目的:了解地震住院伤员的身心状态,进行针对性心理干预。方法:采用方便抽样,应用作者根据应激理论设计的应激身心反应调查表［1］,通过对地震伤员的观察和访谈,对在2008年5月12日至5月30日在四川大学华西医院住院的371名地震伤员进行身心状态的评估,并进行有针对性的心理干预。结果:①地震伤员灾后急性期心身应激反应较严重,其中出现频率最多的症状是睡眠困难,对突然的噪音或声音感到紧张害怕,心情沮丧,感到身体紧张,心情难以平静;②不同性别地震伤员身心反应存在一定差异,女性反应症状重于男性;③年龄在小于12岁、12～18岁和41～50岁年龄段地震伤员的身心反应与其他年龄段地震伤员的身心反应存在差异;④地震伤员的身心反应与其性别、年龄、文化、个人受伤情况有关。结论:地震伤员灾后身心反应严重,急性期给予针对性心理干预十分重要。
摘要:目的:探讨地震伤员中膝关节损伤的机制、类型及处理方法。 方法:对我院收入住院的2728例 5·12汶川特大地震伤员伤情特点进行分析,筛选出有膝关节损伤的病例进行分析。 结果: 膝关节损伤前三位分别是髌骨骨折(42.15%)、胫骨平台骨折(21.05%)、股骨髁骨折(13.16%),这与人们在地震时奔跑摔伤以及被房屋倒塌砸伤有很大关系。结论:地震后膝关节损伤其发病率、受伤机制、损伤类型、合并伤情况及治疗处理均有其特点,总结这些特点和规律将对地震伤膝关节损伤患者的处理产生积极作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.
目的：研究四川汶川大地震骨折伤员的日常生活活动（ADL）能力受限的特点，为地震骨折伤员的康复治疗提供依据。方法：对因2008年5月12日四川汶川地震后1月仍在华西医院骨科病房诊治的36例骨折伤员，进行生活状况问卷，记录其早期并发症，根据Barthel指数评定不同性别和不同部位骨折伤员各项ADL能力，统计伤员各项ADL等级构成比，比较不同性别和不同部位骨折伤员总ADL评分。结果：本次地震骨折伤员以下肢骨折多见，其次是躯干骨折（主要是脊柱骨折），上肢骨折相对少见；且ADL下降明显，尤其是躯干骨折和下肢骨折伤员；而早期并发症以伤口感染为主。结论：地震骨折伤员ADL明显下降，加强ADL能力训练尤其重要，临床康复措施主要集中于下肢和脊柱骨折的康复；早期并发症的防治主要是预防伤口感染。
ObjectiveTo explore the possible association between early injury assessment indexes and the length of stay (LOS) in first-line hospitals, in order to help the hospitals take advantage of resource effectively and transfer victims reasonably during earthquakes. MethodWe retrospectively analyzed the medical information of 3 576 traumatic patients injured in the Wenchuan Earthquake who were transferred to 242 first-line medical institutes between 14:28, May 12th and 14:30, May 19th in 2008. Three kinds of 15 variables were extracted for the analysis, including gender, age, heart or lung disease, pre-hospital time, head injury, trunk injury, open injury, crush injury, asphyxia, body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, and Glasgow coma score. Multiple stepwise linear regression analysis was performed to identify the factors associated with LOS. ResultsThe multiple linear regression analysis showed that age as well as other six factors affected LOS significantly (P<0.05). The partial regression coefficients of age, pre-hospital time, head injury, trunk injury, crush injury, complication of cardiac or pulmonary disease, and Glasgow coma score were -0.062, 0.157, 3.703, 4.111, 12.602, 14.762 and -1.312, respectively. ConclusionsEarthquake trauma patients with older age, long pre-hospital time, head injury, trunk injury, heart or lung disease, crush injury, and lower Glasgow coma score are at increased risk for extended LOS.
Objective To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use. Method Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems. Result We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes. Conclusion Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.
Objective To investigate the recovery status of people wounded in the Wenchuan earthquake. Method Data were retrospectively collected from administrative documents in the Bureau of Medical Affairs, Sichuan Provincial Health Department. The severity of injury was assessed by Injury Severity Score (ISS). The data were recorded by EXCEL software and descriptive analysis was conducted. Results Our analysis results of rehabilitation treatment through Feb. 5, 2009 shows that 27,080 of the 28,008 patients had been treated and discharged, for a discharge rate of 97.8%. There were 928 patients still in hospitals at that time, including 55 cases of traumatic brain injury, 163 cases of paraplegia, 260 amputees, and 449 cases of severe spine, pelvis and other fractures. Some amputees needed to receive replacement of artificial limbs or stump dressing operation and rehabilitation; most patients who were installed internal fixation needed to removal and post-rehabilitation. Conclusions The effectiveness of rehabilitation is significant. Our work in the next stage should focus on (1) continuing to improve the establishment of province’s rehabilitation capabilities and increasing capital investment; (2) enhancing training for medical rehabilitation practitioners in order to improve operational standards and service capabilities; (3) developing the wounded rehabilitation standards in later stages, conducting follow-up and functional training in order to maximize recovery and return to society; (4) increasing employment opportunities for disabled persons.
Objective To explore the traumatic situation and transfer methods of the in-patients injured in Lushan Earthquake, and to provide evidence for treating injured mass in future. Methods The information of the patients injured in Lushan Earthquake who were admitted in Chengdu Military General Hospital were collected by “No. 1 Military Medical Project” hospital information system and a self-edited “Questionnaire for Hospitalized Patients Injured in 4.20 Lushan Earthquake”. Results A total of 65 patients were admitted in this hospital: 63 (96.92%) patients were injured in the main shock; 28 (43.08%) patients were injured by building collapse; 23 (35.38%) patients got injured due to falls or got bruised when escaping; and 14 (21.54%) patients were accidentally injured. Rescue methods: 32 (49.23%) patients were saved by themselves; 23 (35.38%) patients were mutually helped; 10 (15.38%) patients were rescued by local non-military rescue team; 34 (52.31%) patients were rescued by military rescue teams; and 26 (44.83%) patients were transferred by air transport. Conclusion In order to cope with emergencies and major disasters (e.g. earthquake) and to treat injured mass scientifically in the future, we should set up emergency wards scientifically and reasonably, carry out education on earthquake prevention and disaster mitigation widely, reinforce self-care and mutual aid in the stricken area, quickly send rescue and medical teams, and organize training for air transportation of patients.
目的：了解ICU病房地震伤员的功能障碍的特点，为临床康复治疗提供依据。方法：运动功能评定应用MMT方法；运用关节角度尺评定关节活动度（ROM）；利用被动关节活动法评定肌张力、痉挛评定选用改良的Ashworth分级法；坐位平衡和站位平衡采用平衡反应试验评定；日常生活活动（ADL）能力选用国际通用的Barthel指数量表评定。由我科研究生作为评定人员。结果：①ICU病房地震伤员以骨折患者为主,占70%，神经系统损伤占20%，挤压综合症和肺挫伤各占5%；②女性骨折比例高于男性，为11∶3；神经系统损伤没有多大差异；截肢和瘫痪的患者中，男性高于女性，比例分别为4∶1和3∶2；肺部感染以女性更为明显，为7∶1；③47.6%的地震伤员关节活动受限（评定21人），93.3%的肌力下降（评定15人），15.8%肌张力下降（评定19人），36.8%肌张力增高（评定19人），30.0%的坐位平衡下降（评定10人），96.4%站立平衡下降；④ADL能力100%受限（评定20人），其中洗澡、修饰、如厕、平地行走45 m、上下楼梯受限均为100%，95%地震伤员进食能力下降，90%穿衣能力受限，35%大便失禁，60%小便控制能力下降，多数使用导尿管，95%地震伤员床椅转移能力下降；⑤40%出现肺部感染。结论：关节活动度受限、肌力下降、肌张力异常、平衡功能障碍、ADL能力受限及肺部感染是ICU地震伤员主要功能障碍。早期康复介入、维持和改善关节活动度、肌力训练、减张和牵伸训练、平衡训练、呼吸训练、站立和行走训练及ADL能力训练应当作为康复治疗的基本原则和方法。
Objective To analyze retrospectively the overall situation of medical rescue in the First Affiliated Hospital of Guangxi Medical University after the Wenchuan earthquake, so as to provide references for the emergency preparation for the disaster of earthquake. Methods Analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the hospital. The software Microsoft EXCEL was used for data management, and SPSS 13.0 was used for statistical analysis. Results From May 22 to May 26, 91 cases from the disaster area had been treated in the hospital, of which 90 were from Mianyang and 1 from Chengdu. These patients included 44 males with a median age of 38 (27, 53) years old and 47 females with a median age of 51 (33, 62) years old. Most patients were sent to the hospital within the first 10 or 11 days after the earthquake, with 86.8% hospitalized after 10 days and 22.0% after 11 days. The number of outpatients reached its peak of 37.1% of all the outpatients (33 cases) within 34 days after the earthquake. The wounded were mainly admitted into the Department of Orthopaedics, with 34.81% of the patients having lower limb fracture, 18.26% having spine fracture, and 12.59% suffering pelvis fracture. Only 2 out of the 89 patients died. One death was due to 60% burning injury and 1 died of multiple catastrophic injuries. Conclusion Based on the data, it is important to develop an emergent plan for medical rescues after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, scientific field triage and the construction of information platforms.