| Part One The Wenchuan earthquake:Epidemiological analysis of 1070 earthquake victimsObjective To provide a epidemiologic survey of patients admitted in Chengdu Army General Hospital,Sichuan,China,after the 2008 Wenchuan earthquake.Method Retrospective analysis of the medical records of 1070 earthquake victims transferred to Chengdu Army General Hospital from 5.12 to 5.28. Patients' demographic data,diagnosis,dispositions,prognosis and treatments were reviewed based on investigational questionnaires and the medical records.Result A total of 1070 patients with earthquake related injuries and illness admitted to our Chengdu Army General hospital from 5.12 to 5.28,and 692 patients(64.7%)were transferred here within the first 48h after the earthquake. About 66.4%of total 1070 patients were suffered from bone juries.The most frequent injuries were extremity fractures(34.7%),the else injuries included soft tissue injure(17.9%),spinal fracture(11.4%),pelvic fracture(4.6%)and crush syndrome(1.6%).The overall mortality rate was 0.5%(5/1070),and three of the death were crush syndrome patients,the other two of them died from abdominal injury with hemorrhagic shock and non-traumatic but earthquake related illness(cardiac infarction)。Conclusion Bone related injuries were the most common type of trauma induced by the earthquake.And in the first 24-48 hours after earthquake,hospital emergency departments are flooded with the largest number of patients,so it is important for government and rescue organizations to help hospitals to enforce proper triage and prompt treatments.The mortality of crush syndrome patients is high,which need more attention and strong medical support.Part Two The Wenchuan earthquake:Epidemiological analysis of 17 earthquake victims with crush syndromeObjective To analyze the epidemiological characteristics of the crush syndrome victims of wenchuan earthquake,and to assess the treatment and outcome of these patients.Methods In order to analyze the clinical characteristics,treatment and outcome,special questionnaires were sent out to all crush syndrome victims of wenchuan earthquake admitted in chengdu PLA general hospital.Results From 14thto 30thMay 2008,of the 1070 hospitalized patients in chengdu PLA general hospital,17(1.6%)patients suffered from crushing syndrome.There was no significant difference between mobidity of male and female.And 94.1%patient were adults within the range of 20-59 years.52.9%patients underwent fasciotomy and 47.1%had amputations directly.Oliguria and renal dysfunction were seen in 8 patients and 4 of them underwent dialysis,two of them suffered acute respiratory distress syndrome(ARDS),and one patient died of diffuse intravascular coagulation(DIC)and multiple organ dysfunction(MODS).Conclusion In case of severe earthquake,Crush syndrome victims should be rapidly transferred to undamaged general hospital.The proper measurements such as fasciotomy,amputation together with dialysis would reduce the mortality of crushing syndrome. Part three The relationship of compression area,time and weight with crush injury in rats and the experimental model of crush syndrome in ratsObjective To investigate the relationship of compression area,time and weight as risky factor with crush injury in rats,and try to establish the experimental model of crush syndrome induced by crush injury of hind limb in rats.Methods 144 male SD rats were divided into 2 groups:mortality investigation group and biochemical indicator investigation group.Every group include the same 18 subgroups based on 18 kinds of combination with different levels of compression area(the fight or both hind limbs),time(4h,6h,8h)and weight(2kg,3kg,4kg). In other words,the fight or both hindlimbs of anesthetized rats were compressed for different hours under blocks weighing different kinds of kilograms,which were followed by 3 hours of reperfusion.The circumference of the compressed hindlimb(s)of all rats were measured before compression and 3 hours of reperfusion.Incidence of myoglobinuria of all rats was recorded too.The mortality within 7 days of the rats in mortality investigation group was recorded.Serum potassium(K+),Serum creatine phosphokinase(CK),creatinine and carbamide were measured at before compression as baseline and 3 hours of reperfusion. Muscles and kidneys were evaluated morphologically in this group.Results the compressed hindlimb(s)of all rats swelled significantly after 3hs reperfusion.The mortalities of rats with different compressed area(mono-/ambo-hindlimbs)were 2.8%and 50%(p＜0.05),and mortalities with different compressed weight(2kg, 3kg,4kg)were 4.2%,29.2%and 45.8%respectively(p＜0.05),and mortalities with different compressed time(4h,6h,8h)were 25%,20.8%and 33.3% (p＞0.05).Serum K+,CK,CR and BUN all increased significantly with the increase and prolongation of the compression area,time and weight(p＜0.05). Signs of direct cellular damage and ischemia-reperfusion injury were found in histology specimens of local compressed muscle.And the hyperemia of glomeruli and renal tubular necrosis and renal tubular cast.Conclusion Increase and prolongation of the compression area,time and weight could aggravate the crush injury,and compression area is more risky factor of sever crush injury.Both hind limbs as compression area,block weighing＞3kg as compression weight and over 6h as compression time could be the effective experimental condition of establishing crush syndrome model in rats.
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