从疾病谱变化规律划分灾难医学

感谢 ：作者 刘爱兵 王海燕 郝钦芳 席梅 曲国胜
【摘要】目的探讨划分地震灾难后医学救援阶段的方法及其意义、方法 按WHO灾难医学救援疾
病分类法，分为外伤／伤口、急性上呼吸道感染、急性出血性肠炎、急性肠炎和其他共5类疾病。以对巴基
斯坦和印尼两次国际救援中所救治的疾病种类为依据， 分析灾后3～37 d疾病谱变化规律，划分出地震灾
难医学救援三个阶段。结果 灾后1周内，外伤／伤口类疾病为主． 巴基斯坦和印尼分别占61．46％ ～
79．52％和61．48％ ～72 35％ 。1周后，其它类内科疾病明显上升，分别占33 93％ ～71．11％ 和31．50％ ～
52 11％ ；且急性呼吸道感染疾病发病率较高。印尼灾后6～16 d， 出血性肠炎病洌时有检出(6／2779)，约
占2／1000人； 巴基斯坦灾区未检出出血性肠炎病例，急性肠炎检出例数较高，约占35／1000人。结论 将
灾难医学救援时问划分为：① 早期或应急期(灾昏6 d内)，以外伤／伤口类疾病为主．抢救生命为首位。②
中期或亚急期(灾后7～30 d)，各类疾病均有较高发生率．．此期需要大量医疗资源以降低患者致残率、治
疗上呼吸道感染、防治传染病暴发流行。③ 晚期或恢复期(灾后1～3个月)，疾病谱接近或略高于当地常
见病、多发病。此期当地医疗自救能力仍差，需要大营医疗资源以治疗各类疾病， 同时应重视卫生防疫工
作。三个阶段的划分对指导灾区疾病救冶、传染病防治、医疗资源的调用有指导意义。对参加国际救援时，
出队时间掌握， 各类人员、专业、药品器材及设备的配备奠定基础。对当地政府灾害自救决策和我国政府
实施救援决策提供客观依据。
【关键词】地震灾难；救援阶段；疾病谱
Stages of medical rescue after disaster based on clinical features and their significance L1U Ai—bing ， WANG Hai—
yang，HAO Qing-fang，Xl Mei，QU Guo—sheng． Department ofInspection，General Hospital ofChinese People's Armed
Police Forces，Beijing 100039，China
【Abstract】Objective To define the stages of medit·al rescue after eaahquake or tsunami disaster and their
significance．M ethod Three stages of medical rescue were defined according to the clinical features of diseases in 3-37
days after eaahquake or tsunami in Pakistan and Indonesia． Tile classification of diseases was based on the criteria of
disaster medical rescue set by World Health Organization．Five diseases including i~uries／wounds，acute upper respiratory
tract infection，acute hemorrhagic enterocolitis，acute enterocolitis and other diseases of internal medicine except epidemic or
suspected epidemic diseases were employed to define the stages of disaster medical rescue．Results Injuries／wounds mainly
OcculTed in 6 days after disaster．The incidences were 61．45％ to 79．52％ and 61．48％ to 72．35％ in Pakistan and
Indonesia， respectively．Th e incidence of aeute upper respiratory tract infection reached to a considerably high rate one
week after disaster．Other diseases usually appeared one week later with incidence of 33．93％ to 71．11％ and 31．50％ to
52．1 1％ in Pakistan and Indonesia． respectively．Th e rate Ilf aoute hemorrhagic enteroeolitis was 2‰ in Indonesia whereas
35％ of acute enterocolitis was found in Pakistan．Conclus!on Th ree stages of disaster medical rescue could be well
defined． (1)Early or critical stage(in 6 da)s after disaster)：Treatment of i~ufies／wound and resuscitation was the
pfima~ step to deal with．(2)Intermediate of subaeute stage(7-30days following disaster)：Th e incidences of various kinds
of diseases increased and more medical resources were needed in order to treat the upper respiratory tract infection an d to
lower the disable rate，and to prevent the prevalence of epidemic diseases．(3)Later or recovery stage(1-3months after
disaster)：The general condition of victims became even better than that of those affected by commonly OccutTed lOcaldiseases， and during this period，there were shortages of medical facilities and medical personne1．Therefore，supplement of
medical resources was required．Th e well defined stages of medical rescue have an important significance for medical rescue
teams to treat victims and prevent epidemic diseases more efficiently and timely，and also provide a guidance of scientific
basis for the logistics officers of local government as well as our government to make a proper and reasonable distribution of
medical resources，and dispatch and arrangement of medical rescue teams．This guidance also helps to make victims re—relian t．
【Key words】Earthquake disaster；Rescue stage；Tsunami
作者单位：100039 北京，武警总医院检验科(刘爱兵、王海燕、
郝钦芳、席梅)；中国地震应急援救中心(曲国胜)

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