地震救援中现场截肢的探讨
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摘要
目的探讨地震救援中现场截肢手术适应证、手术方法及伦理问题。方法映秀镇地震救援中现场截肢2例共3个肢体,采用局部麻醉,截肢平面靠近压迫物。术后补充等张盐水,补液速度1.5L/h,静脉滴注5%碳酸氢钠溶液150mL。口服头孢克肟胶囊,400mg顿服。结果截肢后2例患者均未出现严重并发症,次日送后方医院行二次截肢。结论灾难救援中现场截肢必须综合考虑,严格掌握适应证,必要的截肢可以挽救伤员生命。
Objective To investigate the indications,process and ethical issues of amputation on the spot in Wenchuan earthquake rescue.Methods Two female had amputations on the spot in 3 limbs in Yingxiu of Wenchuang county.Local anaesthesia were used,the level of amputation as near the compression.Intravenous isotonic saline solution at a speed of 1.5 L/h,intravenous sodium bicarbonate and single-dose oral cefixime of 400 mg were given after operation.Result There were no severe complications,and secondary amputation was performed in two patients 1 d after rescue.Conclusions It is difficult to determine whether or not an amputation on the spot amputation should be performed,but amputation is recommended in the unavoidably necessary situation.
Objective To investigate the indications,process and ethical issues of amputation on the spot in Wenchuan earthquake rescue.Methods Two female had amputations on the spot in 3 limbs in Yingxiu of Wenchuang county.Local anaesthesia were used,the level of amputation as near the compression.Intravenous isotonic saline solution at a speed of 1.5 L/h,intravenous sodium bicarbonate and single-dose oral cefixime of 400 mg were given after operation.Result There were no severe complications,and secondary amputation was performed in two patients 1 d after rescue.Conclusions It is difficult to determine whether or not an amputation on the spot amputation should be performed,but amputation is recommended in the unavoidably necessary situation.
引文
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2Present DA,Meislin R,Shaffer B.Gas gangrene A review[J].Orthop Rev,1990,19(4):333-341.
3Reis ND,Better OS.Mechanical muscle-crush injury and acute muscle-crush compartment syndrome:with special reference to earthquake casualties[J].J Bone Joint Surg Br,2005,87(4):450-453.
4Lucas GL.Intravenous regional anesthesia in peripheral extremity surgery[J].Clin Orthop Relat Res,1969,65:138-142.
5Abramson DM,Morse SS,Garrett AL,et al.Public health disaster research:surveying the field,defining its future[J].Disas-ter Med Public Health Prep,2007,1(1):57-62.
6汤金洲,郭照江.灾难医学救治的伦理学初探[J].中国医学伦理学,2000,71(3):17-19.
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