1070例汶川地震伤员的流行病学调查及挤压伤大鼠模型的初步研究

发布时间：2018-08-09 11:32

【摘要】： 第一部分1070例汶川地震伤员的流行病学调查目的总结分析5.12汶川特大地震中成都军区总医院救治地震伤员的伤型和伤情等流行病学特点以及伤员收容和医疗救治等方面的特点。方法通过病案文书查阅以及调查问卷等方法,回顾成都军区总医院在震后5月12日～5月28日期间所救治的1070例地震伤员特别是骨科伤伤员的临床流行病学特点,包括伤型、受压时间、年龄、性别、诊断等,同时回顾震后伤员就诊的时间分布特点,以及入院后对伤员实施救治的时间及方法(手术和非手术方法)及预后等。结果成都军区总院(成总)在5月12日～5月28日期间共收治地震伤员1070例,48h内入院人数达到692例,占入院总数的64.7%。骨科伤员710例,占总伤员数的66.4%,其中最常见的骨科伤型为四肢骨折、软组织伤、脊柱骨折、骨盆骨折及挤压综合症(CS)患者,发生率分别为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术(清创术除外)治疗者440例(41.1%)。四肢挤压伤患者中接收截肢手术者23例,其中确诊为挤压综合症患者9例,重度感染4例,严重毁损伤10例。1070例患者中死亡5例(0.5%),其中挤压综合症患者3例,腹部损伤伴失血性休克1例,地震相关非创伤性疾病(心肌梗塞)1例。结论地震伤员中骨科伤为最主要的伤型;地震后24-48h运送至成都军区总医院就诊的伤员最多,因此在这段时间内尽快组织和集中医疗救援力量对伤员的救治工作非常重要。挤压伤所导致的挤压综合症患者死亡率较高,应当在医疗救援上予以重视。第二部分17例汶川地震挤压综合症患者的临床流行病学特点分析目的总结分析17例汶川地震致挤压综合症患者的临床流行病学特点、治疗方法及其预后,总结救治经验。方法通过调查问卷对成都军区总院收治的汶川地震致挤压综合症患者进行调查研究,了解其临床流行病学特点、治疗时机、治疗方式、转归及并发症等。结果成都军区总院在5月12日～5月30日期间共收治地震伤员1070人,其中挤压综合症患者17例,发生率为1.6%。挤压综合征患者无明显性别差异,有明显的年龄分布特点,94.1%的患者集中于20-59岁之间。52.9%的患者接受了1次或1次以上的筋膜切开术,47.1%的患者直接进行了截肢术,最终的保肢率为17.6%。8例患者出现少尿型肾功能障碍,其中4例接受透析治疗,2例出现急性呼吸窘迫综合征(ARDS),1例出现弥散性血管内凝血(DIC)和多器官功能障碍(MODS)并死亡。结论挤压综合征患者应尽早被送至非震区的综合性医院救治。早期恰当的内、外科干预可有效降低此征的死亡率及致残率。第三部分压迫面积、时间和重量与大鼠挤压伤的相关性以及挤压综合症大鼠模型的初步建立目的:研究压迫面积、压迫时间和压迫重量与局部损伤及全身病理生理反应的相关性,确定大鼠发生挤压综合症的危险相关因素,初步摸索可重复的挤压综合症大鼠模型。方法:清洁级雄性SD大鼠144只,随机分为两大组(n=72),分别为观察生存率组和观察血生化指标组。每一大组中都包含将压迫面积(单侧后肢、双侧后肢)、压迫重量(2kg、3kg、4kg)和压迫时间(4h、6h、8h)进行排列组合后形成的18组(n=4)。观察生存率组的大鼠记录压迫解除后7天内的生存率后处死;观察血生化指标组的大鼠在压迫开始前和再灌注3h取血后处死,检测血钾离子、肌酸激酶、肌苷和尿素氮。所有大鼠均分别测量压迫开始前和再灌注3h受压后肢的周径;并在实验过程中观察肌红蛋白尿的发生率。观察血生化指标组的大鼠再灌注3h后取其受压局部肌肉及肾脏进行病理切片检查。结果:所有大鼠再灌注3h后受压肢体均明显肿胀(p＜0.05),各组间无统计学差异。不同压迫面积组(单/双侧后肢)的死亡率分别为2.8%和50%,有明显统计学差异(p＜0.05);不同压迫重量组(2kg、3kg、4kg)的死亡率分别为4.2%、29.2%和45.8%,有明显统计学差异(p＜0.05);不同压迫时间组(4h、6h、8h)的死亡率分别为25%、20.8%、33.3%,各组间无明显统计学差异(p＞0.05)。各组中血钾、肌酸激酶、肌酐及尿素氮随着压迫面积、时间及重量的增加和延长而明显上升(p均＜0.05)。局部受压肌肉呈明显的水肿和缺血再灌注损伤表现;单侧组大鼠肾脏出现肾小球充血表现,双侧、压迫重量≥3Kg、压迫时间≥6h组大鼠可见肾小管坏死及管型。结论:压迫时间、重量及面积的增加和延长可增加挤压伤局部损伤和全身反应的严重程度,并恶化其预后,其中压迫面积是更为重要的影响因素。受压面积为双侧后肢、压迫重量≥3kg、压迫时间≥6h可造成大鼠典型的挤压综合症表现,可初步作为建立挤压综合症大鼠模型的实验条件。
[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.
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R641;R181.3

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