汶川地震后第1周一线医院伤员收治情况分析
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摘要
目的分析汶川地震后江油野战医院第1周伤员的收治情况,为地震灾区医疗队的组建和一线救治提供经验。方法对1 905名急诊救治伤员进行分类,回顾性分析其中需住院治疗伤员的病历资料,包括伤员地域分布、损伤类型、诊断、初期处理、转归等。结果需住院治疗的伤员629名,占急诊救治伤员的33%;年龄2～100岁,中位年龄41.2岁。震后前3 d收治的伤员数为384人(61%)。伤员主要来源分布为江油市245人(39%)、北川县194人(31%)、平武县158人(25%)。受伤类型中软组织裂伤326例(51.8%),软组织挫伤87例(13.9%),骨折202例(32.1%);其中有肢体严重挤压伤15例。主要受伤部位位于骨盆和四肢318例(50.6%),头部117例(18.6%),背部43例(6.8%);多发伤73例(11.6%)。接受手术治疗376例(59.8%),其中清创术326例,外固定支架术21例,内固定19例,截肢术11例,筋膜切开减压术4例,剖腹探查术4例,开颅术2例;术后感染率为11.8%。死亡39例,可能原因是脑外伤、骨盆骨折、腹部出血和多发伤。结论地震造成灾区内大部分医疗设施严重破坏时,快速组建医疗队、尽量利用灾区未损坏的医疗资源、迅速恢复供电等后勤补给对伤员救治和减少死亡极为重要;地震伤员以四肢创伤为主,应多选派骨创伤外科医师参加医疗队以提高治疗效果。
Objective To evaluate the injuries in Jiangyou Field Hospital first week after Wenchuan earthquake,and accumulate experience for better medical services and better-built field hospitals to meet the demands of the earthquake-stricken areas.Methods Classification was performed in 1 905 patients with emergency treatment.The medical records of those with hospital stay were retrospectively analysed,including geographical distribution,trauma type,diagnosis,initial treatment and outcomes.Results Six hundred and twenty-nine(33%)patients were hospitalized,with an average of 2 to 100 years old(median,41.2).Three hundred and eighty-four patients(61%)were admitted within the first three days after earthquake.The patients were mainly from Jiangyou City(245,39%),Beichuan County(194,31%)and Pingwu County (158,25%).The most common types of injuries were superficial lacerations(326,51.8%),fractures(202,32.1%) and soft tissue contusions/sprains(87,13.9%),among whom 15 experienced severe squeeze.There were 318 injuries to pelvis and extremities(50.6%),117 to head(18.6%)and 43 to back(6.8%),and 73 cases had multiple injuries (11.6%).Of 376 patients(59.8%)with operation,326 received debridement,21 external fixation,19 internal fixation, 11 amputation,4 laparotomy,4 fasciotomy and 2 craniotomy.The incidence of postoperative infections was 11.8%.Death occurred in 39 patients due to cerebral trauma,pelvic fracture,abdominal hemorrhage and multiple injuries.Conclusion When the earthquake has destroyed the major medical facilities,rapid organization of medical rescue teams,making full use of remaining medical resources and recovering electricity play an important role in the rescue of victims and reduction of mortality.Orthopaedic surgeons must dominate the medical teams as most of the earthquake victims suffer from injuries to the extremities.
Objective To evaluate the injuries in Jiangyou Field Hospital first week after Wenchuan earthquake,and accumulate experience for better medical services and better-built field hospitals to meet the demands of the earthquake-stricken areas.Methods Classification was performed in 1 905 patients with emergency treatment.The medical records of those with hospital stay were retrospectively analysed,including geographical distribution,trauma type,diagnosis,initial treatment and outcomes.Results Six hundred and twenty-nine(33%)patients were hospitalized,with an average of 2 to 100 years old(median,41.2).Three hundred and eighty-four patients(61%)were admitted within the first three days after earthquake.The patients were mainly from Jiangyou City(245,39%),Beichuan County(194,31%)and Pingwu County (158,25%).The most common types of injuries were superficial lacerations(326,51.8%),fractures(202,32.1%) and soft tissue contusions/sprains(87,13.9%),among whom 15 experienced severe squeeze.There were 318 injuries to pelvis and extremities(50.6%),117 to head(18.6%)and 43 to back(6.8%),and 73 cases had multiple injuries (11.6%).Of 376 patients(59.8%)with operation,326 received debridement,21 external fixation,19 internal fixation, 11 amputation,4 laparotomy,4 fasciotomy and 2 craniotomy.The incidence of postoperative infections was 11.8%.Death occurred in 39 patients due to cerebral trauma,pelvic fracture,abdominal hemorrhage and multiple injuries.Conclusion When the earthquake has destroyed the major medical facilities,rapid organization of medical rescue teams,making full use of remaining medical resources and recovering electricity play an important role in the rescue of victims and reduction of mortality.Orthopaedic surgeons must dominate the medical teams as most of the earthquake victims suffer from injuries to the extremities.
引文
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[2]Mulvey JM,Awan SU,Qadri AA,et al.Profile of injuries arising from the 2005 Kashmir earthquake:the first 72 h[J].Injury,2008, 39(5):554-560.
[3]Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake[J]. Emerg Med J,2005,22(7):494-498.
[4]Chen WK,Cheng YC,Ng KC,et al.Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999[J]. Ann Emerg Med,2001,38(5):556-561.
[5]Kuwagata Y,Oda J,Tanaka H,et al.Analysis of 2,702 traumatized patients in the 1995 Hanshin-Awaji earthquake[J].J Trauma, 1997,43(3):427-432.
[6]Tanaka H,Oda J,Iwai A,et al.Morbidity and mortality of hospitalized patients after the 1995 Hanshin-Awaji earthquake[J].Am J Emerg Med,1999,17(2):186-191.
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