“5.12”汶川地震中地震伤员及急诊医疗救助分析
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摘要
目的:研究"5.12"汶川地震中地震伤员的发病率和死亡率以及急诊科对突发灾难作出的反应。方法:回顾性分析四川大学华西医院救治685例地震伤员病历。将685例地震伤员中分为四组。(1)挤压综合症n=21;(2)骨折伤员n=503;(3)主要生命器官损伤伤员(包括脑、主要内脏器官)n=134;(4)非地震伤员但与地震有关的疾病发作的患者n=27。根据年龄、性别、诊断、预后、是否有复合伤等危险因素数据用spss13.0软件处理,找出伤员发病的特点和规律,探讨与之相适应的医疗救治特点及决策。结果:在685例地震伤员中,其中挤压综合症的死亡率为0%;骨折伤员,内脏损伤员及非地震伤员但与地震有关患者的死亡率分别为0%;0.145%;0.58%。急诊科总死亡率0.72%,有490例患者与强震后72小时入院。结论:在强震后24～72h内大量的地震伤员拥入医院急诊科,恰当分诊和迅速抢救受伤严重的伤员可降低发病率和死亡率。通过这次汶川地震的回顾性分析能够对急诊科医生及医院急诊科管理者对应将来突发性自然灾害给予有用的启示。
Objective:This study aimed to provide an overview of morbidity and mortality among patients admitted the West China Hospital of the Medicine Faculty of Sichuan University,after the 2008 wenchuan earthquake.To evaluate the disaster response of the emergency services receiving patients after a major earthquake.Methods:Retrospective analysis of the medical records of 685 earthquake victims.A total of 685 patients with earthquake related injures and illness admitted to our hospital were included and divided into four main groups:(1)Crush syndrome(n=21),(2)Extremity fractures,pelvis and spine injuries(n=503),(3)vital organ injuries(n=134),(4)non-traumatic but earthquake related illness(n=27).Patients'demographic data,age,sex,diagnosis,dispositions,prognosis and mortality rates were reviewed.Results:A total of 685 patients with earthquake related injures and illness admitted to our hospital were included and divided into four main groups:The rate of mortality associated with the crush syndrome,0.14%(1/685),bone fracture,vital organ injury,and non-traumatic medical problems was 0%(0/685),0.875%(6/685),0.583%(4/685),respectively.72.59 Per cent of patients were hospitalized during the first three days after the earthquake.The overall mortality rate was 1.605%(11/685).Conclusion:In the first 24-48 hours after a major earthquake,hospital emergency departments are flooded with large numbers of patients.Among this patient load,those patients with crush syndrome or vital organ injuries are particularly at risk.Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality.Early diagnosis and proper treatment should be done to improve survival.It is hoped that this review of the challenges met after the Wenchuan earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disaster.
Objective:This study aimed to provide an overview of morbidity and mortality among patients admitted the West China Hospital of the Medicine Faculty of Sichuan University,after the 2008 wenchuan earthquake.To evaluate the disaster response of the emergency services receiving patients after a major earthquake.Methods:Retrospective analysis of the medical records of 685 earthquake victims.A total of 685 patients with earthquake related injures and illness admitted to our hospital were included and divided into four main groups:(1)Crush syndrome(n=21),(2)Extremity fractures,pelvis and spine injuries(n=503),(3)vital organ injuries(n=134),(4)non-traumatic but earthquake related illness(n=27).Patients'demographic data,age,sex,diagnosis,dispositions,prognosis and mortality rates were reviewed.Results:A total of 685 patients with earthquake related injures and illness admitted to our hospital were included and divided into four main groups:The rate of mortality associated with the crush syndrome,0.14%(1/685),bone fracture,vital organ injury,and non-traumatic medical problems was 0%(0/685),0.875%(6/685),0.583%(4/685),respectively.72.59 Per cent of patients were hospitalized during the first three days after the earthquake.The overall mortality rate was 1.605%(11/685).Conclusion:In the first 24-48 hours after a major earthquake,hospital emergency departments are flooded with large numbers of patients.Among this patient load,those patients with crush syndrome or vital organ injuries are particularly at risk.Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality.Early diagnosis and proper treatment should be done to improve survival.It is hoped that this review of the challenges met after the Wenchuan earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disaster.
引文
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[13]Martchenke J,Pointer JE.Hospital disaster operations duringthe1989LomaPrieta earth-quake[J].Prehosp Disaster Med,1994,9:146-53.
[2]张建平译.灾害医学[M].北京:人民军医出版社,1992:121-251.
[3]蒋国谦,王衍法.美军灾害救援方面的训练[M].北京:人民军医出版社,1995:1430-1431.
[4]李宗浩,金辉.论中国救援医学的创立及其在国家公共突发事件中的地位[J].中华医学杂志,2005,85:1519-1520.
[5]Mahoney LE,Reutershan TP.Catastrophic disasters and the design of disastermedical care systems[J].Ann Emerg Med,1987,16:1085-91.
[6]BuildingSeismic Safety Council.Seismic Con-siderations:Health care facilities[M].Washington DC:Federal Emergency Manage-ment Agency Publication,1990:FEMA150.
[7]Taviloglu K.17Agustos1999Marmara de-preminin ard-ndan felaketorganizasyonunda neredeyiz[J].Ulusal Cerrahi Dergisi,1999,6:333-42.
[8]Peak-Asa C,Kraus J F,Bourque LB,et al.Fatal and hospitalised injuriesresulting fromthe1994Northridge earthquake[J].Int J Epidemiol,1998,27:459-65.
[9]Zhi-Yong S.Medical support inthe Tang-shan earthquake:a reviewof themanagement of mass casualties and certain major injuries[J].J Trauma,1987,27:1130-4.
[10]Yankauer A.Preparing for disaster[J].AmJ Public Health,1986,76:233-5.
[11]Kuwagata Y,Oda J,Tanaka H,et al.Analysis of2702traumatized patientsin the1995Hanshin-Awaji earthquake[J].J Trauma,1997,43:427-32.
[12]Haynes BE,Freeman C,RubinJL,et al.Medical response to catastrophicevents:Cal-ifornia’s planningandthe Loma Prieta earth-quake[J].Ann Emerg Med,1992,21:368-74.
[13]Martchenke J,Pointer JE.Hospital disaster operations duringthe1989LomaPrieta earth-quake[J].Prehosp Disaster Med,1994,9:146-53.
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