地震伤严重伤员早期救治.docVIP

地震伤严重伤员早期救治 　 作者：黄显凯，沈岳，郭庆山，王芳 【摘要】 　　目的 探讨地震伤严重伤员的早期救治方法。方法 对286例严重地震伤员实施早期救治，单部位伤189例（66.1%），AIS评分平均3.8分；多发伤97例（33.9%），ISS评分平均27.7分。紧急手术65例:其中肝破裂修补12例，脾破裂行脾切除13例，肠系膜血管损伤修补3例，腹部多脏器损伤修补6例，膈肌破裂修补4例，颅内血肿清除术12例，大量血气胸行开胸手术9例(肺破裂修补4例，肺及支气管部分切除5例)，心脏压塞行心包切开1例，连枷胸行肋骨内固定5例。早期手术72例：清创加骨折外固定支架固定57例，截肢术15例。结果 59例治愈出院，196例经初期治疗后转院，28例接受后期康复治疗，死亡3例。结论 分级救治可保证严重伤员得到及时有效救治；危重伤员及伴有严重心肺等基础疾病的伤员应实施损害控制；做好反复检诊是防止延误诊治的有效方法；加强多专业合作对提高危重病人救治成功率具有非常重要的作用。 【关键词】 地震伤 救治 创伤分级 损害控制 　　Abstract: Objective To explore the methods of treatment in the early period for severe patients with earthquake injury.Methods A total of 286 patients with serious earthquake injury were treated.There were 189 cases of single part injury，whose average abbreviated injury score was 3.8,and 97 cases of multiple injuries,average injury severity score was 27.7.Sixty five patients received emergency operation,including 12 cases of liver repair，13 splenectomy，3 mesenteric blood vessel repair，6 repair of multiple organs in abdomen,4 repair of diaphragmatic rupture,12 evacuation of intracranial hematoma,4 lung repair,5 partial resection of lung and bronchus,1 pericardiotomy for heart tamponade,and 5 internal fixation of ribs for flail chest.Sixtytwo patients received early operation,including 57 debridement and external fixation and 15 amputation.Results Fiftynine patients were cured,196 patients were transferred to higher level hospitals after initial treatment,28 patients received convalescent care and 3 cases died.Conclusion Grading treatment can ensure prompt and effective remedy for severe patients with earthquake injury.Damage control should be used for severe patients and patients accompanyed with serious disease of heart and lung.Repeated inspection is important for preventing delayed diagnosis and treatment，and cooperation of multispeciality is also important for treatment of severe patient. 　　Key words：earthquake injury;remedy;trauma grading;damage control 　　地震伤绝大多数为房屋或建筑物垮塌造成的砸伤、挤压伤或掩埋伤，部分伤员损伤的部位及脏器多、