汶川特大地震极重灾区危重症医疗救治的绩效评价
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摘要
目的回顾性分析评价2008年5月12日汶川特大地震后3个月内极重灾区危重症医疗救治的绩效,为全球地震医学救援降低死亡率、伤残率,提高康复率提供决策参考。方法查找并分析评价所有与本研究目的相关的回顾性分析、原始研究和二次研究。结果①据不完全统计,震后72小时极重灾区自救伤员共30620人,其中危重伤员数占住院伤病员总人数的22%。②地震极重灾区市属、近灾区市属、省属和部属医疗机构院内危重伤员死亡率依次为12.21%、4.50%、2.50%、2.17%。③二线医院收治住院的躯干、四肢和部位不详骨折、危重伤和其他伤员人数高于一线医院,伤情更重。④震后4个月,转运到三线医院的10373名稳定期伤员出院99.07%,死亡率0.017%。结论①汶川地震极重灾区危重伤员救治基本形成"上级帮下级,重灾区帮极重灾区,一般灾区帮重灾区和极重灾区,极重灾区以自救互救为主"的医疗救治模式。②对极危重伤员采取"四集中"治疗能有效降低死亡率,使重伤员院内死亡比例由15.06%降至2.9%以下。③在准确伤情信息指导下及时、科学、规范的现场分检后送是降低伤残率和死亡率的关键。汶川特大地震极限条件下极重灾区危重症伤员的救治工作还有很大改进空间。
Objectives Performance of critical injury treatment among extremely-hit areas after great earthquake was retrospectively analyzed to provide references for policy-making as reducing mortality and disable rate besides increasing rehabilitation rate for global post-quake medical relief.Methods Retrospective analysis,primary research and secondary research were comprehensively applied.Results 1.According to incomplete statistics datum,there were 30,620 self-save injured among extremely-hit areas in 72 post-quake hours.And,the number of critical injured took 22% of the total inpatient injured.2.Mortalities decreased successively from that of municipal healthcare centers in extremely-hit areas to that municipal medical units in peripheral quake-hit areas and then to those of municipal,provincial and MOH-affiliated hospitals as 12.21%,4.50%,2.50% and 2.17% respectively.3.Injured with fractures on body,limbs or unknown-parts,severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals were much more than those treated in first-line hospitals with more severe injuries.4.Among 10,373 injured in stable conditions transferred to third-line hospitals,99.07% were discharged off hospitals with mortality as 0.017% during 4 post-quake months.Conclusions The medical relief model as "supervising body helping subordinate unit,severely-stricken areas assisting extremely-hit ones,quake-hit areas supporting both extremely-hit and severely-stricken ones,and save-saving & mutual assistance applied between extremely-hit areas" is roughly established for injured from severely-stricken areas after Wenchuan earthquake.2."Four concentration treatment" principle for those injured in critical conditions did effectively reduce mortality(15.06%→2.9%).3.Timely,scientific and standard on-site triage and post-medical transfer under guidance of accurate injury information determine rescue effect for the injured,while there is large space to fulfill as for treatment for critical diseases among extremely-hit areas under extreme conditions after Wenchuan earthquake.
Objectives Performance of critical injury treatment among extremely-hit areas after great earthquake was retrospectively analyzed to provide references for policy-making as reducing mortality and disable rate besides increasing rehabilitation rate for global post-quake medical relief.Methods Retrospective analysis,primary research and secondary research were comprehensively applied.Results 1.According to incomplete statistics datum,there were 30,620 self-save injured among extremely-hit areas in 72 post-quake hours.And,the number of critical injured took 22% of the total inpatient injured.2.Mortalities decreased successively from that of municipal healthcare centers in extremely-hit areas to that municipal medical units in peripheral quake-hit areas and then to those of municipal,provincial and MOH-affiliated hospitals as 12.21%,4.50%,2.50% and 2.17% respectively.3.Injured with fractures on body,limbs or unknown-parts,severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals were much more than those treated in first-line hospitals with more severe injuries.4.Among 10,373 injured in stable conditions transferred to third-line hospitals,99.07% were discharged off hospitals with mortality as 0.017% during 4 post-quake months.Conclusions The medical relief model as "supervising body helping subordinate unit,severely-stricken areas assisting extremely-hit ones,quake-hit areas supporting both extremely-hit and severely-stricken ones,and save-saving & mutual assistance applied between extremely-hit areas" is roughly established for injured from severely-stricken areas after Wenchuan earthquake.2."Four concentration treatment" principle for those injured in critical conditions did effectively reduce mortality(15.06%→2.9%).3.Timely,scientific and standard on-site triage and post-medical transfer under guidance of accurate injury information determine rescue effect for the injured,while there is large space to fulfill as for treatment for critical diseases among extremely-hit areas under extreme conditions after Wenchuan earthquake.
引文
1陈锦,赵万华,鲜明,等.汶川地震10373例伤员跨省转运救治纪实.中国循证医学杂志,2009,9(12):1267-1271.
2陈竺,沈骥,康均行,等.特大地震应急医学救援:来自汶川的经验.中国循证医学杂志,2012,12(4):383-392.
3雷百灵,周云,朱颖,等.汶川地震绵阳极重灾区医疗救援应急指挥纪实.中国循证医学杂志,2008,8(8):581-587.
4代小舟,沈骥,赵万华,等.汶川大地震四川省医疗救治阶段工作纪实.中国循证医学杂志,2008,8(10):797-802.
5陈晓松,于成,苗挺,等.汶川大地震医疗转运上万灾区伤员“进出成都”的救援学特征.中国急救医,2008,28(9):800-802.
6卫生部医疗防疫志编纂委员会.汶川特大地震抗震救灾志.灾区医疗防疫志.
7谢娟,杜亮,夏天,等.四川大学华西医院1861例汶川地震住院和死亡伤员伤情与死因分析.中国循证医学杂志,2008,8(8):591-596.
8赵鲁平,张标,徐巍,等.四川省德阳市人民医院1950例汶川地震伤员救援组织指挥纪实.中国循证医学杂志,2009,9(2):147-151.
9彭涛,徐宏,巫奇,等.一线三甲医院汶川地震256例颅脑外伤救治分析.中国循证医学杂志,2009,9(2):158-161.
10李群,武秀坤,白红,等.能源中断和基础设施毁损时医疗卫生机构的准备和应对工作.中国循证医学杂志,2009,9(11):1147-1150.
11马家奇,周脉耕,李言飞,等.汶川地震灾区应急手机疫情报告系统的研发与应用.中国循证医学杂志,2009,9(6):614-619.
12邹锟,刘关键,李幼平,等.地震伤亡危险因素的系统评价.中国循证医学杂志,2008,8(7):477-482.
13 Baker MS.Creating Order from Chaos:Part I:Triage,Initial Care,and Tactical Considerations in Mass Casualty and Disaster Re-sponse.Military Medicine,2007,172(3):232-236.
14 Iserson KV,Moskop JC.Triage in Medicine,Part I:Concept,History,and Types.Annals of Emergency Medicine,2007,49(3):275-281.
15列本蒂施,斯托尔茨,王衍发.军事医学若干问题.北京:解放军出版,1984:438-446.
16温世浩,周亚平,戴阳.灾害现场救援大批伤员分类的方法.灾害学,2007,22(1):138-140.
17王凌,李静,李幼平,等.大规模伤亡事件伤员分类的系统评价.中国循证医学杂志,2008,8(7):469-476.
2陈竺,沈骥,康均行,等.特大地震应急医学救援:来自汶川的经验.中国循证医学杂志,2012,12(4):383-392.
3雷百灵,周云,朱颖,等.汶川地震绵阳极重灾区医疗救援应急指挥纪实.中国循证医学杂志,2008,8(8):581-587.
4代小舟,沈骥,赵万华,等.汶川大地震四川省医疗救治阶段工作纪实.中国循证医学杂志,2008,8(10):797-802.
5陈晓松,于成,苗挺,等.汶川大地震医疗转运上万灾区伤员“进出成都”的救援学特征.中国急救医,2008,28(9):800-802.
6卫生部医疗防疫志编纂委员会.汶川特大地震抗震救灾志.灾区医疗防疫志.
7谢娟,杜亮,夏天,等.四川大学华西医院1861例汶川地震住院和死亡伤员伤情与死因分析.中国循证医学杂志,2008,8(8):591-596.
8赵鲁平,张标,徐巍,等.四川省德阳市人民医院1950例汶川地震伤员救援组织指挥纪实.中国循证医学杂志,2009,9(2):147-151.
9彭涛,徐宏,巫奇,等.一线三甲医院汶川地震256例颅脑外伤救治分析.中国循证医学杂志,2009,9(2):158-161.
10李群,武秀坤,白红,等.能源中断和基础设施毁损时医疗卫生机构的准备和应对工作.中国循证医学杂志,2009,9(11):1147-1150.
11马家奇,周脉耕,李言飞,等.汶川地震灾区应急手机疫情报告系统的研发与应用.中国循证医学杂志,2009,9(6):614-619.
12邹锟,刘关键,李幼平,等.地震伤亡危险因素的系统评价.中国循证医学杂志,2008,8(7):477-482.
13 Baker MS.Creating Order from Chaos:Part I:Triage,Initial Care,and Tactical Considerations in Mass Casualty and Disaster Re-sponse.Military Medicine,2007,172(3):232-236.
14 Iserson KV,Moskop JC.Triage in Medicine,Part I:Concept,History,and Types.Annals of Emergency Medicine,2007,49(3):275-281.
15列本蒂施,斯托尔茨,王衍发.军事医学若干问题.北京:解放军出版,1984:438-446.
16温世浩,周亚平,戴阳.灾害现场救援大批伤员分类的方法.灾害学,2007,22(1):138-140.
17王凌,李静,李幼平,等.大规模伤亡事件伤员分类的系统评价.中国循证医学杂志,2008,8(7):469-476.
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