汶川大地震送院患儿的伤情特点及专科救治流程分析  

Reflection on the triage of injured children after the Wen-ehuan earthquake

作　　者：向波[1] 刘菊先[1] 李园[1] 黄鲁刚[1] 刘利君[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中华小儿外科杂志》2009年第10期684-687,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结救治“汶川大地震”儿童伤员的经验。方法评估截止2008年5月31日住院治疗的119例地震患儿伤情特点，分析各阶段专科救治流程的影响。结果①83%（98／119）患儿送院时间超过震后48h，学龄期患儿（93／119）明显多于学龄前期（26／119）；②89％（106／119）为骨关节创伤患儿，其中14％（17／119）伴有严重骨筋膜室综合征；其余11％（13／119）为胸部伤（4／119）、腹部伤（5／119）、广泛软组织挤压伤（4／119）等；65％（78／119）伴有震后心理障碍；③第一阶段（震后24h），按照常规急救原则，急诊科救治时间为（1．3±0．2）h，儿外亚专业组前救治时间为（3．5±0．4）h，术前等待时间为（7．5±0．3）h；第二阶段（震后24～72h），调整专科救治流程，急诊科救治时间缩短为（0．5±0．1）h，亚专业组前救治时间为（0．5±0．1）h，术前等待时间为（4．5±0．3）h；第三阶段（震后4～19d）增加气性坏疽筛查流程。第二、三阶段救治效率明显提高（P〈0．05）。结论汶川大地震送院患儿以骨关节创伤为主；儿外专科医师主导的“专病专治”救治模式明显提高了急救效率。Objective To report the experience in resuscitating injured children at the Wen- Chuan earthquake in Department of Paediatric Surgery of Huaxi hospital affiliated to Sichuan University. Methods We reviewed the triage and management of 119 admitted children with severe injuries. Results The majority of the victims were school-aged, eighty-three percent reached our hospital after the 48-hour critical period; the majority （106/119, 89%） of the injuries was orthopaedic trauma with lower limb fracture, intra-abdominal （5/119, 4. 2%） and thoracic （4/119, 3. 36%） injuries and extensive soft tissue crush injury （4/119, 3. 36%） were relatively uncommon; and sixty five percent （78/119） had significant psychological sequelae. Phase 1 （24 hours after the quake） ： The triage waiting time was 1.3 ± 0. 2 h; the waiting time for pediatric sub-specialty consultation was 3. 5 ± 0. 4 h; there was an additional 7. 5 ± 0. 3 h delay before operations. Phase 2 （24-72 after the quake） .. Senior pediatric surgeons carried out the triage and consultation. The consultation waiting time was reduced to 0. 5 ±0. I h; the waiting time for operation was reduced to 4. 5 ± 0. 3 h. Phase 3 （4-19 days after the earthquake） ： Gas gangrene screening was implemented. Compared to that of Phase 1, the waiting times for both consultation and operation of phase 2 and 3 were significantly shortened, P〈0. 05. Conclusions 1） The predominance of orthopaedic injuries in earthquake indicates the focus of medical resource allocation in natural disaster in the future. 2） Triage managed by pediatric surgeons in the reception area greatly reduced the delay of treatment.

关 键 词：地震 医院 专科 

分 类 号：R686[医药卫生—骨科学]