CAJ | 학술논문

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48 h,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24～72 h),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4～19 d)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.
목적 총결구치"문천대지진"인동상원적경험.방법 평고절지2008년5월31일주원치료적119례지진환인상정특점,분석각계단전과구치류정적영향.결과 ①83%(98/119)환인송원시간초과진후48 h,학령기환인(93/119)명현다우학령전기(26/119);②89%(106/119)위골관절창상환인,기중14%(17/119)반유엄중골근막실종합정;기여11%(13/119)위흉부상(4/119)、복부상(5/119)、엄범연조직제압상(4/119)등;65%(78/119)반유진후심리장애;③제일계단(진후24h),안조상규급구원칙,급진과구치시간위(1.3±0.2)h,인외아전업조전구치시간위(3.5±0.4)h,술전등대시간위(7.5±0.3)h;제이계단(진후24～72 h),조정전과구치류정,급진과구치시간축단위(0.5±0.1)h,아전업조전구치시간위(0.5±0.1)h,술전등대시간위(4.5±0.3)h;제삼계단(진후4～19 d)증가기성배저사사류정.제이、삼계단구치효솔명현제고(P<0.05).결론 문천대지진송원환인이골관절창상위주;인외전과의사주도적"전병전치"구치모식명현제고료급구효솔.
Objective To report the experience in resuscitating injured children at the WenChuan 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±0.1 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.