汶川地震远程转运骨折伤员治疗分析

目的 通过对汶川地震转运伤员中需要骨科手术的55例骨折伤员进行安置与治疗,探讨重大灾害后远程转运骨折伤员的救治方法.方法 了解接诊医院的组织及医疗情况,分析伤员的一般情况,观察接诊医院治疗前后伤员的一般状态和治疗效果.结果 94.6%的伤员对医院的接待和病房布置非常满意,5.4%的伤员表示满意.所有伤员术后未出现明显并发症.54名伤员入院时抑郁、焦虑测试得分分别为(14.35±3.82)、(22.69±4.12)分,8名未手术伤员得分分别为(17.71±1.26)、(19.45±1.11)分,46名手术伤员术后1周得分分别为(21.74±4.98)、(16.02±3.33)分.结论 对于因重大灾害而远程转运来的骨折伤员,在积极行手术治疗恢复伤残肢体功能的同时,通过温馨的医疗生活环境和充满爱心的生活氛围来改善伤员的不良心理,更有利于伤员生理功能和心理健康的恢复.     

汶川地震伤员中股骨颈骨折的初步临床分析

目的 分析汶川地震后股骨颈骨折类型及特点.方法 收集因地震所致股骨颈骨折15例,行X线片、CT三维重建.将这15例按年龄、性别、发病率、骨折类型、有无其他部位骨折进行分析比较.结果 15例中男性明显高于女性(P相似文献   

汶川地震后送伤员的伤情调查分析

目的：调查分析汶川地震后送伤员的伤情。方法：对汶川地震后2周转来长海医院的34例地震伤员伤情进行调查，重点对伤员伤情、分类、救治方法进行分析。结果：受伤现场伤员急救、分类与转送，对合并软组织损伤的骨折伤员选择性应用外固定支架、积极修复软组织损伤，辅以积极的心理评估与干预，能有效地提高地震伤治愈率，减少并发症的发生。结论：总结汶川地震后送伤员的伤情特点与救治经验，为地震伤员的救治提供了初步依据和方法。     

汶川地震中脊柱骨折伤员的救治体会

[目的]分析汶川地震后脊柱骨折伤员的临床特点及救治经验.[方法]分析整理本科94例地震脊柱骨折伤员的临床资料,包括一般情况、受伤机制、合并伤情况及救治措施.[结果]在所有脊柱骨折伤员中,男性伤员的发病率明显高于女性伤员,21～60岁年龄段为脊柱骨折高发年龄段.同时,脊柱骨折的合并伤有54例,占57.4%.脊柱骨折分型显示屈曲压缩性骨折及爆裂型骨折共89例,占94.7%.[结论]地震伤脊柱骨折的伤员数量较大,送达时间集中,损伤严重,合并伤多,因而,科学组织,合理分工,可以在短时间内完成大批伤员的及时治疗.     

汶川地震骨科伤员伤情分析

目的 探讨地震骨科伤员伤情特点.方法 对2008年5月12日至2008年6月15日收治的1410例汶川地震骨科伤员的基本情况和总体救治情况进行回顾性分析.结果 1410例骨科伤员平均年龄48岁.受伤类别分别为钝器伤(744例,52.7%)、挤压/掩埋伤(379例,26.9%)、跌倒/坠落伤(287例,20.4%);骨折伤员1317例,单纯四肢软组织损伤者93例;261例伤员伴有其他伤病,其中截瘫伤员45例;挤压综合征伤员66例、气性坏疽伤员25例、急性肾功能衰竭伤员76例、多器官功能哀竭伤员26例.共施手术912例次,其中骨折固定术402例,扩创术224例次,清创缝合术152例次,截肢术85例,植皮术29例次,关节脱位手法复位术8例次,皮瓣转移术5例次,神经肌腱修复术4例次,关节镜手术2例次,人工关节置换术1例.66例挤压综合征伤员中,有49例接受持续肾脏替代治疗,其中出现创面知名动脉大出血9例次,进行主干血管栓塞治疗20支.1410例骨科伤员中,因多器官功能衰竭死亡1例.结论 老年伤员较多、伴发伤病多、开放性骨折伤口污染严重、挤压综合征伤员创而处理难度大、截瘫伤员较少、截肢伤员较多,是汶川地震骨科伤员的伤情特点.     

汶川地震伤员的紧急救治

2008年5月12日汶川地震发生30h后，海军总医院抗震救灾第一医疗队抵达灾区绵阳。截止7月4日，抢救重伤员37人次，开展各类手术125台次，诊治灾民12025人次，先后4次向重庆、昆明、广州、德阳等地远距离转运伤员583名。从战伤救治的角度看，我们经历了全部三级救治过程。在最初的紧急救治基本结束后，对其中的体会和经验进行小结。     

地震伤员麻醉——雅安芦山地震与汶川地震比较

目的 比较雅安芦山地震（Ya＆#39;an Lushan-earthquake,YLE）与汶川地震（Wenchuan-earthquake,WCE）伤员的麻醉特点,为提高地震救援麻醉水平提供经验. 方法 收集四川大学华西医院麻醉记录完整的YLE和WCE手术伤员相关资料,对比分析手术类型、患者病情、麻醉方法和术中及术后并发症等. 结果 YLE和WCE伤员手术量分别为225例和875例,手术类型以骨折切开复位内固定术为主（YLE 65.3％,WCE 41.7％）,且WCE伤员截肢术远高于YLE伤员（11.8％ vs1.8％）.YLE伤员美国麻醉医师协会（ASA）分级Ⅰ级所占比例明显低于WCE伤员（4.4％ vs 23.2％）,而Ⅳ级伤员所占比例明显高于WCE伤员（8.0％vs 1.4％）.地震伤员麻醉以全身麻醉为主（YLE 92.9％,WCE 70.5％）,YLE伤员椎管内麻醉所占比例更低（0.8％ vs 13.2％）.地震伤员较常见的并发症是低血压（YLE中28例,WCE中73例）、低氧血症（YLE中1例,WCE中42例）和返流误吸（YLE中0例,WCE中13例）. 结论 地震伤员手术以骨科手术为主,选择全身麻醉下手术较多,抢救过程中应加强低血压、低氧血症和返流误吸的防治.     

汶川地震老年伤员的治疗对策

目的：探讨汶川地震伤后送老年伤员的治疗对策。方法：回顾性分析地震后我院收治的14例老年伤员的伤情特点与救治方法。结果：经过4—8周的处理，14例老年伤员均获得有效治疗。所有伤员预后良好，无麻醉及手术并发症，均无下肢深静脉血栓形成、坠积性肺炎、肺栓塞、褥疮、脑卒中等并发症，出院时合并的内科疾患得到有效控制，心理状况良好，营养状况明显好转。结论：对老年伤员的伤情与全身状态评估，小组方式的治疗护理与康复，积极营养支持，根据伤情积极对症处理，辅以必要的心理干预，是提高老年地震伤员疗效的关键。     

汶川地震1070例伤员救治报告

目的 总结分析地震伤员的临床特点及救治经验.方法 分析整理2008年5月12日至30日收治的1070例地震伤员的临床资料,包括一般情况、伤情及治疗措施.结果 1070例伤员中,开放性损伤412例(38.5%),闭合性损伤658例(61.5%).单纯四肢躯干损伤557例(52.1%);单纯胸腔、腹腔、头颅损伤248例(23.2%);多发伤232例(21.7%).据ISS评分,轻度损伤372例(34.8%)、中度损伤183例(17.1%)、重度损伤480例(44.9%)、极重度损伤35例(3.3%).并发休克25例(2.3%),四肢筋膜间隙综合征25例(2.3%),挤压综合征并急性肾功能衰竭8例(0.75%),气性坏疽1例.本组共截肢23例26肢,截肢率2.1%.结论 地震伤员的迅速转运、早期明确诊断与及时手术治疗可降低死亡率、致残率.     

玉树地震骨折伤员的伤情分析

目的 分析玉树地震所致骨折伤员的伤情特点,为合理调配、使用医疗资源,更好实施地震灾区的医疗救援提供参考. 方法 对2010年4月14至21日收治的582例玉树地震骨折伤员的临床资料进行整理,分析性别、年龄、民族构成,伤情分布,以及骨折特点(骨折部位、骨折类型、合并伤)与性别和年龄的关系. 结果 582例骨折伤员中男性占48.3％ (281/582),女性占51.7％ (301/582).不同年龄段所占比率大小依次为成人(81.6％,475/582)、老年(12.4％、72/582)、儿童(5.8％,34/582)、婴儿(0.1％,7/582).骨折伤员中85.1％ (495/582)为藏族、汉族其次(12.0％,70/582).最常见的是下肢骨折(26.3％,153/582),其次是骨盆、髋臼骨折(21.6％,126/582),最少见的是手外伤(5.0％,29/582).骨盆、髋臼骨折伤员中女性例数多于男性,差异有统计学意义(p=0.001);而其他骨折部位、骨折类型、合并伤的男女例数差异均无统计学意义(P＞0.05).骨折部位、骨折类型、合并伤在不同年龄段分布差异均无统计学意义(p＞0.05). 结论 玉树地震骨折伤员中成年人占绝对多数,男女比率相当;骨折特点与伤员的年龄和性别无关系;地区特殊的房屋结构决定了开放骨折和合并挤压综合征的伤员比率相对低.     

Treatment for 332 cases of lower leg fracture in ＂5.12＂ Wenchuan earthquake

Objective： To retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital. Methods： From May 12, 2008 to June 15, 2008, 332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital. The data on trauma condition and clinical treatment were collected and analyzed. Results： Among the 332 cases of lower leg fracture, there were 179 eases of open fracture, accounting for 53.9%, in which 91% belonged to Gustilo Ⅱ or Ⅲ injury with serious pollution. Many patients had posttraumatic complications, vascular and nerve injury, wound infection or osteofascial compartment syndrome. After medical treatment, blood vessels were reconnected, wound surface was repaired and wound infection was under control. Conclusion： For the patients with lower leg fracture in earthquake, we followed the principle of ＂complete debridement - restoring the continuity of bone bracket - timely recovering blood supply of limbs and repairing nerve damage - repair the wound surface at stage Ⅰ or Ⅱ ＂ so as to reduce the incidence of amputation and infection.     

"5·12"汶川地震华西医院收治患者上肢伤情分析

[目的]探讨地震上肢伤员的伤情及救治情况.[方法]收集地震期间本院收治 236例上肢患者的基本情况,分析上肢患者的受伤机制、临床表现及处理和预后等情况.[结果]236例上肢患者中骨折208例378例次,其中锁骨骨折35例次,肩胛骨骨折31例次,肱骨骨折113例次,尺骨骨折46例次,桡骨骨折87例次,腕掌指骨骨折66例次.开放性骨折64例次.行清创缝合(含扩创)50例次,骨折复位内固定60例次,外固定支架7例次,截肢(含残端修整)19例次,神经血管修复术8例次,保守治疗(石膏托或卧床等)113例次,仅1例病人因高血钾合并颅脑腹部脏器损伤死亡.[结论]分析本次地震中上肢伤的受伤机制、部位等以及伤后救援、治疗、预后等情况,为以后地震及类似情况上肢伤的救治提供参考.     

芦山地震中骨盆骨折的特点及救治措施

目的 探讨芦山地震中骨盆骨折伤员的伤情特点及救治措施. 方法 2013年4月20日至5月3日共收治23例地震伤所致骨盆骨折患者,男12例,女11例;年龄24 ～ 81岁,平均48.9岁.致伤原因:重物压砸伤10例,高处坠落伤8例,摔伤5例.骨盆骨折按Tile分型:A型10例,B型6例,C型7例.合并伤:失血性休克4例,男性尿道损伤l例,胸部损伤5例,颅脑损伤2例,其他部位骨折16例.分析此23例患者的伤情特点及治疗方式选择. 结果 5例摔伤患者骨折均为A型,平均年龄为74.7岁.8例高处坠落伤患者骨折Tile分型:A型2例,B型3例,C型3例;平均年龄为36.4岁.10例重物压砸伤患者骨折Tile分型:A型3例,B型3例,C型4型;平均年龄为51.3岁.10例TileA型骨折患者均行保守治疗.6例Tile B型骨折患者中,3例行保守治疗,3例采用手术治疗:2例经导航引导下行微创固定,l例经Stoppa入路行切开复位内固定.7例Tile C型骨折患者均采用手术治疗:4例经导航引导下行微创固定,1例经髂窝入路联合Stoppa入路行切开复位内固定,2例经髂窝入路联合髂腹股沟入路行切开复位内固定. 结论 地震中骨盆骨折的受伤机制、骨折类型、合并伤及治疗均有其自身特点,应根据不同的骨折特点结合医疗资源采取个体化的救治措施.     

Secondary definitive surgery for multiple injuries from Wenchuan earthquake in China

Objective: To investigate the opportune time of sec-ondary definitive surgery for patients with multiple injuries from earthquakes based on the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and the principles of damage control.Methods: Twenty-one patients with critical earthq-ake injuries were treated with damage control strategies, fol-lowed by medical support and surgical intervention to re-store their physical potential in the intensive care unit (ICU). Successive APACHE Ⅱ scoring was adopted to evaluate the patients' physiological status, and then, internal fixa-tion of fractures and other definitive operations were performed.Results: All the patients were effectively treated with few complications, low deformity rate and no death.Conclusions: Appropriate evaluation of patients' physi-ological potential, right decision on surgical time and proper operative method can reduce the rates of complications, disability and death for patients with critical earthquake injuries.     

The epidemiological analyses of trauma patients in Chongqing teaching hospitals following the Wenchuan earthquake

Background

Well-equipped comprehensive hospitals may provide better emergency and patient services for the recovery of injured patients from the earthquake zone. This study aimed to provide an overview of injuries among the patients admitted to the six teaching hospitals in Chongqing, China, after the 2008 Wenchuan earthquake.

Materials and methods

The medical records of 533 earthquake victims who were treated and followed-up by the six hospitals were analysed retrospectively. Patients’ demographic data, diagnosis, microbiological assessment and dispositions were reviewed.

Results

Of the 533 patients, 45.0% patients had an Injury Severity Score (ISS) below 8, 41.1% had an ISS between 9 and 14 and 13.9% had an ISS above 15. The patients were classified based on their fracture sites as follows: head and neck (7.9%), face (1.3%), chest (21.4%), abdomen and pelvis (15.2%), limb and pelvis (58.9%) and body surface (38.5%). Of the 533 patients, 41.6% had a single fracture site, 32.1% had two combined fracture sites and 26.3% had more than three combined fracture sites, while 32 (6.0%) patients suffered from amputation, 3.9% suffered from crush syndrome and 52.7% underwent surgical operations at the hospitals. Seventy-nine (14.8%) patients suffered from infections, including 87.3% of pre-hospital infections. The results from bacterial culture and antibiotic susceptibility assays showed that the infectious bacteria mainly involved Escherichia coli, Staphylococcus aureus, Staphylococcus haemolyticus, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus and Bacillus aerogenes capsulatus. The sensitivity of various bacterial strains to antibiotics did not exhibit obvious changes, except that the previously multi-drug-resistant hospital bacteria were sensitive to antibiotics.

Conclusions

For emergency conditions after a catastrophe, comprehensive hospitals must be prepared to meet the massive numbers of severely injured patients. Trauma patients from delayed rescue and admission should be given broad-spectrum antibiotics, such as cephalosporin and macrolide antibiotics. The selection of antibiotics in the combination therapy, as described in this study, may greatly enhance the effectiveness of early specific treatments and prevent severe trauma complications in future natural disasters.     

二期计划再手术治疗地震多发伤

目的：探讨损伤控制策略（DC）治疗后地震多发伤病员的处理及APACHEⅡ评分判定计划再手术时机。方法：于2008年5月18日至6月30日对21例已实施DC的危重地震伤病员进行内科支持、外科干预，于重症监护室（ICU）恢复生理潜能，连续APACHEⅡ评分，判定伤病员生理状况及创伤程度，分期分阶段对骨与软组织伤实施关节内骨折的切开复位内固定、更改外固定支架为坚强的内固定方式、椎体爆裂骨折的内固定手术以及软组织重建等确定性手术。结果：通过二期计划再手术策略对伤病员的确定性治疗，21例患者得到有效救治，并发症少，伤残率低，无死亡事件。结论：适时评估患者生理潜能、判定手术时机、正确的选择手术方式可减少此类伤病员的并发症、伤残率及病死率．     

汶川地震肢体创伤后方医院处理原则与要点

目的 总结地震伤后3周肢体创伤转送后方医院时的伤情特点与处理原则.方法 对从四川汶川地震灾区医院转送的33例骨科创伤伤员的救治工作进行同顾性分析.结果 地震肢体创伤3周后的处理原则与要点有:[1]正确处理伤口,尽早闭合创面;[2]运用综合措施,合理处理骨折;[3]特殊情况伤情须行个体化处理;[4]全面检查,防止脊柱损伤漏诊;[5]重视肢体术后的早期功能锻炼.结论 地震肢体创伤3周后伤口大多有不同程度的感染、骨折多未处理、脊柱损伤漏诊较多,应制定出个体化的处理措施,做好地震肢体创伤的二期治疗工作.     

Management of limb fractures in a teaching hospital: comparison between Wenchuan and Yushu earthquakes

Objective: To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods: We retrospectively investigated 944 patients sustaining limbfractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH) of Sichuan University. Results: In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED) 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals outside the Sichuan Province. In Yushu earthquake, the maximum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0%) open limb fractures, including 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower (6/61, 9.8%). The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7%) was much higher than that inYushu earthquake (5/53, 3.8%). In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion: Provision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system, prediction of the injury types and number of injuries, and confirmation of participating hospitals’ exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.     

对地震灾害中下肢严重损伤进行保肢治疗的若干思考

作出保肢还是截肢的决定仍然是一个高度个体化的方案,需权衡肢体和生命的关系,综合考虑肢体损伤程度、全身情况、伤员心理、年龄、潜在的疾病和职业要求以及医疗技术、社会经济等多方面的因素.在抗震救灾的特殊环境下,伤员转运至后方将失去宝贵的治疗"时间窗",因而进行保肢尝试的危险性极大,不得不早期施行截肢术以保全生命.而在具备医疗技术与设备的前方医疗机构,应尽量保全伤员肢体.     

汶川地震伤致脂肪栓塞综合征的早期诊断和治疗分析

目的 探讨分析汶川地震伤致脂肪栓寨综合征(FES)的早期诊断标准和治疗措施.方法 对在2008年5月12日发生的汶川大地震期间收治的13例脂肪栓塞综合征患者,行动态血气分析及血常规榆查,结合临床表现,早期诊断,并使用氢化可的松、低分子右旋糖酐、丹参,同时强调支持呼吸功能,纠正低氧血症等进行早期治疗.结果 13例患者之中12例抢救成功(92.30%);1例爆发性FES死于继发出血性肺炎及呼吸衰竭.结论 早期诊断及快速准确的处理是治疗FES的关键.呼吸功能支持,纠正低氧血症和早期大剂量激素等综合疗法足治疗FES的有效措施.