中国修复重建外科杂志

中国修复重建外科杂志

“8·8”九寨沟地震伤员伤情特点分析和救治策略

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目的总结“8·8”九寨沟地震伤员伤情特点和救治策略。方法回顾性总结“8·8”九寨沟地震转运至绵阳市中心医院的 48 例地震伤员临床资料。其中男 25 例,女 23 例;年龄 5~87 岁,平均 36 岁。受伤至入院时间 3~53 h,平均 30 h。地震伤员来自四川省内 22 例(45.8%),省外 25 例(52.1%),国外 1 例(2.1%)。主要为房屋垮塌或石头滚落造成的砸伤。地震伤员中单部位伤 37 例(77.1%),以四肢伤最多,高达 36 例(75.0%);多部位伤 11 例(22.9%)。开放性骨折 10 例(20.8%):其中 GustiloⅠ 型 1 例、Ⅱ 型 2 例、Ⅲa 型 3 例、Ⅲb 型 2 例、Ⅲc 型 2 例。37 例单部位伤员根据简明损伤定级标准(AIS)评分为 2~3 分;11 例多部位伤员根据损伤严重程度评分(ISS)系统评分为 8~22 分,平均 13.2 分。根据汉密尔顿焦虑量表(HAMA)评分,心理障碍患者 16 例(33.3%),其中 HAMA 评分≥29 分 8 例,21~28 分 4 例,14~20 分 3 例,7~13 分 1 例;16 例患者中 2 例有自杀倾向。结果48 例地震伤员中手术治疗 30 例[其中骨科手术治疗 28 例(93.3%)],非手术治疗 16 例,转院 2 例。手术内容涉及骨折内固定、软组织清创、骨折外固定、人工双极股骨头置换、颈内动脉海绵窦动静脉瘘栓塞、截肢。除 2 例转院伤员外,其余伤员中 21 例于入院后 2~12 d(平均 6.7 d)出院,25 例留院或转回当地医院康复治疗。16 例心理障碍伤员无因心理疾病导致不良后果。感染伤员 5 例,均发生于院外,经清创后痊愈。无死亡及院内感染病例。结论集中救治、专科管理、多学科协作团队以及院内感染和深静脉血栓的早期干预是成功救治地震伤员的关键。

ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation[28 patients (93.3%) for orthopaedic surgeries]and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.

关键词: 地震伤; 流行病学; 多学科综合治疗团队

Key words: Earthquake injury; epidemiology; multidisciplinary team

引用本文: 石波, 刘刚, 李琳, 唐诗添, 王军, 谢明锐, 代小雨, 何健勇, 张芸, 唐毅, 鲜于剑波, 王东, 何梅, 徐卫云, 宋中金, 马英, 黄富国, 宋跃明. “8·8”九寨沟地震伤员伤情特点分析和救治策略. 中国修复重建外科杂志, 2018, 32(3): 358-362. doi: 10.7507/1002-1892.201710077 复制

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