【摘要】： 第一部分1070例汶川地震傷員的流行病學(xué)調(diào)查 目的總結(jié)分析5.12汶川特大地震中成都軍區(qū)總醫(yī)院救治地震傷員的傷型和傷情等流行病學(xué)特點(diǎn)以及傷員收容和醫(yī)療救治等方面的特點(diǎn)。方法通過(guò)病案文書(shū)查閱以及調(diào)查問(wèn)卷等方法,回顧成都軍區(qū)總醫(yī)院在震后5月12日～5月28日期間所救治的1070例地震傷員特別是骨科傷傷員的臨床流行病學(xué)特點(diǎn),包括傷型、受壓時(shí)間、年齡、性別、診斷等,同時(shí)回顧震后傷員就診的時(shí)間分布特點(diǎn),以及入院后對(duì)傷員實(shí)施救治的時(shí)間及方法(手術(shù)和非手術(shù)方法)及預(yù)后等。結(jié)果成都軍區(qū)總院(成總)在5月12日～5月28日期間共收治地震傷員1070例,48h內(nèi)入院人數(shù)達(dá)到692例,占入院總數(shù)的64.7%。骨科傷員710例,占總傷員數(shù)的66.4%,其中最常見(jiàn)的骨科傷型為四肢骨折、軟組織傷、脊柱骨折、骨盆骨折及擠壓綜合癥(CS)患者,發(fā)生率分別為371(34.7%)、191(17.9%)、122(11.4%)、49(4.6%)和17(1.6%)例。1070例患者中接受外科手術(shù)(清創(chuàng)術(shù)除外)治療者440例(41.1%)。四肢擠壓傷患者中接收截肢手術(shù)者23例,其中確診為擠壓綜合癥患者9例,重度感染4例,嚴(yán)重毀損傷10例。1070例患者中死亡5例(0.5%),其中擠壓綜合癥患者3例,腹部損傷伴失血性休克1例,地震相關(guān)非創(chuàng)傷性疾病(心肌梗塞)1例。結(jié)論地震傷員中骨科傷為最主要的傷型;地震后24-48h運(yùn)送至成都軍區(qū)總醫(yī)院就診的傷員最多,因此在這段時(shí)間內(nèi)盡快組織和集中醫(yī)療救援力量對(duì)傷員的救治工作非常重要。擠壓傷所導(dǎo)致的擠壓綜合癥患者死亡率較高,應(yīng)當(dāng)在醫(yī)療救援上予以重視。 第二部分17例汶川地震擠壓綜合癥患者的臨床流行病學(xué)特點(diǎn)分析 目的總結(jié)分析17例汶川地震致擠壓綜合癥患者的臨床流行病學(xué)特點(diǎn)、治療方法及其預(yù)后,總結(jié)救治經(jīng)驗(yàn)。方法通過(guò)調(diào)查問(wèn)卷對(duì)成都軍區(qū)總院收治的汶川地震致擠壓綜合癥患者進(jìn)行調(diào)查研究,了解其臨床流行病學(xué)特點(diǎn)、治療時(shí)機(jī)、治療方式、轉(zhuǎn)歸及并發(fā)癥等。結(jié)果成都軍區(qū)總院在5月12日～5月30日期間共收治地震傷員1070人,其中擠壓綜合癥患者17例,發(fā)生率為1.6%。擠壓綜合征患者無(wú)明顯性別差異,有明顯的年齡分布特點(diǎn),94.1%的患者集中于20-59歲之間。52.9%的患者接受了1次或1次以上的筋膜切開(kāi)術(shù),47.1%的患者直接進(jìn)行了截肢術(shù),最終的保肢率為17.6%。8例患者出現(xiàn)少尿型腎功能障礙,其中4例接受透析治療,2例出現(xiàn)急性呼吸窘迫綜合征(ARDS),1例出現(xiàn)彌散性血管內(nèi)凝血(DIC)和多器官功能障礙(MODS)并死亡。結(jié)論擠壓綜合征患者應(yīng)盡早被送至非震區(qū)的綜合性醫(yī)院救治。早期恰當(dāng)?shù)膬?nèi)、外科干預(yù)可有效降低此征的死亡率及致殘率。 第三部分壓迫面積、時(shí)間和重量與大鼠擠壓傷的相關(guān)性以及擠壓綜合癥大鼠模型的初步建立 目的:研究壓迫面積、壓迫時(shí)間和壓迫重量與局部損傷及全身病理生理反應(yīng)的相關(guān)性,確定大鼠發(fā)生擠壓綜合癥的危險(xiǎn)相關(guān)因素,初步摸索可重復(fù)的擠壓綜合癥大鼠模型。方法:清潔級(jí)雄性SD大鼠144只,隨機(jī)分為兩大組(n=72),分別為觀察生存率組和觀察血生化指標(biāo)組。每一大組中都包含將壓迫面積(單側(cè)后肢、雙側(cè)后肢)、壓迫重量(2kg、3kg、4kg)和壓迫時(shí)間(4h、6h、8h)進(jìn)行排列組合后形成的18組(n=4)。觀察生存率組的大鼠記錄壓迫解除后7天內(nèi)的生存率后處死;觀察血生化指標(biāo)組的大鼠在壓迫開(kāi)始前和再灌注3h取血后處死,檢測(cè)血鉀離子、肌酸激酶、肌苷和尿素氮。所有大鼠均分別測(cè)量壓迫開(kāi)始前和再灌注3h受壓后肢的周徑;并在實(shí)驗(yàn)過(guò)程中觀察肌紅蛋白尿的發(fā)生率。觀察血生化指標(biāo)組的大鼠再灌注3h后取其受壓局部肌肉及腎臟進(jìn)行病理切片檢查。結(jié)果:所有大鼠再灌注3h后受壓肢體均明顯腫脹(p＜0.05),各組間無(wú)統(tǒng)計(jì)學(xué)差異。不同壓迫面積組(單/雙側(cè)后肢)的死亡率分別為2.8%和50%,有明顯統(tǒng)計(jì)學(xué)差異(p＜0.05);不同壓迫重量組(2kg、3kg、4kg)的死亡率分別為4.2%、29.2%和45.8%,有明顯統(tǒng)計(jì)學(xué)差異(p＜0.05);不同壓迫時(shí)間組(4h、6h、8h)的死亡率分別為25%、20.8%、33.3%,各組間無(wú)明顯統(tǒng)計(jì)學(xué)差異(p＞0.05)。各組中血鉀、肌酸激酶、肌酐及尿素氮隨著壓迫面積、時(shí)間及重量的增加和延長(zhǎng)而明顯上升(p均＜0.05)。局部受壓肌肉呈明顯的水腫和缺血再灌注損傷表現(xiàn);單側(cè)組大鼠腎臟出現(xiàn)腎小球充血表現(xiàn),雙側(cè)、壓迫重量≥3Kg、壓迫時(shí)間≥6h組大鼠可見(jiàn)腎小管壞死及管型。結(jié)論:壓迫時(shí)間、重量及面積的增加和延長(zhǎng)可增加擠壓傷局部損傷和全身反應(yīng)的嚴(yán)重程度,并惡化其預(yù)后,其中壓迫面積是更為重要的影響因素。受壓面積為雙側(cè)后肢、壓迫重量≥3kg、壓迫時(shí)間≥6h可造成大鼠典型的擠壓綜合癥表現(xiàn),可初步作為建立擠壓綜合癥大鼠模型的實(shí)驗(yàn)條件。
[Abstract]:Part one epidemiological investigation of 1070 cases of Wenchuan earthquake casualties
Objective to summarize and analyze the characteristics of the epidemiological characteristics of the injury type and injury of the wounded in General Hospital of Chengdu Military Region in the 5.12 Wenchuan earthquake, and the characteristics of the casualty collection and medical treatment. Methods through the medical record documents and the questionnaire, the author reviewed the period from May 12th to May 28th after the earthquake. The clinical epidemiological characteristics of 1070 cases of earthquake wounded, especially the wounded in Department of orthopedics, including injury type, compression time, age, sex, diagnosis, and so on. At the same time, the characteristics of the time distribution of the wounded after the earthquake were reviewed, and the time and method of treatment for the wounded after admission (surgical and non operative methods) and prognosis were also found. Results the General Hospital of Chengdu military area military area. (total) 1070 cases of earthquake wounded were admitted from May 12th to May 28th. The number of hospitalized patients in 48h reached 692 cases, accounting for 710 cases in the Department of orthopedics, accounting for 66.4% of the total number of wounded in the total hospital. The most common Department of orthopedics injuries were limbs fracture, soft tissue injury, spinal fracture, pelvic fracture and CS patients, the incidence rate was 371, respectively. (34.7%) 191 (17.9%), 122 (17.9%), 122 (11.4%), 49 (4.6%), and 17 (1.6%) cases of.1070 patients were treated with surgery (excluding debridement) in 440 (41.1%). Among the patients with extremities, there were 23 cases received amputation, among which the patients were diagnosed as crush syndrome, severe infection and severe damage. There were 3 cases of pressure syndrome, 1 cases of abdominal injury accompanied by hemorrhagic shock and 1 cases of earthquake related non traumatic disease (myocardial infarction). Conclusion Department of orthopedics injuries were the most important injuries among the earthquake victims. After the earthquake, 24-48h was transported to the General Hospital of Chengdu Military Region for the most wounded. Therefore, the medical rescue forces were organized and concentrated on the wounded as soon as possible during this period. The treatment of crush injury is very important. The mortality rate of crush syndrome patients caused by crush injury is high, which should be paid attention to in medical rescue.
The second part is the clinical epidemiological characteristics of 17 patients with crush syndrome in Wenchuan earthquake.
Objective to summarize and analyze the clinical epidemiological characteristics, treatment methods and prognosis of 17 cases of Wenchuan earthquake induced crush syndrome, and to summarize the experience of treatment. Methods through the questionnaire, the patients of Wenchuan earthquake induced compression syndrome treated in the General Hospital of Chengdu military region were investigated and studied to understand the clinical epidemiological characteristics, the time of treatment and the treatment methods. Results 1070 people were admitted to the Chengdu military district general hospital from May 12th to May 30th, including 17 cases of crush syndrome. There was no significant gender difference in the incidence of 1.6%. compression syndrome. There was an obvious age distribution, and 94.1% of the patients received 1 or 1 of the patients with.52.9% between 20-59 years old. More than 47.1% of the fasciotomy patients underwent immediate amputation. The ultimate limb salvage rate was 17.6%.8 patients with oliguria, of which 4 were treated with dialysis, 2 had acute respiratory distress syndrome (ARDS), 1 had diffuse intravascular coagulation (DIC) and multiple organ dysfunction (MODS) and died. Patients with syndromes should be sent to general hospitals in non-seismic areas as soon as possible. Early and appropriate surgical intervention can effectively reduce the mortality and disability rate of this syndrome.
The third part is the correlation between compression area, time and weight and crush injury in rats, and the preliminary establishment of rat model of crush syndrome.
Objective: To study the correlation between compression area, compression time, compression weight and local injury and systemic pathophysiology, to determine the risk factors for the occurrence of extrusion syndrome in rats and to find out the reproducible rat model of extrusion syndrome. Methods: 144 clean grade male SD rats were randomly divided into two groups (n=72), respectively, as observation students, respectively. The survival rate group and the blood biochemical index group. In each group, 18 groups (n=4) were composed of compression area (unilateral hind limbs, bilateral hind limbs), compression weight (2kg, 3kg, 4kg) and compression time (4h, 6h, 8h). The survival rate group was recorded and the survival rate within 7 days after oppression was recorded, and the blood biochemical index group was observed. Rats were sacrificed before and after the recompression of 3H in rats. Blood potassium ions, creatine kinase, inosine and urea nitrogen were detected. All rats measured the circumferential diameter of the hind limbs before and after the compression of 3H, respectively, and observed the incidence of myoglobin in the experimental process. The blood biochemical indexes of rats were observed after 3H. Pathological sections of local muscles and kidneys were examined. Results: all rats were obviously swelled after 3H reperfusion (P < 0.05). There was no statistical difference among the groups. The mortality of different compression area groups (single / bilateral hind limbs) was 2.8% and 50%, respectively (P < 0.05); the mortality rate of different compression weight groups (2kg, 3kg, 4kg) There were significant differences between 4.2%, 29.2% and 45.8% (P < 0.05), and the mortality rates of different compression time groups (4h, 6h, 8h) were 25%, 20.8%, 33.3%, respectively (P > 0.05). The blood potassium, creatine kinase, creatinine and urea nitrogen in each group increased with the compression area, time and weight (P < 0.) 05). The local compression muscles showed obvious edema and ischemia reperfusion injury, the renal glomerular hyperemia in the unilateral group of rats, bilateral, compression weight more than 3Kg, compression time more than 6h group of rats can be seen renal tubular necrosis and tube type. Conclusion: compression time, weight and area increase and extension can increase the local injury and systemic reaction of crush injury. The stress area is a more important factor. The compression area is bilateral hind limbs, the compression weight is more than 3kg, and the compression time more than 6h can cause the typical expression of the rat's extrusion syndrome. It can be used as the experimental condition for the establishment of the rat model of the crush syndrome.
【學(xué)位授予單位】：中國(guó)人民解放軍軍醫(yī)進(jìn)修學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R641;R181.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李興鑫;姚一民;張聰;陳施展;陳一平;任翔;;玉樹(shù)地震31例傷殘藏民創(chuàng)傷后應(yīng)激障礙分析[J];實(shí)用醫(yī)院臨床雜志;2011年04期

2 吳學(xué)華;李小麟;陶慶蘭;黃雪花;朱仕超;;玉樹(shù)地震傷員急性應(yīng)激反應(yīng)調(diào)查[J];中國(guó)公共衛(wèi)生;2011年07期

3 唐芳;朱世瓊;何錦華;艾艷;;40例地震截肢患兒的院外康復(fù)護(hù)理[J];中華護(hù)理雜志;2011年09期

4 楊琦;王養(yǎng)民;梁曉燕;張巧娥;武明;;地震擠壓綜合征致急性腎功能衰竭臨床分析[J];西北國(guó)防醫(yī)學(xué)雜志;2011年04期

5 李小麟;李濤;吳學(xué)華;陶慶蘭;黃雪花;朱仕超;;結(jié)合藏文化的心理干預(yù)對(duì)玉樹(shù)地震傷員急性應(yīng)激反應(yīng)的效果[J];中國(guó)心理衛(wèi)生雜志;2011年07期

6 王s，

本文編號(hào)：2173940