“8·8”九寨沟地震伤员伤情特点分析和救治策略  

Injury characteristics and therapeutic strategy of patients injured in “8·8” Jiuzhaigou earthquake

作　　者：石波[1] 刘刚[1] 李琳[2] 唐诗添[1] 王军[1] 谢明锐 代小雨[3] 何健勇 张芸[5] 唐毅[5] 鲜于剑波[6] 王东[6] 何梅[6] 徐卫云[6] 宋中金[7] 马英[7] 黄富国[8] 宋跃明[8] SHI Bo;LIU Gang;LI Lin;TANG Shitian;WANG Jun;XIE Mingrui;DAI Xiaoyu;HE Jianyong;ZHANG Yun;TANG Yi;XlANYU Jianbo;WANG Dong;HE Mei;XUWeiyun;SONGZhongjin;MAYing;HUANG Fuguo;SONG Yueming(Department of Orthopedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;Department of Respiration, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;Department of Nephrology, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;Department of Rehabilitation, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R. China;Department of Psychological Medicine, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R. China;Department of President＇s Office, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;Department of Science and Education, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China)

机构地区：[1]绵阳市中心医院骨科,四川绵阳621000 [2]绵阳市中心医院呼吸科,四川绵阳621000 [3]绵阳市中心医院肾内科,四川绵阳621000 [4]绵阳市中心医院康复科,四川绵阳621000 [5]绵阳市中心医院心理医学科,四川绵阳621000 [6]绵阳市中心医院院长办公室,四川绵阳621000 [7]绵阳市中心医院科教科,四川绵阳621000 [8]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2018年第3期358-362,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：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。Objective To summarize the injury characteristics and therapeutic strategy of patients injured in＂8·8＂ Jiuzhaigou earthquake. Methods The 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 in37 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. Results Except 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 hospit

关 键 词：地震伤 流行病学 多学科综合治疗团队 

分 类 号：R642[医药卫生—外科学]