533例汶川地震伤员感染流行病学分析与思考

Epidemiological analysis and thinking on infections in the 533 trauma patients following Chinese Wenchuan earthquake

目的探讨综合性医院在地震等自然灾害中的应急反应能力和对伤员感染的救治水平。方法选择2008年5月12日汶川大地震后转送至重庆6所三级甲等医院的533例地震伤员，结合创伤ISS和AIS评分，根据伤情及其与院内外感染的关系和抗生素敏感性等指标进行全面的回顾性分析。结果533例后送伤员中，ISS〈16分456例（85．6％）；ISS16～25分65例（12．2％），ISS〉25分12例（2．3％）。骨折433例（81、9％）。头、颈部损伤42例，面部损伤7例，胸部损伤114例，腹部、盆腔损伤8l例，四肢、骨盆损伤314例，体表损伤205例。仅有1处骨折180例，2处骨折139例，3处及以上骨折114例，截肢32例，挤压综合征21例，院内手术处理281例。感染79例，院外感染占87．3％。合并感染伤员抗生素敏感性实验结果显示，病原菌以大肠埃希氏菌、金黄色葡萄球菌、溶血葡萄球菌、肺炎克雷伯氏菌、鲍曼复合不动杆菌、阴沟肠杆菌、铜绿假单胞菌、C群链球菌为主，少数发生产气荚膜杆菌感染。敏感及耐药抗生素谱系各不相同且有部分重叠。抗生素选择应以头孢类和大环内酯类抗生素等为主。结论在自然灾害紧急条件下，对伴有不同程度感染的骨折伤员，科学使用抗生素并采取综合有效的防护性救治措施对于加强伤员早期救治，预防严重创伤并发症，促进伤员康复具有重要意义。

Objective To provide better emergency and patient services in well-equipped comprehensive hospitals, the organization and wisdom therapeutic strategy are of great importance for the recovery of injured patients from the earthquake zone. Method From 12 May 2008, following the 8.0 Magnitude earthquake in Wenchuan county of Sichuan Province, six Chongqing hospitals with third class in grade A were involved in the rescue of the injured patients with great effort. A total of 533 patients were retreated and followed up from quake zone. AU the patients were scored with ISS and AIS system. The profiles of the patients examined, operated and clinical infection investigation were documented. Resuits Of 533 patients, the number of the patients whose ISS is below 16 is 456 （83.6%） , the number between 16 and 25 is 65 （ 12.2% ） , and the number above 25 is 12 （2.3%）. The patients were classfled based on their fracture parts as follows： head and neck （n =42）, face （n =7）,chest （n = 114）, abdominal and cavitas pelvis （ n = 81 ）, limb and pelvis （ n = 314）, body surface （ n = 205 ）, with 180 single fracture site, 139 of them being two combined fracture sites, and 114 of them being above three combined fracture sites. Thirty-two of the patients were suffered from amputation. The number of patients suffered from crushing syndrome reached 21, with 281 surgical operations in hospitals. Seventy-nine patients were suffered from infections including 87.3% of pre-hospital infections. The results from bacteria euhure and antibiotic susceptibility showed that the infected bacteria mainly involved in Escherichia coli, Staphylococcus aureus, Staphylococcus haemolyticus, Klebsiella pneumoniae, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus, Bacillus aerogenes capsulatus. The antibiotic susceptibility to diverse bacteria has no obvious changes and exists partial overlapping, and infected patients should be given the treatment of cephalosporin, macrolide antibiotic and so on. Conclusions For the emergency conditions after the catastrophe, the comprehensive hospitals must be prepared to meet large quantities of severe trauma and infection therapy. The scientific selection of antibiotics in the combinative therapy is of great importance to the enhancement of early specific treatment, prevention of severe trauma complications and rehabilitation of patients.