汶川地震后什邡市周围神经损伤患者调查分析
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摘要
目的:筛查2008年汶川地震后9个月什邡市6个重灾镇的周围神经损伤患者,并调查这些患者接受康复指导与治疗的情况。方法:调查的什邡市六个重灾镇包括蓥华、红白、师古、八角、湔底和洛水。采用三级筛查方法:第一级,村医将所有在地震中受伤患者的名字列表;第二级,镇医对所有受伤的患者进行体格检查,挑选出可疑周围神经损伤的患者;第三级,来自北京大学第一医院的专家对经过两次筛查的患者进行再次体格检查,初步确定周围神经损伤的人群并定位损伤的神经。在进行第三级筛查的同时,对筛查的对象进行康复医疗状况的问卷调查。最后,对三级筛查出的可疑周围神经损伤的患者进行肌电图检查,确定肌电图表现出周围神经损伤的患者。结果:共有372例进入了第三级筛查。经过三级筛查后,140例存在疑似周围神经损伤,其中,31例(22%)存在疑似运动神经损伤,26例(19%)存在疑似感觉神经损伤,83例(59%)存在疑似混合神经损伤。对于所有疑似周围神经损伤的患者,仅42例(30%)接受过康复指导或治疗。105例进行了肌电图检查,48例存在周围神经损伤的异常肌电图表现。另外,进入第三级筛查的患者中123例存在疼痛,16例日常生活活动能力Barthel指数评测低于正常。结论:地震后9个月仍有许多存在周围神经损伤或疼痛或日常生活活动能力受限的患者,但是大多数人没有接受过康复指导或治疗。在重大灾难的救援中,需要关注潜在的周围神经损伤问题,并且及时给予康复治疗。
Objective:To screen the peripheral nerve injured in 6 disaster towns of Shifang City 9 months after Wenichuan earthquake in 2008 and carry out an investigation of rehabilitation instruction and rehabilitation for these injured.Method:There were 6 towns in Shifang City that were disaster regions,including Yinghua,Hongbai,Shigu,Bajiao,Jiandi and Luoshui.Three-grade screening method was used to detect the peripheral nerve injured.Firstly,the village doctors were asked to make sure which person had injury during the earthquake and listed their names.Secondly,the town doctors did the physical examination for the injured and diffentiated which ones were suspected of suffering peripheral nerve injury.Thirdly,the specialists from Peking University First Hospital did physical examination again to make sure if the person had peripheral nerve injury and located the injured nerve.Accompany with the third grade screening,a rehabilitation questionnaire was used to comprehend the rehabilitation circumstance of these injured after earthquake.After the three-grade screening,EMG examinations were tested for the suspected peripheral nerve injured to confirm the injuries manifested in EMG.Result:A total of 372 persons entered the third-grade screening and 140 of them were suspected suffering from peripheral nerve injury 9 months after earthquake.Among them,31(22%) cases were suspected suffering from motor nerve injury,26(19%) sensory nerve injury and 83 (59%) mixed nerve injury.Finally,105 persons had EMG examinations,48 cases of them had peripheral nerve injury abnormal manifests.For all the peripheral nerve injured,only 42 (30%) of them received rehabilitation instruction or treatment.In addition,123/372 persons had pain and 16/372 persons' Barthel indexes were less than normal.Conclusion:Nine months after earthquake,there were still many people had peripheral nerve injury or pain or the in basic activities of daily living were affected,but most of them hadn't rehabilitation instruction or treatment.It warns us that after serious disaster among the emergencies,there may be underlying peripheral nerve injury,so we should pay attention to this and carry out rehabilitation when needed.
Objective:To screen the peripheral nerve injured in 6 disaster towns of Shifang City 9 months after Wenichuan earthquake in 2008 and carry out an investigation of rehabilitation instruction and rehabilitation for these injured.Method:There were 6 towns in Shifang City that were disaster regions,including Yinghua,Hongbai,Shigu,Bajiao,Jiandi and Luoshui.Three-grade screening method was used to detect the peripheral nerve injured.Firstly,the village doctors were asked to make sure which person had injury during the earthquake and listed their names.Secondly,the town doctors did the physical examination for the injured and diffentiated which ones were suspected of suffering peripheral nerve injury.Thirdly,the specialists from Peking University First Hospital did physical examination again to make sure if the person had peripheral nerve injury and located the injured nerve.Accompany with the third grade screening,a rehabilitation questionnaire was used to comprehend the rehabilitation circumstance of these injured after earthquake.After the three-grade screening,EMG examinations were tested for the suspected peripheral nerve injured to confirm the injuries manifested in EMG.Result:A total of 372 persons entered the third-grade screening and 140 of them were suspected suffering from peripheral nerve injury 9 months after earthquake.Among them,31(22%) cases were suspected suffering from motor nerve injury,26(19%) sensory nerve injury and 83 (59%) mixed nerve injury.Finally,105 persons had EMG examinations,48 cases of them had peripheral nerve injury abnormal manifests.For all the peripheral nerve injured,only 42 (30%) of them received rehabilitation instruction or treatment.In addition,123/372 persons had pain and 16/372 persons' Barthel indexes were less than normal.Conclusion:Nine months after earthquake,there were still many people had peripheral nerve injury or pain or the in basic activities of daily living were affected,but most of them hadn't rehabilitation instruction or treatment.It warns us that after serious disaster among the emergencies,there may be underlying peripheral nerve injury,so we should pay attention to this and carry out rehabilitation when needed.
引文
[1]Magnitude of SW China earthquake revised to8.0.Xinhua News Agency.2008-5-18.
[2]汶川地震数据统计.新浪网.2008-6-8.
[3]姚元章,张连阳.急救绿色通道在严重创伤救治早期救治中的作用[J].中华创伤杂志,2008,24(4):268—270.
[4]刘世平,曹小平,邱里.5.12汶川地震伤病员的院前急救[J].中国煤炭工业医学杂志.2010,13(1):161—162.
[5]袁素平,杜光会,杨红.汶川地震大批伤员的救治与管理[J].中国医院管理,2008,28(6):5.
[6]沈骥,代小舟,赵万华,等.汶川地震四川省医疗救援反应力和有效性分析[J].四川行政学院学报,2010,3:83—86.
[7]刁明强,孙小康,彭志忠,等.一线三甲医院汶川地震1348例群体伤的救治分析[J].华西医学,2009,24(4):823—826.
[8]屈纪富,张雷,王静,等.火车转运汶川地震伤员的运前准备及途中救护[J].第三军医大学学报,2009,31(1):46—47.
[9]卢旻鹏,蒋电明,张华,等.四川汶川地震转运骨科伤员的临床特点和救治措施[J].使用医院临床杂志,2010,7(1):14—17.
[10]杜慧敏,于瑞英.汶川地震灾后群体伤员转运接收和护理管理[J].床上外科杂志,2009,11(1):84.
[11]陈忠兰,袁秀蓉,李晔,等.多学科合作模式治疗66例挤压综合征汶川地震伤员的效果分析[J].现代预防医学,2009,36(15):2993—2996.
[12]林金堆,黄建明.四川汶川地震后骨科伤员关节功能障碍治疗经验[J].实用医学杂志,2009,25(1):112—113.
[13]文艳秋,秦敏,付平,等.汶川地震77例挤压综合征伤员813例次血液净化治疗的组织管理[J].中国循证医学杂志,2008,8(7):492—495.
[14]蒋京京,徐海涛,王成才,等.汶川地震后野外条件下111例麻醉经验总结[J].临床军医杂志,2009,37(1):106—108.
[15]苏佳灿,李卓东,禹宝庆,等.汶川地震致周围神经损伤14例诊治体会[J].中国骨伤,2008,21(10):739—740.
[16]杨文涛,屈延,杨立斌,等.汶川地震中颅脑损伤的救治策略[J].西南国防医药,2009,19(4):400—401.
[17]杨玉龙,常有军,潘福琼.针灸联合康复治疗汶川地震伤员截肢后幻肢痛疗效观察[J].实用医院临床杂志,2010,7(1):53—55.
[18]薛云珍,卢莉,梁执群,等.地震灾区患者不同性别心理干预前后比较研究[J].中国康复医学杂志,2009,24(12):1128—1130.
[19]周小东,刘潇,庄宁,等.简易、快捷的心理危机干预在汶川地震中的运用[J].华北国防医药,2008,20(3):1—3.
[20]沈世琴,吴娅利,张敏.认知行为团体辅导对汶川地震伤员焦虑及抑郁情绪的影响[J].检验医学与临床,2010,7(9):825—826.
[21]陈春媚.四川汶川地震伤员心理干预护理体会[J].临床医学工程,2010,17(1):104—105.
[22]李永清,刘昌弟,向定全,等.5.12汶川地震后绵阳市症状监测分析[J].现代预防医学,2010,37(1):147—150.
[23]祝小平,唐雪峰,方刚,等.汶川地震灾后恢复重建期的卫生防病工作[J].中国循证医学杂志,2010,10(7):791—799.
[24]袁菊莲,代庆凯,段鑫,等.地震后下肢截肢患者综合康复治疗的疗效分析[J].中国康复医学杂志,2009,24(8):741—743.
[25]宗慧燕,王晓红,励建安.地震伤后T11完全性脊髓损伤并左肩离断康复治疗1例报告[J].中国康复医学杂志,2009,24(5):453—454.
[26]杨扬,何成奇,伊伟恩.地震所致挤压综合征的康复疗效分析[J].中国康复医学杂志,2009,24(12):1134—1135.
[27]胡卫建,赵万华,李元峰,等.汶川地震伤员的紧急医疗分级救治分析[J].实用医院临床杂志,2010,7(1):20—24.
[28]张霞,卞荣,励建安,等.四川江油地震伤员康复状况分析[J].中国康复医学杂志,2009,24(1):5—8.
[29]刘守国,励建安,艾金飞,等.四川省北川中学地震伤员康复情况调查分析[J].中国康复医学杂志,2009,24(8):680—683.
[30]杜春萍,康霞,谢国省,等.汶川地震伤员的康复护理质量管理[J].中国康复理论与实践,2009,15(3):296.
[31]卓大宏.在地震救援及灾区重建中充分发挥康复医学的作用[J].中国康复医学杂志,2008,23(6):483—486.
[32]何成奇,王茂斌,励建安,等.应急康复专家体系在汶川地震伤员康复治疗中的作用[J].华西医学,2009,24(3):524—526.
[33]蓝谢,赵新,张筱烽.铭记伤痛,展望未来——汶川地震为四川社区康复带来的机遇和发展[J].中国卫生事业管理,2009,3:157.
[34]陈勤,薛力.成都市第三人民医院院内救治汶川地震伤员563例分析[J].实用医院临床杂志,2010,7(1):33—36.
[2]汶川地震数据统计.新浪网.2008-6-8.
[3]姚元章,张连阳.急救绿色通道在严重创伤救治早期救治中的作用[J].中华创伤杂志,2008,24(4):268—270.
[4]刘世平,曹小平,邱里.5.12汶川地震伤病员的院前急救[J].中国煤炭工业医学杂志.2010,13(1):161—162.
[5]袁素平,杜光会,杨红.汶川地震大批伤员的救治与管理[J].中国医院管理,2008,28(6):5.
[6]沈骥,代小舟,赵万华,等.汶川地震四川省医疗救援反应力和有效性分析[J].四川行政学院学报,2010,3:83—86.
[7]刁明强,孙小康,彭志忠,等.一线三甲医院汶川地震1348例群体伤的救治分析[J].华西医学,2009,24(4):823—826.
[8]屈纪富,张雷,王静,等.火车转运汶川地震伤员的运前准备及途中救护[J].第三军医大学学报,2009,31(1):46—47.
[9]卢旻鹏,蒋电明,张华,等.四川汶川地震转运骨科伤员的临床特点和救治措施[J].使用医院临床杂志,2010,7(1):14—17.
[10]杜慧敏,于瑞英.汶川地震灾后群体伤员转运接收和护理管理[J].床上外科杂志,2009,11(1):84.
[11]陈忠兰,袁秀蓉,李晔,等.多学科合作模式治疗66例挤压综合征汶川地震伤员的效果分析[J].现代预防医学,2009,36(15):2993—2996.
[12]林金堆,黄建明.四川汶川地震后骨科伤员关节功能障碍治疗经验[J].实用医学杂志,2009,25(1):112—113.
[13]文艳秋,秦敏,付平,等.汶川地震77例挤压综合征伤员813例次血液净化治疗的组织管理[J].中国循证医学杂志,2008,8(7):492—495.
[14]蒋京京,徐海涛,王成才,等.汶川地震后野外条件下111例麻醉经验总结[J].临床军医杂志,2009,37(1):106—108.
[15]苏佳灿,李卓东,禹宝庆,等.汶川地震致周围神经损伤14例诊治体会[J].中国骨伤,2008,21(10):739—740.
[16]杨文涛,屈延,杨立斌,等.汶川地震中颅脑损伤的救治策略[J].西南国防医药,2009,19(4):400—401.
[17]杨玉龙,常有军,潘福琼.针灸联合康复治疗汶川地震伤员截肢后幻肢痛疗效观察[J].实用医院临床杂志,2010,7(1):53—55.
[18]薛云珍,卢莉,梁执群,等.地震灾区患者不同性别心理干预前后比较研究[J].中国康复医学杂志,2009,24(12):1128—1130.
[19]周小东,刘潇,庄宁,等.简易、快捷的心理危机干预在汶川地震中的运用[J].华北国防医药,2008,20(3):1—3.
[20]沈世琴,吴娅利,张敏.认知行为团体辅导对汶川地震伤员焦虑及抑郁情绪的影响[J].检验医学与临床,2010,7(9):825—826.
[21]陈春媚.四川汶川地震伤员心理干预护理体会[J].临床医学工程,2010,17(1):104—105.
[22]李永清,刘昌弟,向定全,等.5.12汶川地震后绵阳市症状监测分析[J].现代预防医学,2010,37(1):147—150.
[23]祝小平,唐雪峰,方刚,等.汶川地震灾后恢复重建期的卫生防病工作[J].中国循证医学杂志,2010,10(7):791—799.
[24]袁菊莲,代庆凯,段鑫,等.地震后下肢截肢患者综合康复治疗的疗效分析[J].中国康复医学杂志,2009,24(8):741—743.
[25]宗慧燕,王晓红,励建安.地震伤后T11完全性脊髓损伤并左肩离断康复治疗1例报告[J].中国康复医学杂志,2009,24(5):453—454.
[26]杨扬,何成奇,伊伟恩.地震所致挤压综合征的康复疗效分析[J].中国康复医学杂志,2009,24(12):1134—1135.
[27]胡卫建,赵万华,李元峰,等.汶川地震伤员的紧急医疗分级救治分析[J].实用医院临床杂志,2010,7(1):20—24.
[28]张霞,卞荣,励建安,等.四川江油地震伤员康复状况分析[J].中国康复医学杂志,2009,24(1):5—8.
[29]刘守国,励建安,艾金飞,等.四川省北川中学地震伤员康复情况调查分析[J].中国康复医学杂志,2009,24(8):680—683.
[30]杜春萍,康霞,谢国省,等.汶川地震伤员的康复护理质量管理[J].中国康复理论与实践,2009,15(3):296.
[31]卓大宏.在地震救援及灾区重建中充分发挥康复医学的作用[J].中国康复医学杂志,2008,23(6):483—486.
[32]何成奇,王茂斌,励建安,等.应急康复专家体系在汶川地震伤员康复治疗中的作用[J].华西医学,2009,24(3):524—526.
[33]蓝谢,赵新,张筱烽.铭记伤痛,展望未来——汶川地震为四川社区康复带来的机遇和发展[J].中国卫生事业管理,2009,3:157.
[34]陈勤,薛力.成都市第三人民医院院内救治汶川地震伤员563例分析[J].实用医院临床杂志,2010,7(1):33—36.
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