玉树地震高原医疗救援——特殊性及其对策

Highland medical rescue in Yushu earthquake——particularity and countermeasures

目的 2010年4月10日发生在玉树的里氏7.1级地震是世界最高海拔(4000m)青藏高原腹地藏区的大地震,由于救援行动面临高寒缺氧、气候恶劣、地处偏远、交通受阻、伤员高度分散等挑战,故总结高原医疗救援所遇的特殊问题及应采取的对策。方法对玉树地震的伤情特点及死亡原因加以分析,并与汶川地震的伤情分类、严重度、死亡原因及死亡时间分布相比较。分析高原地震创伤学的特殊问题。结果玉树地震与平原地震相比,在创伤学与死亡原因上有很大不同。由于藏区居民房屋的土木沙石结构,地震使90%以上房屋倒塌,形成玉树地震以压埋伤为主和以窒息为主的死因,必须在第一时间采取紧急救援措施。在高原低氧的复合损伤下,各型创伤均易于并发急性呼吸窘迫综合征及多脏器功能障碍综合征,必须紧急救治。为此针对玉树地震高原医疗救援的特殊性,提出了一系列防护措施。结论根据伤亡特点,震后48h进入死亡高峰期,为此强调高原地震"黄金48h"的急救概念。快速有组织向低海拔转运伤病员及转运中供氧是急救成功的两个关键。青藏高原是地震频发区,医疗救援必须加强。

Objective To summarize the special problems and corresponding countermeasures of highland medical rescue as a result of the challenges such as high cold and anoxia, bad weather, remote distance, traffic congestion and highly disperse casualties faced by the rescue activities in the Richter scale 7.1 earthquake that happened in Yushu on April 10, 2010, which was a violent earthquake that happened in the interior Tibetan region of Qinghai-Tibet Plateau with the world''s highest altitude(4000 meters). Methods The features of injuries and the causes of death in Yushu earthquake were analyzed and compared to the classification of injuries, severity, causes of death and death time distribution in Wenchuan earthquake. The special traumatology problems of highland earthquake were analyzed. Results Yushu earthquake and plain earthquake were remarkably different in the traumatology and causes of death. Due to the soil, wood, sand and gravel structure of residential houses in Tibetan region, over 90%of houses collapsed in the earthquake, making crushing and burying injuries the main causes of death in Yushu earthquake, and emergency rescue measures had to be taken immediately. Due to the composite injuries caused by highland hypoxia, various kinds of trauma were liable to be complicated by acute respiratory distress syndrome and multiple organ dysfunction syndrome, and emergency aid and treatment had to be conducted. Therefore, aiming at the particularity of highland medical rescue in Yushu earthquake, a series of protective measures were proposed. Conclusion Based on the features of casualties, 48 hours after earthquake is the death peak period, thus the'Golden 48 hours'emergency rescue concept in highland earthquake is emphasized. Fast and organized transfer of the wounded people to low altitude and oxygen supply during transfer are the two keys of successful emergency rescue. Qingdao-Tibetan Plateau is an earthquake-prone area and therefore medical rescue has to be strengthened.