四川汶川地震转运骨科伤员的临床特点和救治措施
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摘要
目的总结四川汶川地震转运骨科伤员的临床特点和救治经验。方法对我科2008年5月13日至6月10日收治的129例汶川地震转运骨科伤员进行检伤分类,记录内容主要包括:转运人次,伤员的主诉,诊断,损伤部位及类型,是否伴有感染以及接诊后的处理,治疗效果等。结果129例伤员中,骨折伤员95例,其中开放性骨折35例51处,闭合性骨折60例139处;26例(20.2%)39条神经损伤;54例(31.8%)并发感染;110例伤员行手术治疗;无死亡病例;1例院外截肢伤员因残端感染严重多次行残端清创、修整;其余伤员伤口均愈合;无术后切口感染。结论四川汶川地震转运骨科伤员的临床特点明显,必须根据其临床特点予以个体化救治,同时要积极防治相关并发症,以降低死亡率和致残率。
Objective To summarize the clinical characteristics and the treatment experience of the patients evacuated from Wenchuan earthquake area. Methods We admitted 129 patients who had been injuried in the 5·12 Wenchuan earthquake from May 13th to June 10th ,2008. The recording content included chief complaints,diagnosis,damage locations and types ,whether with infection or not,treatment ,efficacy and so on. Results There were 95 fracture cases which included 35 open fractures with 51 fracture sites,and 60 closed fracture cases with 139 fracture sites; 39 associated with neural injuries in 26 patients(20.2%);54 cases had infection(31.8%);110 cases had operations;there were no death cases,but one outside hospital amputation patient had multiple Stump debridement and trimming due to severe infection; all open fracture cases have been healing except 2 cases until now;no cases were with infection after operation. Conclusion The clinical characteristics of the patients evacuated from Wenchuan earthquake were outstanding,individualization remedy was needed according to the clinical characteristics and we should prevent and cure correlate complications positively in order to depress the fatality and disability rate.
Objective To summarize the clinical characteristics and the treatment experience of the patients evacuated from Wenchuan earthquake area. Methods We admitted 129 patients who had been injuried in the 5·12 Wenchuan earthquake from May 13th to June 10th ,2008. The recording content included chief complaints,diagnosis,damage locations and types ,whether with infection or not,treatment ,efficacy and so on. Results There were 95 fracture cases which included 35 open fractures with 51 fracture sites,and 60 closed fracture cases with 139 fracture sites; 39 associated with neural injuries in 26 patients(20.2%);54 cases had infection(31.8%);110 cases had operations;there were no death cases,but one outside hospital amputation patient had multiple Stump debridement and trimming due to severe infection; all open fracture cases have been healing except 2 cases until now;no cases were with infection after operation. Conclusion The clinical characteristics of the patients evacuated from Wenchuan earthquake were outstanding,individualization remedy was needed according to the clinical characteristics and we should prevent and cure correlate complications positively in order to depress the fatality and disability rate.
引文
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[2]王正国.地震灾害的特点及其所致创伤的救治[J].中华创伤杂志,2008,24(6):401-404.
[3]Stone R.Wenchuan earthquake Damaged university mourns its dead-and plans fast recovery[J].Science,2008,320(5880):1145.
[4]Alexander D.Death and injury in earthquakes[J].Disaster,196,9(1):57-60.
[5]Bozkurt M,Ocguder A,Turktas U,et al.The evaluation of trauma pa-tients in Turkish Red Crescent Field Hospital following the Pakistan earthquake in2005[J].Injury,2007,38(3):290-297.
[6]Zhi-Yong S.Medical support in the Tangshan earthquake:a reviewof the management of mass casualties and certain major injuries[J].J Trauma,1987,27(11):1130-1134.
[7]Taviloglu K.17Agustos1999Marmara depreminin ardndan felaket orga-nizasyonunda neredeyiz[J].Ulusal Cerrahi Dergisi,1999,6(3):333-342.
[8]Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the1999Marmara earthquake[J].Emerg Med J,2005,22(7):494-498.
[9]Saris zen B,Durak K.Extremity injuries in children resulting from the1999Marmara earthquake:an epidemiologic study[J].J Pediatr Orthop B,2003,12(4):288-291.
[10]Bhatti SH,Ahmed I,Qureshi NA,et al.Head Trauma Due to Earth-quake October,2005-Experience of300Cases at the Combined Military Hospital Rawalpindi[J].Journal of The College of Physicians and Sur-geons Pakistan,2008,18(1):22-26.
[11]Kuwagata Y,Oda J,Tanaka H,et al.Analysis of2,702traumatized pa-tients in the1995Hanshin-Awaji earthquake[J].J Trauma,1997,43(3):427-432.
[12]Tahmasebi MN,Kiani K,Mazlouman SJ,et al.Musculoskeletal injuries associated with Earthquake A report of injuries of Iran s December26,2003Bam earthquake casualties managed in tertiary referral centers[J].Injury,2005,36(1):27-32.
[13]Yokoyama K,Itoman M,Nakamura K,et al.Newscoring system predic-ting the occurrence of deep infection in open upper and lower extremity fractures:efficacy in retrospective re-scoring[J].Arch Orthop Trauma Surg,2008,66(17):469-476.
[14]Myers SH,Spiegel D,Flynn JM.External fixation of high-energy tibia fractures[J].J Pediatr Orthop,2007,27(5):537-539.
[15]Zinman C,Norman D,Hamoud K,et al.External fixation for severe open fractures of the humerus caused by missiles[J].J Orthop Trauma,1997,11(7):536-539.
[16]Stuzatek M,Gazdzik TS,Mrozek S,et al.External fixation in the treat-ment of severe tibial fractures complicated by soft tissue injury[J].Ortop Traumatol Rehabil,2004,6(1):103-112.
[17]唐浦斌,浦金辉,张壁,等.地震伤员的处理原则[J].创伤外科杂志,2007,9(3):210.
[18]Finsterer J,Hess B.Neuromuscular and central nervous system manifes-tations of Clostridium perfringens infections[J].Infection,2007,35(6):396-405.
[19]Andel H,Kamolz L,Andel D,et al.The use of oxygen as drug and its relevance for wound healing[J].Handchir Mikrochir Plast Chir,2007,39(5):328-332.
[20]Roy N,Shah H,Patel V.The Gujarat earthquake experience in a seis-mically unprepared area:community hospital medical response[J].Pre-hosp Disaster Med,2002,17(4):186-195.
[21]Roy N,Shah H,Patel V,et al.Surgical and psychosocial outcomes in the rural injured-a follow-up study of the2001earthquake victims[J].Inju-ry,2005,36(8):927-934.
[22]张本,王学义.唐山大地震所致孤儿心理创伤后应激障碍的调查[J].中华精神科杂志,2000,33(2):111-114.
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