空难坠落伤 幸存过“三关”
时间：2022-03-23 14:34:01 来源：农村医药报 浏览量：
刘中民 王立祥
3月21日，东航一架波音737客机在梧州上空失联坠毁，机上132名乘客牵动亿万人民的心。无疑空难坠落伤是导致乘客生死存亡的重要因素，空难坠落伤属于创伤的一种类型，创伤是威胁人们生命健康的一大元凶，据世界卫生组织报告，其造成全球人类10%的死亡和16%的残疾，是儿童和44岁以下青壮年死亡的首位原因。我国每年死于各类创伤的总人数70余万，在人口死因中占第4位，且呈持续上升趋势。某种意义上说，空难坠落伤引发的创伤性心脏骤停是影响创伤死亡转归的关键一环，空难外部暴力作用于人体，产生机械性损伤和失血缺氧，引发的心搏、呼吸、意识停止的临床心脏骤停综合征，也称濒临死亡状态。深刻的认识空难坠落伤心脏骤停的发生发展过程，对于我们采取相应的建立人工循环和呼吸的起死回生心肺复苏术甚为重要，故空难坠落伤时，救援者要帮助幸存者过好“三关”。
【CGTN今日亚州】采访同济大学灾难医学工程研究院院长刘中民教授
第一关：空难坠落伤引发的创伤性心脏骤停的第一个死亡高峰，是在空难坠落伤后几分钟就可出现创伤性心脏骤停，有50%即时死亡，此刻与死神赛跑，对幸存者主要防控心脑重要脏器及大血管毁损导致的创伤性心脏骤停。
第二关：空难坠落伤引发的创伤性心脏骤停的第二个死亡高峰，空难创伤后数分钟内可出现创伤性心脏骤停，如何把控好创伤抢救这一“黄金时间”，主要防控低血容量性休克、窒息、张力性气胸、心包填塞、挤压综合征、颅脑损伤和脑疝等。
第三关：空难坠落伤引发的创伤性心脏骤停的第三个死亡高峰，空难创伤后数周可出现创伤性心脏骤停，创伤患者虽经过抢救伤情已控制，基于患者伤情复杂及抵抗力下降等诸多因素，主要防控严重感染或器官功能衰竭导致的创伤性心脏骤停。
空难坠落伤导致的创伤性心脏骤停心电图特征亦是心室静止、心电分离、心室纤颤3种表现形式，与既往报道心脏骤停患者的初始心率为心室颤动者占80%截然不同。空难坠落伤导致的心脏骤停属于创伤性心脏骤停的一种类型，而创伤性心脏骤停的首发心律表现为室颤者＜3%、无脉电活动30～60%，并恶化为心电静止，很显然这有别于非暴力导致的非创伤性心脏骤停患者初始心律排序，故对空难伤导致的心脏骤停，需因人而异、因地制宜的采取个体化心肺复苏防治救方略，以利提升空难创伤性心脏骤停心肺复苏的生存率。
参考文献:
[1]World Health Organization. Health statistics and information systems: disease, injury and causes ofdeath regional estimates, 2000-2012[EB/OL].[2020-01-16]. https://www.who.int/healthinfo/global_burden_disease/estimates_regional_2000_2012/en/.
[2]Hopson LR, Hirsh E, Delgado J, et al. National Association of EMS Physicians Standards and Clinical Practice Committee; American College of Surgeons Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest[J]. J Am Coll Surg, 2003, 196(3): 475-481. doi: 10.1016/s1072-7515(03)00229-1.
[3]王一镗.创伤性心搏骤停的复苏[J].急诊医学,1999,8(3):145-147.DOI:10.3760/j.issn:1671-0282.1999.03.001.
Wang YT. Resuscitation from traumatic cardiac arrest [J]. J Emerg Med, 1999, 8(3): 145-147. DOI: 10.3760/j.issn:1671-0282.1999.03.001.
[4]王正国.创伤研究进展[J].临床外科杂志,2007,15(11):727-730.DOI:10.3969/j.issn.1005-6483.2007.11.001.
Wang ZG. Advance in trauma research [J]. J Clin Surg, 2007, 15(11): 727-730. DOI: 10.3969/j.issn.1005-6483.2007.11.001.
[5]王立祥.论战创伤心脏呼吸骤停的精准心肺复苏模式[J].解放军医学杂志, 2016, 41(4): 263-266 DOI: 10.11855/j.issn.0577-7402.2016.04.01.
Wang LX. The precise cardiopulmonary resuscitation of cardiopulmonary arrest due to war trauma[J]. Med J Chin PLA, 2016, 41(4): 263-266 DOI: 10.11855/j.issn.0577-7402.2016.04.01.
[6]中国研究型医院学会心肺复苏学专业委员会.2016中国心肺复苏专家共识[J].中华危重病急救医学, 2016, 28(12): 1059-1079. DOI:10.3760/cma.j.issn.2095-4352.2016.12.002.
Cardiopulmonary Resuscitation Specialized Committe. 2016 National consensus on cardiopulmonary resuscitation in China [J]. Chin Crit Care Med, 2016, 28(12): 1059-1079. DOI: 10.3760/cma.j.issn.2095-4352.2016.12.002.
[7]姜笃银,赵洁,王兴蕾等.创伤性心搏骤停预防策略[J].中华危重病急救医学,2020,32(4):508-512.DOI: 10.3760/cma.j.cn121430-20200122-00093.
Jiang DY, Zhao J, Wang XL, et al. Prevention strategies for traumatic cardiac arrest [J]. Chin Crit Care Med, 2020, 32(4): 508-512.DOI: 10.3760/cma.j.cn121430-20200122-00093.
[8]冯庚.创伤性心搏骤停[J].中华卫生应急电子杂志, 2018, 4(2): 117-120. DOI: 10.3877/cma.j.issn.2095-9133.2018.02.013.
Feng G. Traumatic cardiac arrest[J]. Chin J Hygiene Rescue (Electronic Edition), 2018, 4(2): 117-120. DOI: 10.3877/cma.j.issn.2095-9133.2018.02.013.
[9]中华医学会创伤学分会创伤感染学组, 中华医学会创伤学分会创伤急救与多发伤学组. 创伤后并发症的定义与诊断专家共识[J].中华创伤杂志, 2013, 29(6): 481-484. DOI: 10.3760/cma.j.issn.1001-8050.2013.06.001.
Trauma infection Group, Trauma first aid and Multiple Trauma Group, Chinese Society of Traumatology, Chinese Medical Association. Expert consensus on the definition and diagnosis of post-traumatic complications[J]. Chin J Trauma, 2013, 29(6): 481-484. DOI: 10.3760/cma.j.issn.1001-8050.2013.06.001.
[10]中国腹部心肺复苏协作组.经膈肌下抬挤心肺复苏共识[J].中华急诊医学杂志,2014,23(4):369-370.DOI: 10.3760/cma.j.issn.1671-0282.2014.04.003.
Chinese Abdominal cardiopulmonary resuscitation Cooperative Group. Consensus for cardiopulmonary resuscitation by subdiaphragmatic compression [J]. Chin J Emerg Med, 2014, 23(4): 369-370. DOI: 10.3760/cma.j.issn.1671-0282.2014.04.003.
[11]中国腹部提压心肺复苏协作组.腹部提压心肺复苏专家共识[J].中华急诊医学杂志,2013,22(9):957-959.DOI: 10.3760/cma.j.issn.1671-0282.2013.09.004.
China Abdominal lift and Pressure CARDIopulmonary resuscitation cooperative group. Abdominal lift and pressure CARDIopulmonary resuscitation expert consensus [J]. Chin J Emerg Med, 2013, 22(9): 957-959. DOI: 10.3760/cma.j.issn.1671-0282.2013.09.004.
[12]中国研究型医院学会心肺复苏学专业委员会.《中国心肺复苏专家共识》之腹部提压心肺复苏临床操作指南[J]. 中华危重病急救医学, 2019, 31(4): 385-389. DOI: 10.3760/cma.j.issn.2095-4352.2019.04.001.
Cardiopulmonary Resuscitation Professional Committee of Chinese Research Hospital Society. Chinese expert consensus on cardiopulmonary resuscitation guidelines for the operation of active abdominal compression-decompression cardiopulmonary resuscitation [J]. Chin Crit Care Med, 2019, 31(4): 385-389. DOI: 10.3760/cma.j.issn.2095-4352.2019.04.001.
[13]刘中民,王立祥.灾难心理救援[M]//灾难医学.北京:人民军医出版社,2021:331-341.
Liu ZM, Wang LX. Disaster psychological assistance [M]// Disaster medicine. Beijing: People's Military Medical Press, 2021: 331-341.
[14]王立祥,刘中民.中国心肺复苏建设概论[J].中华危重病急救医学,2021,33(9):1029-1031.DOI:10.3760/cma.j.cn121430-20210901-01307.
Wang ZX, Liu ZM. Construction of China's cardiopulmonary resuscitation [J]. Chin Crit Care Med, 2021, 33(9): 1029-1031. DOI: 10.3760/cma.j.cn121430-20210901-01307.
第二关：空难坠落伤引发的创伤性心脏骤停的第二个死亡高峰，空难创伤后数分钟内可出现创伤性心脏骤停，如何把控好创伤抢救这一“黄金时间”，主要防控低血容量性休克、窒息、张力性气胸、心包填塞、挤压综合征、颅脑损伤和脑疝等。
第三关：空难坠落伤引发的创伤性心脏骤停的第三个死亡高峰，空难创伤后数周可出现创伤性心脏骤停，创伤患者虽经过抢救伤情已控制，基于患者伤情复杂及抵抗力下降等诸多因素，主要防控严重感染或器官功能衰竭导致的创伤性心脏骤停。
空难坠落伤导致的创伤性心脏骤停心电图特征亦是心室静止、心电分离、心室纤颤3种表现形式，与既往报道心脏骤停患者的初始心率为心室颤动者占80%截然不同。空难坠落伤导致的心脏骤停属于创伤性心脏骤停的一种类型，而创伤性心脏骤停的首发心律表现为室颤者＜3%、无脉电活动30～60%，并恶化为心电静止，很显然这有别于非暴力导致的非创伤性心脏骤停患者初始心律排序，故对空难伤导致的心脏骤停，需因人而异、因地制宜的采取个体化心肺复苏防治救方略，以利提升空难创伤性心脏骤停心肺复苏的生存率。
参考文献:
[1]World Health Organization. Health statistics and information systems: disease, injury and causes ofdeath regional estimates, 2000-2012[EB/OL].[2020-01-16]. https://www.who.int/healthinfo/global_burden_disease/estimates_regional_2000_2012/en/.
[2]Hopson LR, Hirsh E, Delgado J, et al. National Association of EMS Physicians Standards and Clinical Practice Committee; American College of Surgeons Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest[J]. J Am Coll Surg, 2003, 196(3): 475-481. doi: 10.1016/s1072-7515(03)00229-1.
[3]王一镗.创伤性心搏骤停的复苏[J].急诊医学,1999,8(3):145-147.DOI:10.3760/j.issn:1671-0282.1999.03.001.
Wang YT. Resuscitation from traumatic cardiac arrest [J]. J Emerg Med, 1999, 8(3): 145-147. DOI: 10.3760/j.issn:1671-0282.1999.03.001.
[4]王正国.创伤研究进展[J].临床外科杂志,2007,15(11):727-730.DOI:10.3969/j.issn.1005-6483.2007.11.001.
Wang ZG. Advance in trauma research [J]. J Clin Surg, 2007, 15(11): 727-730. DOI: 10.3969/j.issn.1005-6483.2007.11.001.
[5]王立祥.论战创伤心脏呼吸骤停的精准心肺复苏模式[J].解放军医学杂志, 2016, 41(4): 263-266 DOI: 10.11855/j.issn.0577-7402.2016.04.01.
Wang LX. The precise cardiopulmonary resuscitation of cardiopulmonary arrest due to war trauma[J]. Med J Chin PLA, 2016, 41(4): 263-266 DOI: 10.11855/j.issn.0577-7402.2016.04.01.
[6]中国研究型医院学会心肺复苏学专业委员会.2016中国心肺复苏专家共识[J].中华危重病急救医学, 2016, 28(12): 1059-1079. DOI:10.3760/cma.j.issn.2095-4352.2016.12.002.
Cardiopulmonary Resuscitation Specialized Committe. 2016 National consensus on cardiopulmonary resuscitation in China [J]. Chin Crit Care Med, 2016, 28(12): 1059-1079. DOI: 10.3760/cma.j.issn.2095-4352.2016.12.002.
[7]姜笃银,赵洁,王兴蕾等.创伤性心搏骤停预防策略[J].中华危重病急救医学,2020,32(4):508-512.DOI: 10.3760/cma.j.cn121430-20200122-00093.
Jiang DY, Zhao J, Wang XL, et al. Prevention strategies for traumatic cardiac arrest [J]. Chin Crit Care Med, 2020, 32(4): 508-512.DOI: 10.3760/cma.j.cn121430-20200122-00093.
[8]冯庚.创伤性心搏骤停[J].中华卫生应急电子杂志, 2018, 4(2): 117-120. DOI: 10.3877/cma.j.issn.2095-9133.2018.02.013.
Feng G. Traumatic cardiac arrest[J]. Chin J Hygiene Rescue (Electronic Edition), 2018, 4(2): 117-120. DOI: 10.3877/cma.j.issn.2095-9133.2018.02.013.
[9]中华医学会创伤学分会创伤感染学组, 中华医学会创伤学分会创伤急救与多发伤学组. 创伤后并发症的定义与诊断专家共识[J].中华创伤杂志, 2013, 29(6): 481-484. DOI: 10.3760/cma.j.issn.1001-8050.2013.06.001.
Trauma infection Group, Trauma first aid and Multiple Trauma Group, Chinese Society of Traumatology, Chinese Medical Association. Expert consensus on the definition and diagnosis of post-traumatic complications[J]. Chin J Trauma, 2013, 29(6): 481-484. DOI: 10.3760/cma.j.issn.1001-8050.2013.06.001.
[10]中国腹部心肺复苏协作组.经膈肌下抬挤心肺复苏共识[J].中华急诊医学杂志,2014,23(4):369-370.DOI: 10.3760/cma.j.issn.1671-0282.2014.04.003.
Chinese Abdominal cardiopulmonary resuscitation Cooperative Group. Consensus for cardiopulmonary resuscitation by subdiaphragmatic compression [J]. Chin J Emerg Med, 2014, 23(4): 369-370. DOI: 10.3760/cma.j.issn.1671-0282.2014.04.003.
[11]中国腹部提压心肺复苏协作组.腹部提压心肺复苏专家共识[J].中华急诊医学杂志,2013,22(9):957-959.DOI: 10.3760/cma.j.issn.1671-0282.2013.09.004.
China Abdominal lift and Pressure CARDIopulmonary resuscitation cooperative group. Abdominal lift and pressure CARDIopulmonary resuscitation expert consensus [J]. Chin J Emerg Med, 2013, 22(9): 957-959. DOI: 10.3760/cma.j.issn.1671-0282.2013.09.004.
[12]中国研究型医院学会心肺复苏学专业委员会.《中国心肺复苏专家共识》之腹部提压心肺复苏临床操作指南[J]. 中华危重病急救医学, 2019, 31(4): 385-389. DOI: 10.3760/cma.j.issn.2095-4352.2019.04.001.
Cardiopulmonary Resuscitation Professional Committee of Chinese Research Hospital Society. Chinese expert consensus on cardiopulmonary resuscitation guidelines for the operation of active abdominal compression-decompression cardiopulmonary resuscitation [J]. Chin Crit Care Med, 2019, 31(4): 385-389. DOI: 10.3760/cma.j.issn.2095-4352.2019.04.001.
[13]刘中民,王立祥.灾难心理救援[M]//灾难医学.北京:人民军医出版社,2021:331-341.
Liu ZM, Wang LX. Disaster psychological assistance [M]// Disaster medicine. Beijing: People's Military Medical Press, 2021: 331-341.
[14]王立祥,刘中民.中国心肺复苏建设概论[J].中华危重病急救医学,2021,33(9):1029-1031.DOI:10.3760/cma.j.cn121430-20210901-01307.
Wang ZX, Liu ZM. Construction of China's cardiopulmonary resuscitation [J]. Chin Crit Care Med, 2021, 33(9): 1029-1031. DOI: 10.3760/cma.j.cn121430-20210901-01307.
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