浅谈汶川地震腹部损伤

The character, classification, scoring, diagnosis and treatment of abdominal injuries after the Wenchuan earthquake were analyzed based on the data collected in Chengdu and Dujiangyan. Most of the abdominal injuries were closed injury, and complicated with injuries in other organs. All the injured persons were classified into different groups according to the degree of injuries, so as to determine the optimal sequence of treatment. Open abdominal injuries were comparatively easy to diagnose, while the diagnosis of closed abdominal injuries was difficult and consisted of preoperative diagnosis and intraoperatire exploration. The principle of damage control surgery should be well followed in rescuing the persons with severe abdominal injuries.     

汶川地震腹部损伤的诊治

After analyzing the clinical data of 5 injured persons diagnosed with delayed spleen or liver rupture combined with fractures after the Wenchuan earthquake, we found that the abdominal injuries in earthquake were rare but usually very severe. Since almost all the injured persons had multiple injuries, mortality was extremely high. First aid service should be applied in the first 6 to 8 hours. Orderly physical examination and peritoneocentesis in multiple sites are in favor of diagnosis. Reducing the missed diagnosis rate of abdominal injuries is important in raising the rate of successful treatment. Therapy for earthquake injuries should be focused on the most deadly injuries after a thorough examination, besides this, precise employment of control surgery, swift transportation of the injured persons, and prevention and dealing with complications are also important.     

汶川地震腹部损伤的救治体会与思考

At 2:28 p.m. local time on 12 May, 2008, the Wenchuan earthquake struck with a magnitude of 8.0. After the earthquake, 1364 injured persons, including 732 women and 632 men, were admitted to Deyang People's Hospital. The ages of the injured persons ranged from 0.2 years to 102 years (mean, 42.5 years). Of all injured persons, 4.65% aged under 7 years, 13.84% between 7 and 18 years, 39.57% between 19 and 45 years, 24.48% between 46 and 65 years, and 17.46% above 65 years. A total of 1713 injuries were found in all the injured persons, and the predominant injuries were found in limbs, body surface, head and chest. The incidence of the multiple injuries was 23.64%. Eighteen persons with abdominal injuries received operation. Prompt, accurate and systematic evaluation of the injury is necessary in raising the rescue efficiency. Treating the injured persons according to a classification optimizes the usage of the limited medical resources. Early definitive operation is crucial in rescuing the lives of the injured persons, and the treatment should be applied within 24 hours after the earthquake, then the emphasis of the rescue work should shift to helping orthopedic surgeons with operation and debridement.     

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.     

四川大学华西医院在汶川地震和芦山地震中收治的伤员伤情对比分析

摘要：目的了解不同震级的地震对地震医学救援中三甲医院所收治伤员伤情的差异,为地震医学救援决策的制定和医疗资源的配置提供参考。方法回顾性分析2008年“5·12”汶川地震和“4·20”芦山地震中四川大学华西医院收治的住院地震伤员的临床资料,比较两次地震伤员的性别、年龄、来院时间、受伤机制、伤情分类和治疗转归。结果共纳入汶川地震伤员1856例,其中男974例、女882例,年龄（45．8±22．7）岁;芦山地震伤员316例,其中男174例、女142例,年龄（43．0±23．1）岁。两次地震伤员的性别与年龄差异均无统计学意义（P〉0．05）。但汶川地震伤员来院的高峰明显后移,持续时间明显延长;汶川地震中,重物砸伤和掩埋伤所占比例明显高于芦山地震,伤情也明显较重,住院死亡率明显较高;与汶川地震伤员相比,芦山地震伤员中胸外、颅脑外伤的患者比例明显较高,四肢外伤的比例有所下降。结论（1）地震时地质物理破坏程度将会对地震伤员的受伤机制产生明显影响,高震级的地震,重物砸伤和掩埋伤的患者比例将会明显增高,相应的,高处坠落伤和跌伤的患者比例会下降,导致患者病情更重,死亡率更高。（2）地震时地质物理破坏程度将会明显影响到地震伤员的后送,越高震级的地震后,伤员来院的高峰会越往后推迟,甚至无明显的高峰出现,但病员流的时间会明显延长,对医院工作的影响较持久。相应的,在伤员后送影响不大的较低震级地震中,伤员来院的高峰会明显提前,病员流的持续时间不会太长,对医院日常工作的影响持续较短。（3）伤员后送的障碍将会影响到患者的及时处理,从而影响到胸外、颅脑外伤患者的预后,最后影响到到院伤员胸外和颅脑外伤的构成比例。与震级较高的地震相比,在较低震级的地震后,应更加加强胸外科、神经外科的救治力量,以保证对此类伤员的及时救治。     

地震灾害所致腹部损伤的救治

2008年5月12日14时28分汶川大地震,给灾区人民群众生命财产造成巨大损失.我院作为距地震灾区最近的大型军队医院,短时间内接受了大量从现场直接后送以及经前线医疗队初步处理而转来的伤员,震后1周时间内,医院共接诊地震伤员2320例,收治入院1760例[1],其中腹部损伤收治46例,行手术探查25例,分别为胃穿孔行修补术1例,小肠穿孔行穿孔修补或部分小肠切除7例,肝破裂行修补术4例,脾破裂行切除术5例,肠系膜血管损伤行部分肠切除1例,小肠离断伤行部分肠切除2例,肝脾联合损伤行肝修补脾切除2例,延迟性小肠溃疡伴出血行部分肠切除3例.     

汶川、玉树、芦山地震伤员伤情分析与救治比较

目的分析比较汶川、玉树、芦山地震伤员的伤情特点及治疗方法,总结经验,为应急救治提供参考。方法首先对后送的406例伤员进行损伤分类,成立以骨科为主的医疗小组,请专家会诊手术,优先处理急、危重伤员,制定综合治疗措施。结果所有救治的伤员均未死亡,汶川地震中10例(11肢)行截肢术,3例截瘫,无严重并发症发生。结论汶川、玉树、芦山地震因地震强度、地域差异及发生时间的不同导致伤情不同,但治疗策略相同,根据伤员自身特点制定其具体治疗方案,疗效满意。     

震区后方医院快速分检处理腹部损伤

The main causes of early mortality after the earthquake are traumatic shock, hemorrhage and dehydration, and the ratios of shock and hemorrhage are high in patients with abdominal injuries. Prompt triage is very important to persons with abdominal injuries who were rescued in 48 hours after the earthquake. Primary triage should be carried out in the rescue field, and then followed by the secondary triage in the hospital. We improved the efficiency and accuracy of triage by following the principle of "5 steps, 3 categories and 1 indication". Nineteen persons with identified abdominal injuries and unstable vital signs received operation. The false positive rate was 5% (1/19), and the successful rate of the operation was 95% (18/19). During the process of rescue, the lives of the injured persons should be put in the first place. The operation should be performed under the principle of simpleness, rapidity and safeness.     

汶川地震陇南灾区伤情调查与分析

目的：调查分析汶川地震甘肃陇南伤情情况，进一步讨论如何采取措施应对突发灾害。方法：采用问卷调查、访谈等方法，对甘肃陇南地震受灾人口进行抽样调查，重点对伤员伤情、致伤原因、救治方法进行统计学分析。结果：在此次地震伤抽样调查中共有1652例，死亡16例，四肢骨折患者750例，占45．4％，精神、神经方面40例，占2．4％。通过有组织的及时救助伤员，减少了并发症的发生，降低了死亡率。结论：加强地震伤的预防与救治，从而有效地减少致死率和致残率。     

汶川地震陇南灾区份隋调查与分析

目的：调查分析汶川地震甘肃陇南伤情情况，进一步讨论如何采取措施应对突发灾害。方法：采用问卷调查、访谈等方法，对甘肃陇南地震受灾人口进行抽样调查，重点对伤员伤情、致伤原因、救治方法进行统计学分析。结果：在此次地震伤抽样调查中共有1652例，死亡16例，四肢骨折患者750例，占45．4％，精神、神经方面40例，占2．4％。通过有组织的及时救助伤员，减少了并发症的发生，降低了死亡率。结论：加强地震伤的预防与救治，从而有效地减少致死率和致残率。     

汶川地震灾害远期康复现状引发的思考

总结汶川地震后远期康复现状,指出灾后康复的长期性并分析其原因,回顾国外灾害护理的发展经验,提出我国护理人员可借鉴国外先进的康复方案及灾害护理经验,并结合中国国情,促进受灾者的康复,发展灾害护理学。     

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。     

A contrast study of the traumatic condition between the wounded in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake

Purpose: 5.12 Wenchuan earthquake and 4.25 Nepal earthquake are of the similar magnitude, but theclimate and geographic environment are totally different. Our team carried out medical rescue in bothdisasters, so we would like to compare the different traumatic conditions of the wounded in twoearthquakes.Methods: The clinical data of the wounded respectively in 5.12 Wenchuan earthquake and 4.25 Nepalearthquake rescued by Chengdu Military General Hospital were retrospectively analyzed. Then a contrast study between the wounded was conducted in terms of age, sex, injury mechanisms, traumatic conditions, complications and prognosis.Results: Three days after 5.12 Wenchuan earthquake, 465 cases of the wounded were hospitalized inChengdu Military General Hospital, including 245 males (52.7%) and 220 females (47.3%) with theaverage age of (47.6 ± 22.7) years. Our team carried out humanitarian relief in Katmandu after 4.25 Nepal earthquake. Three days after this disaster, 71 cases were treated in our field hospital, including 37 males (52.1%) and 34 females (47.9%) with the mean age of (44.8±22.9) years. There was no obvious difference in sex and mean age between two groups, but the age distribution was a little different: there were more wounded people at the age over 60 years in 4.25 Nepal earthquake (p<0.01) while more wounded people at the age between 21 and 60 years in 5.12 Wenchuan earthquake (p<0.05). The main cause of injury in both disasters was bruise by heavy drops but 5.12 Wenchuan earthquake had a higher rate of bruise injury and crush injury (p<0.05) while 4.25 Nepal earthquake had a higher rate of falling injury (p<0.01). Limb fracture was the most common injury type in both disasters. However, compared with 5.12 Wenchuan earthquake, 4.25 Nepal earthquake has a much higher incidence of limb fractures (p<0.01), lung infection (p<0.01) and malnutrition (p<0.05), but a lower incidence of thoracic injury (p<0.05) and multiple injury (p<0.05). The other complications and death rate showed no significant differences.Conclusion: Major earthquakes of the similar magnitude can cause different injury mechanisms, traumatic conditions and complications in the wounded under different climate and geographic environment. When an earthquake occurs in a poor traffic area of high altitude and large temperature difference, early medical rescue, injury control and wounded evacuation as well as sufficient warmth retention and food supply are of vital significance.     

5·12汶川地震挤压伤患者高钾血症的救治及相关因素分析

[目的]回顾性分析5·12汶川地震挤压伤患者高钾血症的救治情况、预后及相关危险因素,更好地指导类似灾害事件的救治工作.[方法]地震发生后1周内,本院收治挤压伤患者66例,根据患者伤情分3组:(1)单纯挤压伤,无挤压综合征;(2)挤压综合征,血钾浓度正常;(3)挤压综合征,高钾血症.针对性给予补液、利尿及碱化尿液、纠正电解质紊乱、血液透析、防治感染及支持治疗.探讨挤压时间、挤压部位与高钾血症发生的关系.[结果]66例患者中49例发生了挤压综合征,39例患者合并高钾血症.随着受累肢体的增加和受压时间的延长,患者发生挤压综合征、高钾血症的风险显著上升.经过积极有效的治疗,全部高钾血症患者均在入院后1 d内得以控制,3 d内完全纠正高钾.截止至2008年11月28日,66例患者无1例死亡.[结论]灾害现场救治时,通过患者挤压时间及受累部位可以迅速判断患者伤情,预测挤压综合征、高钾血症的发生,尽早采取措施.对于挤压综合征、高钾血症的治疗,应及时快速补液、利尿及碱化尿液、血液透析,适时骨筋膜室切开减压、截肢或关节离断,遵循抢救生命、挽留肢体、促进康复的原则.     

腹腔镜在闭合性腹部损伤中的应用

目的:探讨腹腔镜用于诊治闭合性腹部损伤患者的价值。方法:回顾分析我院2004年1月至2006年12月收治的28例闭合性腹部损伤患者的临床资料。结果:28例患者经腹腔镜探查均明确诊断,其中23例经腹腔镜完成探查及治疗,5例中转开腹。全部病例术后未发生并发症。结论:腹腔镜用于诊断和治疗闭合性腹部损伤具有独特的优势,既可明确诊断又能同时治疗,降低了阴性剖腹探查率。     

Non-operative management for abdominal solidorgan injuries: A literature review

The philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%–90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.