摘要目的 探讨阶梯救治原则在地震灾害紧急医疗救援中的应用价值和方法改进.方法 对参加四川汶川大地震的现场医疗急救、前方医院和后方医院的医疗工作进行总结分析.结果 现场救治伤员4 689例次,处置危重伤员413例,完成清创术等各类手术197例,3例重伤员死亡,开放伤口感染率近80%;前方医院收治伤员1 400多例次,完成手术200台次,抢救危重伤员110例次,截肢率3.0%,伤口感染率66.8%;后方医院为125例伤员开展了1-5次/部位的确定性手术治疗,术后无医院感染,无死亡,无截肢.结论 阶梯救治原则是重大自然灾害批量伤员救治的基本原则,急救人员应尽早开展现场急救;后送力量是保障救治成功率的重要因素,完善伤票制度能显著提高救治效率;前方医院主要开展生命支持、创面处理和简单骨折的救治工作;确定性专科治疗应在后方医院进行.

abstractsObjective To discuss the application value and improvement of principle of multi-echelon medical care in emergent rescue of the injured in Chinese Wenchuau earthquake. Methods The author analyzed and evaluated the medical rescue that was done at disaster site, in the front line hospital and higher level hospitals during earthquake. Results A total of 4 689 patients were treated at disaster site, including 413 patients with severe injury, of whom 3 died. Different kinds of operations including debridement were performed at disaster site, with infection incidence of open wound was nearly 80%. In the front hne hospital, 1 400 patients were treated, with 200 operations done. Of all, 110 patients with severe trauma were treated emergenfly, with an amputation rate of 3.0% and postoperative infection incidence of 66.8%. In the station hospitals, 125 patients received definite surgeries, with 1-5 surgeries per injury site. There was no postoperative cross infection, amputation or death. Conclusions The multi-echelon medical care is the basic mode for medical rescue of large number of patients in natural disaster rescue. First aid at disaster site should be performed as early as possible. Transportation is crucial for successful rescue and an improved patient grading system can help increase the efficiency of rescue. The front line hospitals should mainly provide life support, debridement and fixation of simple fracture, while the specific treatment and definite surgery should be carried out in the station hospitals.