地震后危重多发伤患者野外条件下的救治体会

Experience on rescue of patients with severe multiple injuries after sudden disaster under field condition

目的:探讨突发灾难后危重多发伤患者在野外条件下的救治方案。方法和结果:患者女性,53岁,因"地震中骨盆砸伤、大量血尿"入院,呼吸困难,全腹压痛,褥疮。便携式B超示腹腔积液,左胸腔积液,膀胱破裂。便携式血气分析仪提示"严重贫血+低氧血症+低钾+酸中毒"。术前行左胸腔穿刺,膀胱穿刺引流。剖腹探查见直肠破裂(穿孔),遂行Harttman手术加膀胱造瘘术和抗感染治疗。术后第18日基本恢复。结论:术者具有精湛的技术和丰富的经验、充分发挥便携式设备的作用、依靠具有地理优势的当地医院、积极抗感染是艰苦环境下救治危重多发伤患者的成功因素。

Objective： To study the rescue strategy for patients with severe multiple injuries after sudden disaster under field condition. Methods and results： A 53-year-old female patient was referred to us after hit on the pelvis in the China Wenchuan earthquake. Her symptoms included large volume of hematuria, difficult breath, tenderness of the whole abdomen, and bedsore. Portable B ultrasound revealed effusion of abdomen and left chest cavity, and bladder rupture. Portable blood-gas analyzer indicated severe anemia ＋ hypoxemia ＋ hypokalemia ＋ acidosis. Drainage was done through left chest cavity aspiration and bladder aspiration. Abdominal examination found rectal rupture （perforation）, which was managed by Harttman＋ cystostomy followed by anti-infection treatment. The patient recovered 18 days after operation. Canclusion： The rich experience and skillful surgical management,the full play of portable equipment, the help from the local hospital, together with timely anti-infection management, are the keys to successful rescue of patients with severe multiple injuries under field condition.