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:了解参与“5?12”四川大地震救援医护人员的应急减灾与备灾现状,为促进备灾教育和备灾行为提供参考依据。方法： 用自行设计的调查表,对参加四川大地震医疗救援的223名医护人员及其所在医疗机构的应急减灾与备灾情况等进行调查。结果: 本调查中的全体医护人员所在医疗机构地震发生时均采取了积极的应急减灾处理,成功地履行了医护人员救死扶伤的神圣使命。经历大地震后,95.1%～83.9%医护人员所在医疗机构对急救减灾对策、物资应急供应装备与后勤保障方面的备灾措施进行了加强与完善,但信息畅通的保障与备灾行动的落实方面尚存在不足;85.7%～64.6%医护人员所在医疗机构建立或完善了相关备灾规章制度与指南。结论： 经历“5?12”大地震后,医疗机构在应急救治能力的储备、救援人员的反应力与意识、信息畅通、物资供应保障等方面具有了一定的备灾基础,同时也提示了对于促进备灾教育和备灾行动的落实以及进一步完善相关制度/手册的必要性和迫切性。
Shortly after the earthquake in Min county and Zhang county, the department of health of Gansu province immediately established a leadership team for earthquake relief and medical rescue, subordinated by psychological crisis intervention teams, which was responsible for training relevant personnel to carry out psychological intervention, and spreading related knowledge about earthquake. Then, emergency psychological intervention was provided for the key population (more than 90 times in total, involving 8 194 person-times). We also offered individualized psychological services (617 person-times), and diagnosed 31 patients with mental disorders through consultation. After the earthquake, the emotion of victims including depression, anxiety and acute stress disorder increased. The workload of psychological crisis intervention after earthquake was heavy and hard. However, Gansu province needs national support due to poor resources.
【摘要】目的对一线临床科室参与汶川地震抗震救灾的外援护士和本土护士的社会支持系统进行调查研究。方法随机抽取抗震救灾一线科室(ICU、骨科、急诊)外援护士及本土护士各175名,设为外援组和本土组,采用对地震的自我认知问卷及社会支持评定量表(SSRS)进行测评。结果两组护士对地震相关知识的知晓情况、响应抗震救灾的行为表现、地震对专业的影响等方面无明显差异(Pgt;0.05);两组护士的社会支持总分均低于国内常模 (Plt;0.01),除外援组主观支持维度得分与国内常模无显著差异(Pgt;0.05)外,两组的社会支持其它各维度得分均低于国内常模,外援组的社会支持总分及主观支持、客观支持得分均高于本土组(Plt;0.01),两组对支持的利用度无明显差异(Pgt;0.05)。结论为抗震救灾一线科室护士提供积极的社会支持是保证心理健康的重要措施。【Abstract】ObjectiveTo evaluate the difference of psychological state between local and nonlocal nurses during the Wenchuan Earthquake. Methods A total of 175 local nurses and 175 nonlocal nurses were randomly selected and investigated by SSRS and the earthquake questionnaire. Results There were no significant differences in their knowledge about the earthquake, professional identity and action (Pgt;0.05). The total and the three dimensions scores of SSRS of the two groups were lower than those of the domestic norms (Plt;0.01) except the subjective support dimensions. The total scores, objective support and subjective support dimensions scores of nonlocal group were higher than that in the local group (Plt;0.01). In coping style questionaire, there were significant differences in solving problems and retreat factor(Plt;0.01)and no significant differences in remorse, salvation and illusion(Pgt;0.05). Conclusion The earthquake affected mental health of the nurses and their psychological state need to be much concerned,especially the nonlocal ones.
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: 了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。 方法 :采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取24‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata30 进行数据录入、SPSS130进行统计分析。 结果 :共发放问卷240份,收回有效问卷229份(有效回收率954%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为454%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为336%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P 值分别是0033,0001)。 结论 :震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
目的:探讨5·12地震灾区11～16岁少年儿童的心理健康状况及其影响因素，为下一步开展创伤后心理危机干预提供依据。方法:在地震发生后一个月，使用长处与困难问卷（SDQ）学生版，调查了1268名来自于灾区的少年儿童（平均年龄14.20±1.02岁，男女比例1:1.02）的心理健康状况及其影响因素。结果:（1）灾区少年儿童SDQ总困难因子平均得分为13.66±5.75，74.9%的人报告自身存在主观困难；（2）女性的总困难因子、情绪因子、亲社会因子得分高于男性（z=-4.317，-7.963，-3.717；Pslt;0.001）；（3）困难对少年儿童社会功能的影响程度随年龄增加（χ2=7.684，P=0.021）。年龄越大，多动因子得分有增加的趋势（χ2=13.881，P=0.001）；（4）重度暴露组其总困难因子、情绪因子、影响因子得分高于轻度暴露组（z=-2.374，-4.279，-2.114；Pslt;0.05），困难造成的主观精神困扰程度前组高于后组（z=-2.920，P=0.004）；（5）女性、高年龄者、教师/同学伤亡较重者、震后被转移至安全的帐篷或房屋的间隔时间越长者，SDQ总困难因子异常的危险性越高。结论:震后灾区少年儿童的心理健康状况受到暴露水平、性别、年龄以及震后被转移至安全地点的时间的影响，心理干预应综合考虑相关因素。
Objective To summarize the experience of epidemic prevention in order to offer the first-hand data for reconstruction after the earthquake and epidemic control and prevention in the active seismic zone. Method We collected and analyzed the data of epidemic control and prevention and summarized their strengths and weaknesses. Results Of the 13 counties in Aba Prefecture, 12 were affl icted with 2 worst-hit counties and 5 worse-hit disaster areas. A total of 20 233 people were dead and 7 873 people were missing. Health system was severely damaged. Aba Center of Disease Control and Prevention started the contingency plan and sent 4 epidemic prevention teams to the disaster areas. With the combination of local materials and external aids, the epidemic prevention network of county, township and village was established. (1) Environment cleaning and el imination: up to August 27, 2008, 2 591 group times of teams involving 88 298 person times and 5 294 set times of vehicles were allocated. Disinfection area covered 18 181.3 m2 including 14 132 dumps, 33 271 cesspits and 154 391 breeding grounds of mosquitoes, fl ies and mice. (2) Critical supervision for the safety of drinking water and food: up to June 20, 21 central ized and 1 032 dispersed water supply sources were restored. We monitored 829 drinking water samples, among which 594 were qual ified with the qual ified rate of 66.59%. (3) A total of 86 396 people were resettled in 17 temporary sites. (4) Wild dogs were killed in Kala-azar epidemic areas. Mosquitoes, flies and mice were supervised once a week. (5) Disease supervision: A total of 762 cases in 15 legal infectious diseases were found within 90 days after the earthquake, and no death was found. No outbreak of infectious epidemic situations and burst publ ic health events was reported. A total of 57 157 Hepatitis A vaccinations were inoculated in the children aged from 18 months to 12 years old and 16 268 in children aged from 13 to 16 years old, medical staff, mil itary personnel and first-l ine workers. A total of 4 435 Japanese encephal itis vaccinations were inoculated in people in Xiaojin county. On June 15, routine inoculation cl inic recovered and on July 1, expansive inoculation was started on schedule. Conclusion Phased victory is gained in epidemic control and prevention in Aba Prefecture, although it is only a latter-wit. It is suggested that a long-term system of the earthquake disaster as well as human and environmental protection should be reconsidered through the first-hand data of anti-epidemic measures of the Wenchuan earthquake.
Objective To find effective ways for controlling the hospital infection to the skeptical gas gangrene patients. Method From May 14th to June 24th, the hospital set up triage spots originally and dealt with the wounded based on their specific conditions in different stages and optimized the flow of admission of the wounded. Owing to correctly treating the wound and screening the skeptical gas gangrene patients, preventing nosocomial infections was shifted forward. Sprending the gas gangrene wound after having flushed it with 3% H2O2. If the wound have been stitched, the stitches should bee taken out, and open the wound and take the debridement for it completely, then treat it with b antibacterial after debridement by sterilization and isolation about operation of gas gangrene. Result Up to June 24th, none of 67 cases of doubtful gas gangrene from the disaster area died and no hospital cross infections happened in courtyard. At present, amomg the 67 cases, 32 were highly suspected of gas gangrene infection, 26 cases were discharged, while 6 cases were undergoing treatment in the hospital. Conclusion Correct management and appropriate treatment are effective ways for controlling hospital cross infection to the skeptical gas gangrene patients.
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.