地震灾害中对儿童紧急救治的临床研究
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摘要
目的通过最早抵达汶川地震中心区域的第三军医大学医疗救援队对于儿童的紧急救治,研究地震等自然灾害发生后的儿童紧急救治所面临的问题。方法收集收治儿童的临床资料,包括年龄、日期、受伤情况、疾病、手术等进行比较。结果 10 d内收治的患者总数为882例次,年龄低于18岁的儿童为192例,占21.8%,其中,学龄期儿童数量最多(105例,55%),其次为青春期儿童(60例,31%),而幼儿(14例,7%)、婴儿(8例,4%)和新生儿(5例,3%)数量相对较少。192例儿童有256处创伤,受伤的最多的部位是四肢(106处,55.2%),其次是身体表面(67处,34.9%)。127例为简单放开性损伤(66.2%),106例骨折(55.2%)。轻度创伤121例(63.0%),中度损伤56例,(29.7%),重度创伤8例(4.2%),致死性创伤7例(3.7%)。结论收治的伤病员中超过20%是儿童,尤其以学龄期儿童数量最多,早期紧急救援中骨科和普通外科医生任务繁重,儿科医生在早期紧急救治中应起更大作用,而后期感染性疾病的控制变得更加重要。
Objective An 8.0-magnitude earthquake struck Sichuan province of China on May 12th,2008.Over the next 10 d,the firstly arrived uniformed pediatricians in the epicenter zone took part in emergency relief care for children.The investigations of major injuries and diseases in children were taken.Methods To collect demographic data including(if possible) age,date of presentation,injury,disease,and performed surgery.Results Total casualties were estimated over 80,000,and much more injured.Eight hundreds and eight-two inpatients were treated by the relief team during the first 10 d.Of 882 inpatients,192(21.8%) were <18 years old.Children′s ages were not evenly distributed.Twenty-seven patients were neonates,infants,and toddlers(14%),105 school-aged(55%),and 60 adolescents(31%).The admitted children suffered from 256 injures.Limb(106 cases,55.2%) and body surface(67 cases,34.9%) were the majorly injured locations.127 cases(66.2%) had simple,open injures and 106(55.2% had fractures.The children′s conditions were evaluated as mild(121,63.0%),moderate(56,29.7%),severe(8,4.2%),and fatal(7,3.7%).Conclusion More than 20% of patients requiring hospitalization were children.School-aged children were heavily injured.The increase of infectious diseases followed on.The data show that there is an immediate need for orthopedic and general surgery skills,and pediatrician should play an important role in early rescue and subsequently control of infectious diseases in a huge earthquake hazard.
Objective An 8.0-magnitude earthquake struck Sichuan province of China on May 12th,2008.Over the next 10 d,the firstly arrived uniformed pediatricians in the epicenter zone took part in emergency relief care for children.The investigations of major injuries and diseases in children were taken.Methods To collect demographic data including(if possible) age,date of presentation,injury,disease,and performed surgery.Results Total casualties were estimated over 80,000,and much more injured.Eight hundreds and eight-two inpatients were treated by the relief team during the first 10 d.Of 882 inpatients,192(21.8%) were <18 years old.Children′s ages were not evenly distributed.Twenty-seven patients were neonates,infants,and toddlers(14%),105 school-aged(55%),and 60 adolescents(31%).The admitted children suffered from 256 injures.Limb(106 cases,55.2%) and body surface(67 cases,34.9%) were the majorly injured locations.127 cases(66.2%) had simple,open injures and 106(55.2% had fractures.The children′s conditions were evaluated as mild(121,63.0%),moderate(56,29.7%),severe(8,4.2%),and fatal(7,3.7%).Conclusion More than 20% of patients requiring hospitalization were children.School-aged children were heavily injured.The increase of infectious diseases followed on.The data show that there is an immediate need for orthopedic and general surgery skills,and pediatrician should play an important role in early rescue and subsequently control of infectious diseases in a huge earthquake hazard.
引文
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[16]Dhar SA,Halwai MA,Mir MR,et al.The Kashmir earth-quake experience[J].Eur J Trauma Emerg Surg,2007,33:74.
[17]Reynolds CR,Richmond BO.What I think and feel:a re-vised measure of children′s manifest anxiety,J Abnorm[J].Psychology,1978,6:271.
[18]Stellard P,Velleman R,Langsford J,et al.Coping andpsychological distress in children involved in road acci-dents[J].Br J Clin Psychol,2001,40:197.
[2]Tepas JJ 3rd,Mollitt DL,Talbert JL,et al.The pediatrictrauma score as a predictor of injury severity in the in-jured child[J].J Pediatr Surg,1987,22(1):14.
[3]王正国.灾害医学[J].重庆医学,2009,38(22):2777.
[4]Jain V,Noponen R,Smith BM.Pediatric surgical emer-gencies in the setting of a natural disater:experiencesfrom the 2001 earthquake in Gujarat,India[J].J PediatrSurg,2003,38:663.
[5]Laverick S,Kazmi S,Ahktar S,et al.Asian earthquake:report from the first volunteer British hospital team inPakistan[J].Emerg Med J,2007,24:543.
[6]Mace SE,Bern AI.Needs assessment:are disater medicalassistance teams up for the challenge of a pediatric dis-ater?[J].Am J Emerg Med,2007,25:762.
[7]Sarisozen B,Durak K.Extremity injuries in children resul-ting from the 1999 Marmara earthquake:an epidemiologicstudy[J].J Pediatr Orthop B,2003,12:288.
[8]Damian F,Atkinson CC,Bouchard A,et al.Disater reliefefforts after Hurricane Marilyn:a pediatric team′s experi-ence in St.Thomas[J].J Emerg Nurs,1997,23:545.
[9]Perrin JM.Disaster and children[J].Ambul Pediatr,2995,5:315.
[10]Redlener I,Markenson D.Disaster and terrorism pre-paredness:what pediatricians need to know[J].Adv Ped-iatr,2003,50:1.
[11]Chung S,Shannon M.Hospital planning for acts of ter-rorism and other public health emergencies involving chil-dren[J].Arch Dis Child,2005,90:1300.
[12]Crippen D.The world Trade Center attack:similarities tothe 1988 earthquake in Armenia:time to teach the publiclife supporting first aid?[J].Crit Care,2001,5:312.
[13]Nufer KE,Wilson-Ramirez G.A comparison of patientneeds following two hurricanes[J].Prehospital DisaterManag,2004,19:146.
[14]Curry MD,Larsen PG,Mansfield CJ,et al.Impacts of aflood disaster on an ambulatory pediatric clinic population[J].Clin Pediatr,2001,40:571.
[15]Roussos A,Goenjian AK,Steinberg AM,et al.Post trau-matic stress and depressive reactions among children andadolescents after the 1999 earthquake in Ano LiosiaGreece[J].Am J Psychiatry,2005,162:530.
[16]Dhar SA,Halwai MA,Mir MR,et al.The Kashmir earth-quake experience[J].Eur J Trauma Emerg Surg,2007,33:74.
[17]Reynolds CR,Richmond BO.What I think and feel:a re-vised measure of children′s manifest anxiety,J Abnorm[J].Psychology,1978,6:271.
[18]Stellard P,Velleman R,Langsford J,et al.Coping andpsychological distress in children involved in road acci-dents[J].Br J Clin Psychol,2001,40:197.
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