放射复合伤的研究进展

放射复合伤是战时核爆炸与平时核事故等条件下发生的主要的、特殊的伤类之一，人们予以高度重视。国外放射复合伤文献以俄、美两国为多。放射损伤所复合的致伤因素较为多样化，国内研究复合伤的机构较少，主要集中在第三军医大学。研究的放射复合伤类型主要是放烧复合伤。...     

复合伤的基本特点和初期急救原则及抢救程序

复合伤是指两种或两种以上致伤因素造成的损伤。过去人们研究较多的 ,由核武器和化学武器所致的复合伤已被各种意外事故所致的复合伤所取代 ,如矿井瓦斯爆炸冲击伤、有毒气体中毒伴挤压伤、现代战争武器复合伤 ,以及在运载火箭、导弹和航天飞行器的研制、试验和使用过程中 ,燃料泄露、中毒 ,甚至爆炸等事故造成的烧、冲、毒复合伤[1] 。复合伤是最难急救的伤类 ,其核心问题是难以诊断 ,难以把握救治时机[2 ] ,因此 ,我们结合有关研究和多次参加抢救的体会 ,探讨复合伤的基本特点和初期急救原则及抢救程序。1　基本特点1 1　致伤因素多 ,伤情…     

放射性复合伤的特点及救治

在核爆炸时,由两种或两种以上致伤因素同时或相继作用于人体而造成的损伤称为复合伤。复合伤主要分为放射性复合伤和烧冲复合伤两大类。 从核试验生物效应资料可得出暴露人员复合伤发生率的概数,空爆时为30～50％,地爆时为60～80％。日本广岛和长崎遭受核武器袭击后,复合伤占总伤亡人数的65～85％。离爆心投影点越近,复合伤的发生率越高。核爆炸复合伤是核武器致伤减员的主要伤类。     

多发伤的紧急处理

一、多发伤 (ｍｕｌｔｉｐｌｅｉｎｊｕｒｉｅｓ)定义由单一致伤因素所造成的多部位、多脏器严重损伤称为多发伤 ,常伴有大出血、休克和严重的生理功能紊乱 ,重者危及生命。二、发生率战伤统计时 ,常将多发伤与多处伤合称为多处伤 ,主要指某伤员同时有两处以上部位受伤。朝鲜战争中志愿军伤员的多处伤占 4.8% ;在 1979年西南边境冲突中 ,解放军伤员的多处伤占16 .3% ;第二次世界大战中 ,苏军多处伤的发生率为 40 .0 % ,美军为 2 5 .0 %。我院 1990年前的 46 8例腹部内脏伤 ,有 2 77例 (5 9.2 % )为多发伤 ,1984年前的 42 6例骨伤住院病人中 …     

特种燃料泄漏、爆炸致中毒复合伤216例

特种燃料泄漏、爆炸是航天工作人员最主要的致命威胁之一。其巨大的冲击波、散落物体及推进剂肼类 (主要为偏二甲基肼、UDMH )和氮氧化物(主要为四氧化二氮、N2 O4 )等有毒气体中毒、燃烧均可引起严重的复合伤。我们曾处理四起特种燃料泄漏、爆炸致复合伤 2 16例。1　临床资料1 1　一般情况　 2 16例中 ,男 14 7例 ,女 6 9例 ;年龄 4 0d～ 74岁 ,平均 36 5岁。一起混合燃料泄漏引起UDMH和N2 O4 混合中毒 ,一起固体燃料爆炸导致烧伤 中毒复合伤 ,二起混合燃料爆炸引起冲击 中毒复合伤1 2　致伤情况　根据UDMH及N2 O4 混合中毒伤分…     

大鼠放射损伤、烧伤和放烧复合伤时肾上腺皮质的病理变化

105只大鼠分设3组,分别致放射损伤(~(?0)Co 550rad)、烧伤(15％Ⅲ度)和放烧复合伤(两者复合),另10只作对照。3类伤后肾上腺皮质的突出变化是:(1)明亮细胞和致密细胞间的转化,有其超微结构和细胞化学变化基础;(2)出现嗜酸性团块细胞,是由于线粒体、脂泡、溶酶体和内质网形成复合体的结果;(3)皮质细胞或其胞浆进入血窦,是激素释放的一种非常方式。这些变化均说明伤后皮质功能亢进。3类损伤具有相同的变化动态趋势和病变分布特点。复合伤的损伤效应大于单一伤而小于其和,这是肾上腺皮质在复合效应中的重要特点。     

放烧复合伤小鼠小肠粘膜免疫变化与肠源性感染关系的研究

目的探讨放射损伤、烧伤与放烧复合伤后小鼠小肠粘膜免疫变化及其用细胞因子调控后与肠源性感染的关系。方法采用斑点杂交、免疫组化、免疫酶联吸附实验、细菌培养等方法。结果①三类伤组伤后均出现小肠粘液ｓＩｇＡ含量显著降低,浆细胞数量减少,肠道细菌移居增多,肠系膜淋巴结ＩＬ４ｍＲＮＡ表达降低,尤以复合伤组最重。②用ＩＬ４蛋白调控后,三类伤组肠道浆细胞的数量增多,小肠粘液中ｓＩｇＡ含量相应增加,肠道细菌移居减少。结论伤后粘液中ｓＩｇＡ的降低与肠源性感染的发生密切相关,其原因与分泌ｓＩｇＡ的淋巴细胞数量减少和功能障碍有关;而促进粘膜免疫功能恢复,对减低肠源性感染发生较为有利     

烧冲复合伤心脏病理变化的实验研究

烧冲复合伤是核爆炸所致的重要伤类,在常规战争与平时爆炸事故中也有发生。心脏是烧冲复合伤时较常受损的脏器,且心脏损伤对全身伤情有重要影响。本文对核爆炸效应动物和实验室致伤动物着重观察和分析心脏的宏观、组织学和超微结构的病理变化。     

战伤要素诊断谱的构建研究

战伤诊断是指医务人员运用医学诊断技术,对战斗中发生的伤员通过详尽的检查及调查后做出的对伤员伤病情的基本认识和判断,包括伤部、伤类等构成的战伤要素诊断及伤后疾病和并发症的诊断,是指导战伤救治的基本医学依据。战伤诊断的准确与否对于挽救伤病员生命、降低伤残率具有重     

几种抗放药物对单纯放射病和放烧复合伤防治作用的对比观察

放射损伤复合烧伤是核爆炸及核事故时发生的主要伤类之一,伤情严重,救治困难。大量实验和临床资料证明,辐射防护剂（抗放药）可减轻射线对人体的损伤。放烧复合伤时抗放药是否有效,国内外报道较少。本文作者选用几种抗放药,对单纯放射损伤和放烧复合伤的防治效果作对...     

War injuries of blood vessels of the extremities

Treatment results of 200 injured with the lesions of 282 magistral blood vessels were analyzed. All were combat injuries, and the majority was caused by the fragments of explosive device. The mechanisms of such the injuries produced large defects of soft tissues as well as the high level of the wound contamination, which aggravated reconstructive procedures and increased the risk of infection. In the majority of cases anatomic reconstruction of the artery was performed, and the ligature was used only in the case of graft infection and in the injuries of one artery of the lower leg or the forearm. The majority of injuries was solved by lateral suture or patch plastic, since postoperative constriction caused by those methods did not cause greater hemodynamic disorders due to the size of venous lumen. The duration of ischemic interval was of the utmost importance for the favorable final result of the treatment, as well as the adequate debridement of the wound, good soft-tissue cover of the reconstructed blood vessel and precise atraumatic technique. Total percentage of amputations was 14.5%, and all were involving the lower extremities, and were mostly caused by popliteal artery lesion.     

Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack

In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.     

颜面部动物咬伤伤口美容缝合处置进展

颜面部动物咬伤较常见,近年研究表明对颜面部动物咬伤的伤口进行I期美容缝合,不会增加伤口感染率,且可提高美容效果和患者满意度。因此,对于颜面部动物咬伤的伤口推荐早期整形外科治疗。笔者就颜面部动物咬伤的特点和伤情评估、伤口清创技术、美容缝合技术及各部位动物咬伤美容缝合伤口等方面进行综述,为颜面部动物咬伤的美容缝合伤口处置提供参考。     

Computed tomography of blunt and penetrating diaphragmatic injury: sensitivity and inter-observer agreement of CT Signs

Diaphragmatic injury is an uncommon but clinically important entity in the setting of trauma. Computed tomography (CT) is widely used to evaluate hemodynamically stable trauma patients. While prior studies have identified CT signs of diaphragm injury in blunt or penetrating trauma, no study has directly compared signs across these two types of injuries. We identified patients with surgically proven diaphragm injuries who underwent CT at presentation. Three reviewers examined each for 12 signs of diaphragm injury, as well as for an overall impression of diaphragm injury. We reviewed a total of 84 patients (37 % blunt trauma, 63 % penetrating). The initial interpreting radiologists discovered 77 % of blunt and 47 % of penetrating injuries (p?=?0.01). We found that the majority of signs of diaphragmatic injury were split between those common in blunt trauma and those common in penetrating trauma, with minimal overlap. The presence of at least one blunt injury sign has 90 % sensitivity for diaphragm injury in blunt trauma; the presence of a wound tract traversing the diaphragm has 92 % sensitivity in penetrating trauma. Inter-observer reliability of these signs is also high (κ?>?0.65). Penetrating diaphragm injuries present a different spectrum of imaging findings from those in blunt trauma and are underdiagnosed at CT; looking for a wound tract traversing the diaphragm is highly sensitive for diaphragm injury in these cases. Signs of organ or diaphragm fragment displacement are sensitive for blunt diaphragm injuries, consistent with these injuries being caused by increased intra-abdominal pressure.     

Studies on combined lesions. 22. Studies on serum proteins by means of CAF-electrophoresis in mice, treated with whole body radiation and with open skin wounds]

After combined injuries, much more pronounced changes in the protein composition of serum develop than simply after skin wounding or irradiation. A decrease was found in the prealbumin, albumin, alpha1-globulin and gamma-globulin fractions while the alpha2-globulin and beta-globulin fractions increased. If skin wounds were inflicted prior or almost simultaneously to irradiation, the serum protein changes as induced by irradiation become normalized earlier. I1 skin wounds were inflicted after irradiation they caused very pronounced alteration in the protein picture which develops in a course parallel to the increasing lethality. Only if the skin wounds were inflicted 21 days after irradiation, that they appeared to have nearly no influence in the form of augmenting protein changes. The gamma-globulin content increased considerably after the 14th day after irradiation. An additional skin wound, however, caused a depression of the gamma-globulins; but the values were still significantly higher than normal.     

Investigations on combined injuries, 29th communication. Protective effect of aminopropylamino-ethylthiophosphate (WR 2721) in mice with radiation and combined injuries (irradiation and skin wound or burn) (author's transl)

Because of the crucial practical importance of combined injuries, investigations of the efficacy of the radioprotective agent aminopropylamino-ethylthiophosphate (WR 2721) were performed on mice which were whole-body X-irradiated and stressed with a second trauma either as an open wound or as burn wounds on the skin. In cases of sole whole-body irradiation, probit analyses of our data yielded the dose reduction factors (DRF) of 2.42 (NMRI-Hannover) and 2.12 (NMRI-Kisslegg). In case of a combination of an open skin wound (SW) with irradiation in mice of the Hannover breed the following dose reduction factors have been obtained: for irradiation+SDW 10 min p. r. the DRF 2.22, for irradiation+SW 2 d p. r. the DRF 2.30, and for irradiation+SW 8 d p. R.. the DRF 2.29. In cases of combined injuries with two burn wounds (BW) as second trauma in mice of the Kissblegg breed yielded: the DRF 2.01 for irradiation+BW 10 min p. r., and the DRF 1.91 for irradiation+BW 2 d p. r. The protective effect of WR 2721 is apparently similar in the various groups with combined injuries as compared to the animals exposed to whole-body irradiation only. The mechanisms of action of the sulphur-containing radioprotective agents are discussed.     

Wound and injury awareness amongst students and doctors

INTRODUCTION: Concern has been raised in the medical press regarding the inability of doctors to describe wounds and injuries of medico-legal significance correctly. METHODS: Medical students and doctors of all grades, from the Department of Surgery at a London teaching-hospital affiliated unit were shown a series of photographs illustrating wounds and injuries expected to be encountered in emergency medical practice. They were asked to identify the type of wound or injury as well as the manner in which that injury may have been caused. RESULT: The results indicated that students and doctors of all grades in this unit were not confident at identifying wounds and injuries, using the correct terminology. The term 'laceration' was widely used to describe incised wounds, and vice versa. Gun shot wounds were poorly identified as such, and were only correctly described by those who clearly 'knew' what they were looking at. CONCLUSION: In order to provide doctors with the skills with which they need to correctly describe wounds and injuries encountered in an emergency setting, this author proposes the introduction of specific teaching in wound identification at undergraduate and postgraduate levels.     

The incidence of injury in light infantry soldiers

U.S. Army soldiers lose substantial training hours as a result of musculoskeletal injuries. Most military injury data have focused on basic trainee populations. This study examines activities associated with injuries in operational infantry soldiers. We conducted a randomized, retrospective medical record review of 339 records from a total of 3,195 light infantry soldiers over 13 months. The annualized incidence of injuries was 95 per 100 soldiers per year vs. 74 per 100 for illness. There were 372 injuries, representing 56% of sick-call diagnoses. Physical training caused 50% of all injuries, and 30% of those were linked to running. Injuries caused nearly 10 times the number of limited duty days as illness. Soldiers with lower extremity running injuries spent seven times more days on profile than those with nonrunning injuries. We conclude that physical training is related to a high number of injuries in infantry soldiers. This study provides important data on activities and injuries in operational infantry soldiers.     

汶川地震致四肢开放性损伤伤员细菌感染分布及药敏监测

目的 对汶川大地震中414例四肢开放性损伤伤员细菌感染分布特性及药敏结果进行分析,以指导临床特别是自然灾害中抗生素的使用.方法 对414例四肢开放性损伤伤员的创面分泌物进行细菌培养和药敏监测.结果 G+球菌12例(2.9%),G-杆菌66例(15.9%),G+杆菌2例(0.5%),多重感染6例(二重感染5例,三重感染1例),感染率为1.5%.主要致病菌:(1)G+球菌:表皮葡萄球菌、金黄色葡萄球菌、人葡萄球菌;(2)G-杆菌:阴沟肠杆菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞细菌、普通变性菌、美洲爱文菌;(3)G+杆菌:枯革芽孢杆菌.对G+球菌较敏感的药物有万古霉素、利福平、左旋氧氟沙星、庆大霉素;对G+球菌敏感较低的药物有青霉素、氨苄西林、红霉素等.对G-杆菌较敏感的药物有亚胺培南、丁胺卡那霉素、左旋氧氟沙星、妥布霉素;对G-杆菌敏感较低的药物有氨苄西林、哌拉西林等.结论 地震中四肢开放性损伤伤员细菌感染率较高,感染菌株种类较多.因此,应尽早作创面分泌物的细菌培养+药敏鉴定,针对性合理使用抗生素.     

Neck injury patterns resulting from the use of petrol and electric chainsaws in suicides. Report on two cases

Suicides due to neck injuries caused by chainsaws are uncommon events. The cutting elements of petrol and electric chainsaws produce different features in lethal neck injuries. The accurate evaluation of the death scene, of the power and mechanical characteristics of the chainsaw and of wound morphology are all essential in distinguishing a case of suicide.