目的:探討四川汶川地震腹部損傷傷員CT表現及其診斷價值。方法:對我院因汶川地震受傷,需做腹部CT的傷員27例的治療,進行CT分析。結果:在本組腹部損傷傷員中, 肝臟病變7例,膽囊病變2例,胰腺病變11例,脾臟病變8例,腎臟病變11例,腹腔積液6例,腹腔積氣9例,胃腸道病變8例,子宮病變1例。部分傷員為兩個或兩個以上器官受累。結論: CT檢查結合臨床治療能快速、準確、有效的對地震腹部損傷傷員進行判斷,對臨床診治具有重要作用。
目的:本文研究5·12四川汶川大地震造成停藥、居住條件惡劣、創傷后應激障礙（posttraumatic stress disorder，PTSD）、是否并發感染、地震破壞烈度等多種因素對類風濕關節炎（RA）患者的影響。方法:對58例確診為RA的重災區（北川、平武、江油、安縣）地震前病情穩定患者震后一月進行血沉（ESR）和C反應蛋白（CRP）測定，同時評估患者關節腫脹、關節壓痛、晨僵情況，了解患者是否病情活動，分析地震造成停藥、居住條件惡劣、PTSD、并發感染及地震破壞烈度等多種因素對RA的影響。采用fisher確切概率法，分析地震破壞烈度與疾病活動是否有相關性，采用SPSS12.0軟件對地震可能影響RA患者病情活動的其它相關因素進行Logistic回歸分析。結果:58例患者中34例RA患者出現病情活動。fisher確切概率法分析顯示:上述四縣患者疾病活動構成比差別無統計學意義。病情活動者中62%患者停藥；85%患者居住條件惡劣；59%患者患有PTSD；35%患者并發感染。Logistic回歸分析發現停藥、居住條件惡劣、PTSD及并發感染與RA患者病情活動相關（P均小于0.05）。結論：本研究中涉及的四個縣RA患者疾病活動構成比差異無顯著性，地震造成的停藥、居住條件惡劣、PTSD、并發感染可使一部分RA患者病情活動。
目的：探討綜合康復治療體系對54例地震致下肢骨折患者功能恢復的影響。方法：采用綜合康復治療方法治療“5·12”汶川大地震所致54例下肢骨折患者，臨床觀察患者傷口的愈合情況和骨折的復位情況，有無骨折并發癥，分析比較治療前后患者下肢功能恢復情況及日常生活活動能力的改善。結果：康復治療后關節活動度明顯改善，由入院時的平均218.61°增加至出院時的237.5°（P＜0.001）。Barthel指數由入院時的平均55.4增加至出院時的70.8（P＜0.001），日常生活活動能力有較大幅度提高。結論：綜合康復治療體系對于地震傷致下肢骨折患者的功能恢復至關重要，一套完善的體系應包括：①康復治療早期介入，功能鍛煉長期堅持；②發揮大型綜合性醫院的優勢，多學科交叉，多部門合作；③功能康復和心理康復并重；④專業人士與社會團體共同參與。
【摘要】 目的 調查汶川地震傷殘人員的日常生活活動能力(ADL),分析影響傷殘人員日常生活活動能力的相關因素,為汶川地震傷殘人員的社區康復提供依據。方法 利用ADL量表對283名汶川地震傷殘人員的日常生活活動能力進行測量。結果 283名傷殘人員地震傷殘人員ADL平均得分為85.08±14.73,其中20.8%ADL完全正常,71.0%的傷殘人員ADL日常生活能力輕度障礙,8.2%ADL中重度障礙；經多因素分析,地震傷殘人員ADL的主要影響因素依次是:傷殘程度、傷殘合并疾病、傷殘并發癥、是否參與殘疾人組織或相關活動(Plt;0.05)。結論 傷殘人員ADL關鍵在于殘疾程度,避免傷殘并發癥和二次殘疾的發生,控制傷殘合并疾病的發生,增加傷殘人員的社會參與度,均有利于傷殘人員ADL的提高。
To investigate the method of using vacuum seal ing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic effect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 woundson the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or flap transposition was used to repair the wounds. Results In 21 cases (40.4%), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia col i, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or flap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stabil ity of condition. Conclusion VSD treatment can cover the wound promptly, el iminate contamination, prevent secondary infection and benefit late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can rel ieve the pain suffered by the injured and decrease theworkload of medical stuff, thus facil itating the rescue work.
【摘要】目的對一線臨床科室參與汶川地震抗震救災的外援護士和本土護士的社會支持系統進行調查研究。方法隨機抽取抗震救災一線科室(ICU、骨科、急診)外援護士及本土護士各175名,設為外援組和本土組,采用對地震的自我認知問卷及社會支持評定量表(SSRS)進行測評。結果兩組護士對地震相關知識的知曉情況、響應抗震救災的行為表現、地震對專業的影響等方面無明顯差異(Pgt;0.05);兩組護士的社會支持總分均低于國內常模 (Plt;0.01),除外援組主觀支持維度得分與國內常模無顯著差異(Pgt;0.05)外,兩組的社會支持其它各維度得分均低于國內常模,外援組的社會支持總分及主觀支持、客觀支持得分均高于本土組(Plt;0.01),兩組對支持的利用度無明顯差異(Pgt;0.05)。結論為抗震救災一線科室護士提供積極的社會支持是保證心理健康的重要措施。【Abstract】ObjectiveTo evaluate the difference of psychological state between local and nonlocal nurses during the Wenchuan Earthquake. Methods A total of 175 local nurses and 175 nonlocal nurses were randomly selected and investigated by SSRS and the earthquake questionnaire. Results There were no significant differences in their knowledge about the earthquake, professional identity and action (Pgt;0.05). The total and the three dimensions scores of SSRS of the two groups were lower than those of the domestic norms (Plt;0.01) except the subjective support dimensions. The total scores, objective support and subjective support dimensions scores of nonlocal group were higher than that in the local group (Plt;0.01). In coping style questionaire, there were significant differences in solving problems and retreat factor(Plt;0.01)and no significant differences in remorse, salvation and illusion(Pgt;0.05). Conclusion The earthquake affected mental health of the nurses and their psychological state need to be much concerned,especially the nonlocal ones.
Objective To evaluate the psychological trauma incurred by the people in wenxian after the Wenchuan earthquake so as to provide relevant information for psychological and medical interventions. Methods Thepsychological state of the people after the earthquake was investigated using a mental health self-assessment questionnaire, self-rating anxiety scale, and self-rating depression scale. Results We found: 56.0% of the respondents were not happy, 39.6% often cried bitterly, 56.7% felt pain, 40.7% lost interest, 69.2% felt uneasy, nervous, or worried, and 27.0% would like to end their lives; the SDS scores (56.48±110.43) and SAS scores (39.88±11.38) of the people were significantly higher than those of the national norms (Plt;0.001). The following symptons appeared: 59.3% had headache, 50.5% poor appetite, poor sleeping 56.0%, 58.2% were easily frightened, tremors 29.7%, 50.5% dyspepsia, 42.9% thoughts fuzzy, 60.4% stomach discomfort, fatigue 85.7%. Conclusion The earthquake disaster brought about serious psychological harm to people. It is necessary to strengthen post-earthquake psychological relief and strengthen interventions in order to reduce the psychological suffering of victims.
目的:分析汶川8.0級大地震致腹部外傷的患者的心理問題并探索其護理對策。方法:以汶川8.0級大地震致腹部外傷的19名患者為暴露組,普通患者20名和醫務人員19名作為對照組。由3名醫護人員運用漢密頓抑郁量表進行調查和分析。結果:地震傷員在睡眠質量、精神焦慮、抑郁情緒等3個方面與普通患者及醫務人員比較有明顯異常。結論:地震致腹部外傷患者的心理影響明顯大于普通患者及醫務人員,應進行及時有效的心理干預護理,以控制和減緩其心理問題。
Objective To explore the structure and influencing factors of overall medical treatment expenses of 1 635 inpatients of Wenchuan earthquake in West China Hospital and to provide references for setting up the criteria of medical expenses and for assess the cost-effect of medical rescue and treatment. Methods The data of earthquake casualties were collected to analyze the constitution and influencing factors of the overall medical expense by SPSS 13.0 software. The data were described by X±SD. Comparison of data categories was tested by rank sum and influencing factors were analyzed by multi ple l inear regression analysis. Results A total of 1 635 casualties including 1 413 (86.04%) earthquake wounded and 222 (13.96%) patients from the disaster area were identified. The average expense per capita was 9 165.05±12 426.11 yuan. The overall cost was made up of operation expenses (71.75%) including material cost, examination fee and treatment fee, drug cost (18.41%) as well as bed fee and others (less than 10%). The cost of patients from the disaster area was higher than that of the earthquake wounded (Z= –4.109, P=0.000). The operation, compl ications, multiple-site damages, injures induced by the secondary disaster of the earthquake such as burn and corrosion were the direct reason leading to the high overall expense. The influencing factors included operation (r=0.386), ICU (r=0.336) and the day of hospital ization (r=0.246). Conclusion The earthquake wounded occupy the predominant percentage of the earthquake inpatients in West China Hospital. The operation, compl ications, multiple-site damages and injures induced by the secondary disaster of the earthquake lead to a high overall expense. The influencing factors include operation, ICU and the day of hospital ization. The relationship between the expense and the disease category largely depends on the classification criteria. The relationship between the expense and the age as well as the prognosis needs further study. But no correlation between the expense and the gender is found.