后方医院救治61例地震伤员分析

目的探讨后方医院诊治地震伤员时应掌握的要点。方法对2008年5月由灾区前线医院转送重庆急救中心救治的61例汶川地震伤员的病例资料进行回顾性分析。结果 26例(42.6%)早期漏诊颅脑、胸和腹部损伤,在转入1小时～4天内补充诊断;2例延迟性血气胸和2例腹内脏器延迟性破裂及时发现和处理。11例下肢严重挤压伤和挤压综合征避免了截肢;6例伤口采样培养有梭状芽胞杆菌生长但未发生气性坏疽。除2例遗留截瘫外,其余全部治愈。结论地震伤员的后方医院处理,重点为对初期抢救中的漏诊和治疗不足及时发现和补救;警惕胸腹脏器损伤的延迟性破裂;肢体挤压伤注意防治挤压综合征和气性坏疽,彻底切除坏死肌肉组织可最大限度地避免截肢。

Management of earthquake victims in rear hospital:an analysis of 61 cases

Objective To discuss the main task to deal with earthquake victims in the rear hospital.Methods The data of 61 earthquate victims transferred from the battlefront hospital to our hospital were reviewed.Results Missed diagnosis of cerebral,thoracic and abdominal injuries were detected in 26（42.6%） patients 1hour-4days after admission.Delayed hemopneumothorax and abdominal viscera rupture occurred respectively in two patients,and immediate treatment were given.In 11 patients sustaining severe crush injuries of lower limbs,amputation was avoided.Clostridium was found by culture of the sample picked from the wound,but gas gangrene wasn＇t occurred in 6 cases.All patients were cured,except paraplegia in 2 cases.Conclusion Special attention should be given to initially missed diagnosis of cerabral,thoracic,and abdominal injuries,as well deficient treatment.Delayed injury inside chest and abdomen requires managemet in time.Crush syndrome and gas gangrene should be prevented and amputation may be altered by thorough debridement of necrotic tissues in therapy of extremity crush injury.