汶川大地震三种医疗环境急诊清创体会.docVIP

汶川大地震三种医疗环境急诊清创体会[摘要]目的 根据震后皮肤软组织裂伤在三种医疗环境下的急诊清创对比,探索灾后及时建立野战医院的可行性以及清创术后抗生素的使用。方法 回顾性分析震后帐篷医院、板房医院、原址医院来诊的449例皮肤软组织裂伤的急诊清创疗效,比较三种环境下急诊清创缝合伤口感染情况并探讨抗生素的应用情况,总结汶川大地震急诊清创经验体会。结果三种医疗环境下,Ⅰ度、Ⅱ度伤口术后未给予抗生素,Ⅲ度、Ⅳ度伤口术后口服短期、足量抗生素,术后伤口愈合佳,不同分度伤口清创术后感染率均无明显统计学差异,P0.05。结论 大型灾害后,应快速建立适应灾区情况的医疗机构,迅速投入工作;医生应该严格按照诊疗规范操作,严守职业道德,合理使用抗生素,减少患者的经济负担,为和谐的医疗关系打好基础。 [关键词] 急诊清创;感染率;愈合情况;汶川大地震 [中图分类号] R642 [文献标识码] A [文章编号] Clinical Study on Emergency Wound Debridement under Three Medical Circumstances in Wenchuan Earthquake YANG Ding-Jun1, SUN Jin-Song1* [Abstract] Objective To discuss the feasibility of timely establishment of a field hospital and indications for use of antibiotics through comparison of recovery outcomes and infection rates after emergency debridement of skin and soft tissue lacerations under 3 medical circumstances in Wenchuan earthquake. Methods Totally 449 consecutive patients undergoing emergency wound debridement were analyzed. Postoperatively, the recovery outcomes and infection rates were compared under 3 medical circumstances: tent, board room, and the original hospital site. Finally, a clinical experience of emergency wound debridement in Wenchuan earthquake was summarized. Results Under 3 medical circumstances, the patients with 3st and 4th degree wound were given short-time and full-dose oral antibiotics while those with 1st and 2nd degree wound not. Postoperatively, wound recovery was good in all patients and there were no statistically significant differences in infections rates of various wounds under 3 medical circumstances (P0.05). Conclusions After the catastrophic disaster, the state should establish adaptive medical systems and make it work promptly, and doctors during disaster relief should stick to medical practice, rational use of antibiotics to decrease patients? economic burdens and to promote establishing good physician-patient relationship. [Key words] emergency wound debridement; infection rates; recovery outcomes; Wenchuan earthqu