高技术条件下局部战争伤类,伤情的特点

高技术条件下局部战争伤类、伤情的特点６３００４２重庆第二军医大学野战外科研究所杨志焕关键词战争；创伤和损伤中国图书资料分类号Ｒ８２６．５海湾战争是历史上现代化程度最高的一场局部战争，它给高技术条件下局部战争的卫勤保障带来了许多新的启示。由于高技术武器...     

重型颅脑损伤与常规生命体征80例临床监测分析

我科对1997年-2000年收治的80例重型颅脑损伤患者常规生命体征监测与发生严重神经科事件之间相关性进行分析,探讨患者呼吸、循环等全身情况与脑组织血供及氧代谢等因素之间的关系,为鉴定颅脑损伤治疗方案提供依据。     

交通伤临床特点及伤情评估

各类交通伤具有不同的致伤机制,而且与其它伤因引起的损伤相比,如坠落伤等,交通伤具有自身独特的临床特点。了解这些特点,将有助干临床的诊断和治疗。笔者在此就交通伤临床特点及伤情评估的主要评分法作一简要介绍。     

问题2：无生命迹象和无生命体征的定义是什么？

解答：无生命迹象（no signs of life）是指创伤患者无可测得的血压、呼吸或运动、心脏电活动或瞳孔反应,即临床死亡。无生命体征（no vital signs）是指创伤患者没有明显的血压,但证明有心脏电活动、呼吸运动或瞳孔反应,即有获救可能者。     

音乐疗法对剖宫产孕妇术前生命体征及胎心的影响

目的:观察音乐疗法对剖宫产孕妇术前生命体征及胎心的影响.方法:将择期剖宫产孕妇50例随机分为观察组和对照组各25例,观察组孕妇术前聆听音乐,对照组不聆听.采用状态焦虑问卷(S-AI)对两组孕妇分别进行焦虑程度测定.结果:观察组孕妇术前焦虑程度、生命体征(血压、脉搏、呼吸)、胎心等均明显下降或趋于平稳,与对照组比较,差异非常显著(P<0.01).结论:剖宫产孕妇术前聆听音乐,可明显缓解其焦虑情绪并稳定胎儿状况.     

汽车侧面碰撞交通伤的伤情特点实验研究

目的探讨猪轿车实车侧面90°碰撞交通伤的发生情况和伤情特点。方法分别以坐姿将大白猪固定于轿车驾驶员及前排乘员座椅上,在计算机控制下,牵引系统以50km/h的速度驱动台车碰撞正前方横停的轿车,以90°角撞击轿车左侧车体。观察现场至伤后24小时动物存活情况,采用解剖学、病理学方法观察形态改变,评判撞击伤发生和伤情特点。结果汽车侧撞致伤后,驾驶员座位猪的伤情重于前排乘员座位猪,24小时内死亡率75%。前排乘员座位猪伤后全部存活24小时以上。主要死亡原因为呼吸衰竭、失血性休克及多脏器损伤。结论车辆侧面90°高速碰撞,车内驾驶员位置乘员更易致伤,而且伤情较前排乘员严重且死亡率高。     

模拟高原环境对心肺复苏术施救者基本生命体征的影响

目的 观察不同海拔高度对正常成年医务人员实施心肺复苏术(CPR)前后基本生命体征的影响.方法 选取2015年6月-2016年3月新疆军区总医院健康成年医护人员90人,随机分为平原常氧组、3700m高原组、4300m高原组,每组30人.参照《国际心肺复苏指南(2010版)》基础生命支持标准,记录各组1个循环CPR操作前后心率(HR)、平均动脉压(MAP)、呼吸(RR)和指脉氧饱和度(SpO2)数值,比较1个循环CPR操作前后各组基本生命体征的变化.结果 3组施救者实施1个循环CPR操作后HR、RR均明显增快(P<0.05),但MAP及SpO2无明显变化(P>0.05).随着海拔增加,4300m高原组的HR、RR快于3700m高原组和平原常氧组(P<0.05),3700m高原组的HR、RR快于平原常氧组(P<0.05).但3组间MAP及SpO2变化差异无统计学意义(P>0.05).结论 随着海拔高度升高,施救者HR、RR增加,但海拔高度对施救者MAP及SpO2无影响.     

基于生命体征时序数据的创伤致死性大出血伤情动态预测模型开发及验证

目的 基于生命体征时序数据和机器学习算法建立创伤致死性大出血伤情动态预测模型.方法 回顾性分析重症监护医疗信息(MIMIC-Ⅳ)数据库2008-2019年7522例创伤伤员的生命体征时序数据,并按照创伤后是否发生致死性大出血事件分为致死性大出血组(n=283)与非致死性大出血组(n=7239).采用逻辑回归(LR)、支持向量机(SVM)、随机森林(RF)、自适应提升(AdaBoost)、门控循环单元(GRU)、门控循环单元-D(GRU-D)共6种机器学习算法开发创伤致死性大出血伤情动态预测模型,对创伤伤员未来T小时(T=1、2、3)发生致死性大出血伤情的风险进行动态预测.通过准确率、敏感度、特异度、阳性预测值、阴性预测值、约登指数以及受试者工作特征(ROC)曲线下面积(AUC)评估模型性能.基于解放军总医院创伤数据库对模型进行外部验证.结果 MIMIC-Ⅳ数据集中,基于GRU-D算法开发的一组动态预测模型效果最优,预测未来1、2和3 h发生致死性大出血的AUC分别为0.946±0.029、0.940±0.032和0.943±0.034,且差异无统计学意义(P=0.905).创伤数据集中,GRU-D模型取得了最佳外部验证效果,预测未来1、2和3 h发生致死性大出血的AUC分别为0.779±0.013、0.780±0.008和0.778±0.009,且差异无统计学意义(P=0.181).该组模型已部署在公开的网页计算器和医院急诊科信息系统中,便于公众和医护人员使用和验证.结论 成功开发并验证了一组动态预测模型,可对创伤致死性大出血伤情进行早期诊断和动态预测.     

1989年上海“8·15”空难伤员伤情伤因分析

1989年8月15日上海虹桥机场，一架安-24型客机在起飞时发生一等事故，机上40人中，32人现场遇难。有8名伤员送到民航上海医院，除2人抵院时已死亡外，其余6人经救治，均恢复健康。作者分析了这组伤员的伤情和致伤因素，提出了预防对策，并总结了这次空难伤员院前急救和院内救治的经验和教训。     

The place of angiography in the evaluation of traumatic injuries to the heart and coronary arteries

The mechanisms leading to traumatic injuries of the heart and coronary arteries and the typical lesions found are analyzed in light of experience with a total of 21 cases from several centers. The indications for angiography are discussed. Early angiography may be used for the emergency verification of a valvular, coronary, or myocardial rupture after intensive treatment has stabilized the patient's condition; in such situations the relative indications for angiography versus immediate surgery must be determined. Delayed angiography may be used in the more usual situations in which clear, persistent anomalies of a clinical, electric, or radiologic nature are observed.     

COX-2在沙漠干热环境创伤失血性休克大鼠肺组织中的表达及其与肺损伤的相关性研究

目的：研究沙漠干热环境中创伤失血性休克大鼠继发性肺损伤病理改变与肺组织丙二醛（MDA）浓度、总超氧化物歧化酶（T-SOD）活力及环氧化物酶-2（COX-2）mRNA表达量的关系。方法140只雄性SD大鼠随机分为常温环境创伤失血性休克组和干热环境创伤失血性休克组,每组又分别设对照组、休克后0h、0.5h、1h、1.5h、2h、3h 7个亚组,每组10只,建立创伤失血性休克模型后,留取肺灌洗液和组织。观察肺组织病理学改变,检测肺灌洗液总蛋白量和肺组织匀浆MDA浓度、T-SOD活力及COX-2 mRNA表达量的变化。结果病理观察可见干热组各时间点肺病理损伤较常温组病理损伤严重,肺损伤病理学评分较高;干热组肺脏灌洗液总蛋白量高于常温组,峰值出现较早。干热组休克后各时间点MDA浓度较常温组高,而T-SOD活力均较常温组低; COX-2 mRNA表达量干热组休克后各时间点均高于常温组,干热组1.5h时峰值出现,常温组则在2h达到峰值,COX-2 mRNA表达与肺损伤病理学评分呈正相关（P＜0.05）。结论在沙漠干热环境中创伤失血性休克继发性肺损伤时,肺脏损伤较常温环境下严重且损伤提前; MDA浓度和T-SOD活力的变化是反映继发性肺损伤的重要指标; COX-2在沙漠干热环境创伤失血性休克继发性肺损伤过程中起重要作用,可能成为药物干预治疗的有效靶点。     

The evaluation of intraarticular lesions accompanying ACL ruptures in military personnel who elected not to restrict their daily activities: the effect of age and time from injury

The purpose of this study was to evaluate arthroscopically the type, localization and prevalence of the meniscal and chondral lesions accompanying complete rupture of the anterior cruciate ligament (ACL) in patients who elected not to restrict their daily activities after the initial trauma. The size of the chondral lesions was also evaluated. Our second aim is to analyze the effects of age, time from injury, and both age and time from injury in the presence or absence of accompanying lesions in these patients. The localization and type of the accompanying lesions of 317 knees with complete rupture of the ACL were recorded by the same observer. We applied therapeutic arthroscopy to all patients after their first visit to our clinic. All of the patients were military personnel and their history revealed that they had elected to not restrict their occupational activities after the first trauma causing ACL insufficiency. We defined the first 6 week period after the initial trauma as the acute, 6 weeks to 12 months as the subchronic and 12 months or longer as the chronic period. The average time from injury to arthroscopy for these patients, who were all male, was 19.4 ± 20.3 months. Eighty-one percent of the patients had at least one meniscal tear, and 45.1% had at least one chondral lesion. The mean ages at the time of surgery of patient groups with or without medial and lateral menisci lesions were compared, and no statistically significant difference was determined. In the chronic period, the relative risk (RR) values of meniscal tears were 7.75 for medial and 2.40 for lateral. The group consisting of patients with chondral lesions was compared with the group of patients without chondral lesions in terms of their ages and the time from injury to arthroscopy, and the difference was statistically significant. The RR value for patients with co-existence of at least two lesions was 1.761 for more than 30 years of age. The RR values for at least two lesions were 2.356 for the subchronic and 14.909 for the chronic group when compared to the acute group. The RR values in patients more than 30 years of age in the chronic group were 13.58 for medial meniscus, 3.21 for lateral meniscus and 71.88 for chondral lesions when compared to patients less than 30 years of age in the acute group. It is important to note that the combined effects of advanced age and prolonged time from injury in patients who elected to not restrict occupational activities are more severe due to the increase in the occurrence of intraarticular lesions accompanying ACL insufficiency as compared to their separate effects.A part of this study was given as an oral presentation at the XIX National Orthopedic and Traumatology Congress in May 2005.