大规模伤亡事件救治中超声的应用策略
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摘要
目的探讨大规模伤亡事件救治中超声的应用策略。方法回顾性分析我院在汶川大地震发生后地震伤员救治中的超声应用策略。结果医院共接诊地震伤员3307人,震后15分钟即开始超声检查,共计1386人次,超声介入诊治占8.30%(115/1386),应用便携式超声仪检查占75.4%(1045/1386),震后初期检查全部采用便携式超声,检查地点以室外为主,方法主要采用"创伤重点超声评估法"。超声筛查出浆膜腔积血(液)、外伤性动静脉瘘、深静脉血栓、肢体软组织深部血肿等创伤性病变,床旁超声监测了多名重症患者(如挤压综合症患者浆膜腔积液变化及肾脏体积和血流灌注改变)。创伤相关病变的超声阳性检出率为6.96%,没有发现假阳性,假阴性率为0.45%。结论科学的超声应用策略可在伤员的救治中发挥重要作用。本次大规模伤亡事件救治中超声应用策略可归纳为快速反应,广泛应用,检查地点灵活,以便携式超声为主要设备以及恰当的超声检查方法。
Objective To discuss the application strategy of sonography in mass casualty incidents.Methods A retrospective analysis was made to the application strategy of sonography in rescuing the wounded in Wenchuan Earthquake in our hospital.Results 3307 earthquake-wounded patients were treated in the hospital; sonographic examination started being applied 15 minutes after the quake and in total,1386 examinations were made;intervention of sonography in diagnosis and treatment took up 8.30%(115/1386) and examinations with portable sonographic devices took up 75.4%(1045/1386);examinations in the initial period after the earthquake were performed all with portable devices,mainly outdoor and the method of Focused Assessment with Sonography in Trauma(FAST) was adopted;the examinations screened out such trauma-combined syndromes as serous cavity effusion,arteriovenous fistula,deep vein thrombosis(DVT) and soft tissue deep hematom;bedside sonographic monitoring was provided to some severely-wounded patients,such as the patients with crush syndrome having the changes of serous cavity effusion,renal volume and blood glow perfusion;the positive detecting rate of trauma-combined syndrome was 6.96% with no false positive case and the false negative rate was 0.45%.Conclusions The application strategy of sonography in this mass casualty incident could be summarized as quick reaction,wide application,flexible examination site,mainly depending on portable devices and proper sonographic examination method,which reveals that scientific application strategy of sonography plays an important role in rescuing the wounded.
Objective To discuss the application strategy of sonography in mass casualty incidents.Methods A retrospective analysis was made to the application strategy of sonography in rescuing the wounded in Wenchuan Earthquake in our hospital.Results 3307 earthquake-wounded patients were treated in the hospital; sonographic examination started being applied 15 minutes after the quake and in total,1386 examinations were made;intervention of sonography in diagnosis and treatment took up 8.30%(115/1386) and examinations with portable sonographic devices took up 75.4%(1045/1386);examinations in the initial period after the earthquake were performed all with portable devices,mainly outdoor and the method of Focused Assessment with Sonography in Trauma(FAST) was adopted;the examinations screened out such trauma-combined syndromes as serous cavity effusion,arteriovenous fistula,deep vein thrombosis(DVT) and soft tissue deep hematom;bedside sonographic monitoring was provided to some severely-wounded patients,such as the patients with crush syndrome having the changes of serous cavity effusion,renal volume and blood glow perfusion;the positive detecting rate of trauma-combined syndrome was 6.96% with no false positive case and the false negative rate was 0.45%.Conclusions The application strategy of sonography in this mass casualty incident could be summarized as quick reaction,wide application,flexible examination site,mainly depending on portable devices and proper sonographic examination method,which reveals that scientific application strategy of sonography plays an important role in rescuing the wounded.
引文
[1]徐腾达,王仲.突发群体伤亡事件处理思路[J].世界急危重病医学杂志,2006,(3):1519~1523.
[2]Christine S.Schulman.AFASTer method of detecting abdominal trau-ma[J].Nusring Management,2003,9:47~49.
[3]Schultz CH,Koenig KL,Noji EK.A medical disaster response to re-duce immediate mortality after an earthquake[J].N Engl J Med,1996,334:438~444.
[4]Lee BC,Ormsby EL,McGahan JP,et al.The utility of sonography forthe triage of blunt abdominal trauma patients to exploratory laparotomy[J].Am J Roentgenol,2007,188:415~421.
[5]Brenchler J,Walker A,Sloan JP,et al.Evaluation of focused assess-ment with sonography in trauma(FAST)by UK emergency physician[J].EmergMed J,2006,23:446~448.
[2]Christine S.Schulman.AFASTer method of detecting abdominal trau-ma[J].Nusring Management,2003,9:47~49.
[3]Schultz CH,Koenig KL,Noji EK.A medical disaster response to re-duce immediate mortality after an earthquake[J].N Engl J Med,1996,334:438~444.
[4]Lee BC,Ormsby EL,McGahan JP,et al.The utility of sonography forthe triage of blunt abdominal trauma patients to exploratory laparotomy[J].Am J Roentgenol,2007,188:415~421.
[5]Brenchler J,Walker A,Sloan JP,et al.Evaluation of focused assess-ment with sonography in trauma(FAST)by UK emergency physician[J].EmergMed J,2006,23:446~448.
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