一线三甲医院汶川地震1348例群体伤的救治分析
|
摘要
目的:总结汶川地震中群体伤患者的救治经验。方法:回顾性分析2008年5月12~31日我院收治的1348名地震伤患者临床资料。结果:所有伤员中,气管插管或气管切开61例,胸腔闭式引流101例,清创缝合674例,颅内血肿清除,碎骨清除减压41例,截肢49例,清创外固定297例,骨筋膜室综合征切开减压13例,肠切除或修补13例,脾切除8例,肝修补10例,剖腹探查1例。脊柱骨折引起完全性或不全性截瘫8人。死亡45例,入院1 h内死亡30例,1~24 h内7例,>24 h 8例。死亡原因:失血性或/和创伤性休克29例,特重型颅脑伤14例、多器官功能衰竭2例。结论:在地震群体伤的救治中,有三大原则对于提高救治率至关重要:首先,迅速检查、快速诊断和分诊是提高大规模群体伤救治率的关键,早期诊断应以查体、诊断性穿刺和胸部X线、B超检查为主,迅速查明并紧急处理危及生命的伤情,防止漏诊误诊;其次,重视休克复苏和多发伤的处理、防治ARDS、骨筋膜室综合征、继发感染等并发症、防治交叉感染和疫情发生是降低死亡率的关键。第三,按战时前线军队医院管理模式,向周边医院转移患者。
Objective: To aggregate the clinical experience of treatment for groups injury in Wenchuan Earthquake.Methods: The clinic data of 1348 cases of earthquake injury admitted in our hospital during May 12 to May 31,2008 were retrospectively analyzed.Results: In all 1498 cases,61 cases were performed by tracheal intubation or tracheotomy,101 case were performed by thoracic closed drainage,674 cases were performed by debridement and suturing,41 cases were performed by intracranial hematoma craniotomy and hematoma removal and decompression,49 cases were performed by amputation,297 cases were performed by debridement and external fixation,13 cases were performed by compartment syndrome open decompression,13 cases were performed by enterectomy or repair,8 cases were performed by splenectomy,10 cases were performed by hepatic injury repair,1 case were performed by exploratory laparotomy.In all of these patients,8 cases were complete or partial paraplegia caused by spinal fractures.45 cases died,among these,30 cases died in 1h since admit,7 cases died in 24 h since admit,8 cases died after 24 h since admit.Among all these died cases,29 cases died for traumatic or hemorrhagic shock,14 cases died for special advanced craniocerebral trauma,2 cases died for Multiple Organ Failure.Conclusion: In medical rescue of earthquake group injury,there has three important principles to improve the remedy rate: At first,fast examination,classification and distribution diagnosis was the essential for improve the remedy rate of groups injury,early diagnosis should be performed by physical examination,diagnosis puncture,X-ray and B-ultrasonography to quickly find out the critical injury then to emergency treatment and prevent misdiagnosis;The 2nd,emphasis highly treatment of shock and multiple trauma,prevent ARDS,compartment syndrome and complicated infection and cross infection and influenza outbreak was the essential for decrease the mortality;The 3rd,transfer patients to neighboring hospitals by the military hospital management model.
Objective: To aggregate the clinical experience of treatment for groups injury in Wenchuan Earthquake.Methods: The clinic data of 1348 cases of earthquake injury admitted in our hospital during May 12 to May 31,2008 were retrospectively analyzed.Results: In all 1498 cases,61 cases were performed by tracheal intubation or tracheotomy,101 case were performed by thoracic closed drainage,674 cases were performed by debridement and suturing,41 cases were performed by intracranial hematoma craniotomy and hematoma removal and decompression,49 cases were performed by amputation,297 cases were performed by debridement and external fixation,13 cases were performed by compartment syndrome open decompression,13 cases were performed by enterectomy or repair,8 cases were performed by splenectomy,10 cases were performed by hepatic injury repair,1 case were performed by exploratory laparotomy.In all of these patients,8 cases were complete or partial paraplegia caused by spinal fractures.45 cases died,among these,30 cases died in 1h since admit,7 cases died in 24 h since admit,8 cases died after 24 h since admit.Among all these died cases,29 cases died for traumatic or hemorrhagic shock,14 cases died for special advanced craniocerebral trauma,2 cases died for Multiple Organ Failure.Conclusion: In medical rescue of earthquake group injury,there has three important principles to improve the remedy rate: At first,fast examination,classification and distribution diagnosis was the essential for improve the remedy rate of groups injury,early diagnosis should be performed by physical examination,diagnosis puncture,X-ray and B-ultrasonography to quickly find out the critical injury then to emergency treatment and prevent misdiagnosis;The 2nd,emphasis highly treatment of shock and multiple trauma,prevent ARDS,compartment syndrome and complicated infection and cross infection and influenza outbreak was the essential for decrease the mortality;The 3rd,transfer patients to neighboring hospitals by the military hospital management model.
引文
[1]赵喜森.重症难治性休克的机制和治疗[J].中华创伤杂志,2003,19(16):325.
[2]VARELA J E,COHN S M,DIAZ I,et al.Splanchnic perfusionduring delayed,hypotensive,or aggressive fluid resuscitation fromuncontrolled hemorrhage[J].Shock,2003,20(5):476-480.
[3]王一镗.严重创伤救治的策略-损伤控制性手术[J].中华创伤杂志,2005,21(1):32-35.
[4]HOEY B A,SCHWAB C W.Damage control surgery[J].Scand JSurg,2002,91(1):92-103.
[5]WETZEL R C.Multiple trauma in children;critical care overview[J].Crit Care Med,2002,30:s468-477.
[6]WANEK S,MAYBERRY J C.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury[J].Crit Care Clin,2004,20(1):71-81.
[7]BUDUHAN G,MCR ITCHIE D I.Missed injuries in patients withmultiple trauma[J].J Trauma,2000,49(3):600-605.
[8]张连阳.努力提高多发伤救治速度[J].中华创伤杂志,2007,23(4):241-243.
[2]VARELA J E,COHN S M,DIAZ I,et al.Splanchnic perfusionduring delayed,hypotensive,or aggressive fluid resuscitation fromuncontrolled hemorrhage[J].Shock,2003,20(5):476-480.
[3]王一镗.严重创伤救治的策略-损伤控制性手术[J].中华创伤杂志,2005,21(1):32-35.
[4]HOEY B A,SCHWAB C W.Damage control surgery[J].Scand JSurg,2002,91(1):92-103.
[5]WETZEL R C.Multiple trauma in children;critical care overview[J].Crit Care Med,2002,30:s468-477.
[6]WANEK S,MAYBERRY J C.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury[J].Crit Care Clin,2004,20(1):71-81.
[7]BUDUHAN G,MCR ITCHIE D I.Missed injuries in patients withmultiple trauma[J].J Trauma,2000,49(3):600-605.
[8]张连阳.努力提高多发伤救治速度[J].中华创伤杂志,2007,23(4):241-243.
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心