目的:探讨磁共振血管造影(MRA)以及计算机断层扫描血管成像(CTA)对地震挤压伤下肢血管病变的临床价值。方法:对5·12汶川大地震中我院收治的已确诊为地震挤压伤致双下肢横纹肌溶解症3例患者进行双下肢MRA检查,并对严重挤压伤及下肢毁损,并行截肢的另三名患者进行术后CTA检查。对MRA图象双下肢动脉进行回顾性分析,总结MRA征象,同时总结截肢术后患者CTA表现及临床价值,并评价二者检查在挤压伤所至横纹肌溶解症的临床诊治中的作用。结果:3例未行截肢患者MRA双下肢主要动脉未见确切狭窄及闭塞征象,管腔内未见充盈缺损影。3例已行截肢患者可见残余肢体的明显肿胀,双侧髂血管以及部分截断肢体远端血管内见止血弹簧钢圈影像,部分截断肢体远端动脉分支变细。截断血管未见再通,周围无渗血改变。结论:MRA、CTA能直观显示双下肢动脉损伤及术后情况,在临床应用中各有优势和局限性。对二者的合理选择能为临床诊治提供有利信息。
目的 总结大型灾害情况下，急诊伤员信息收集流程，为制定大型灾害救援提供证据支持。 方法 回顾性分析汶川地震（2008年5月12日－6月2日）和玉树地震（2010年4月14日－5月1日）伤员信息收集方法，总结两次地震伤员信息收集管理过程中发现的问题及取得的经验。 结果 通过制作地震伤员登记表、调整病历收集与管理模式、分诊提前、伤员信息登记提前，调整急诊功能分区、头像采集技术的使用、成批伤员信息资料袋和分诊信息卡的应用，最大限度地保证了伤员信息收集的完整性。 结论 地震伤员信息资料的准确性、完整性、及时性在伤员的救治、伤员的查找、伤员的转归和各类医疗信息的收集，以及制定大型灾害事故应急预案等方面起着非常重要的作用。
ObjectiveTo evaluate four triage methods including START, Care-Flight, rapid emergency medicinescore (REMS) and Sacco score for the length of hospital stay, length of ICU stay and the severity of injury in Lushan earthquake victims.MethodsA retrospective analysis was performed in 41 cases of critical earthquake victims in the emergency department of West China Hospital from April 20th to April 26th, 2013 in Lushan earthquake. The length of hospital stay and length of ICU stay were compared for four triage methods. The correlation between four triage methods and length of hospital stay, length of ICU stay and injury severity score (ISS) were also analyzed.ResultsThe length of ICU stay for victims whose triage level were red by START triage method or Care-Flight triage method was longer than whose triage levels were yellow. But the length of hospital stay for victims between the two triage levels had no significant difference. In addition, there was a correlation between critical victims and the length of ICU stay in the classification of START triage method and Care-Flight triage method.ConclusionThe length of ICU stay of the victims, whose triage level are red by START triage or Care-Flight triage methods, are longer than whose triage level are yellow. The levels of START and Care-Flight triage are correlated to length of ICU stay.
【摘要】 目的 探讨汶川大地震伤员胸部外伤的影像学表现特点。 方法 对2008年5月12日-6月21日因地震胸部外伤在我院放射科检查的687例患者（年龄1～96岁）的临床资料进行回顾性分析。将患者按10岁为一个年龄组划分。所有患者均行胸部X线片检查，38例行CT检查。 结果 687例患者中，256例检查结果为阳性，阳性率为37.26%。年龄以30~79岁年龄组为主。在阳性伤员中，98例（38.28%）为多系统多发伤，159例（62.11%）为多种类型胸部伤同时存在，肋骨骨折198例（约77.34%），肺挫裂伤49例(约19.14%)。 结论 本组地震伤员多系统多发伤、多类型胸部伤常见，肋骨骨折及肺挫裂伤为主要损伤表现。影像学检查有助于胸部外伤的及时和准确诊断。【Abstract】 Objective To explore the imaging features of thoracic trauma in patients injured in Wenchuan earthquake. Methods The radiological data of 687 patients (aged from 1 to 96 years) with thoracic trauma who underwent radiological examinations between 12 May and 21 June 2008 were retrospectively analyzed. The patients were divided into subgroups according to the age. All patients underwent X-ray plain film examination, in whom 38 underwent CT examination. Results In 687 patients, the results of the examination were positive in 256 with a positive rate of 37.26%; the major injured patients were in the 30-79 years old group. In the patients with positive findings, 98 (38.28%) were accompanied by multi-system injuries, 159 (62.11%) were comprised of several types of thoracic trauma. There were 198 patients (about 77.34%) with rib fracture and 49 patients (19.14%) with lung contusion. Conclusions Multi-system injuries and several types of thoracic trauma are common in the patients injured in the earchquake. The main traumatic manifestations are rib facture and lung contusion. Imaging examination is very helpful in the diagnosis of thoracic trauma.
Objective To discuss the treatment of craniocerebral injuries caused by earthquake. Methods Retrospective analysis of clinical information for 256 patients with craniocerebral injury caused by an earthquake. Results The ‘Classification and Treatment’ was applied to the patients, whether or not they were operated on. A total of 146 patients were cured, 68 improved, 24 remained dependent on the care of others, and 8 died. The mortality rate was 3.13%. Conclusion Applying the ‘Classification and Treatment’ to patients with craniocerebral injury following an earthquake supported the use of medical resources and was associated with a low rate of death and disability.
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.
目的:通过对地震伤患儿家属心理状态的分析及心里疏导,探讨地震伤患儿家属心理干预的方法.方法:对我科2008年5月12日后收治的116例地震伤患儿家属的心理状态进行分析,并给与相应的心理干预。结果:116例地震伤患儿及家属心态良好,积极配合救治和护理,无心理障碍引起的过激反应,护理满意度达99%。结论:对患儿家属积极有效地进行心理疏导,不仅可以减轻其心理压力,还可以缩短与患儿及家属间的距离,有助于医护人员对患儿进行诊疗与护理,促使患儿早日康复。
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.