the2001 Gujarat earthquake in India:a retrospective analysis of inju-ries treated at a rural hospital in the Kutch district immediately af-ter the disaster[J].Glob Health Action,2011,4:7196.
[7]Chu ZG,Yang ZG,Dong ZH,Chen TW,Zhu ZY,Shao H.Comparative study of earthquake-related and non-earthquake-relat-ed head traumas using multidetector computed tomography[J].Clinics,2011,66(10):1735-1742.
[8]陈隆益,唐健,黄光富,袁利民,刘卫东,李志立,等.地震所致颅脑创伤265例流行病学及临床分析[J].西部医学,2009,21(10):1699-1701.
[9]刁明强,孙小康,彭志忠,谭程,郭向东,赵长明,等.一线三甲医院汶川地震107例多发伤合并胸伤的救治分析[J].中国循证医学杂志,2009,9(2):162-165.
[10]Li T,Jiang XY,Chen H,Yang Z,Wang X,Wang M.Orthopae-dic injury analysis in the 2010 Yushu,China earthquake[J].In-jury Int J,2012,43(6):886-890.
[11]刘国栋,王普杰,王苏星,邱俊,张岫竹,李阳,等.826例汶川地震住院伤员伤情特点及救治分析[J].中华创伤外科,2000,25(5):446-450.
[12]卢世璧.汶川地震伤员救治的几点经验[J].中国矫形外科杂志,2008,16(10):1521-1522.
[13]刘强,王凌,王焱,武麦蕊,尹立雪.急诊超声在重大地震灾害伤员救治中的临床应用[J].中国超声医学杂志,2009,25(7):710-712.
[14]Bhatti SH,Ahmcd I,Qureshi NA,Akram M,Khan J.Head trau-ma due to earthquake October,2005-experience of 300 cases atthe Combined Military Hospital Rawalpindi[J].J Coll PhysiciansSurg Pak,2008,18(1):22-26.
[15]王军,康斌,唐诗添,杨衡.四川汶川地震伤情统计与分析[J].实用骨科杂志,2008,14(12):731-732.
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