影响严重创伤合并急性肺损伤的患者病死率危险因素分析

目的 研究影响严重创伤合并急性肺损伤患者病死率的潜在危险因素.方法 这是一项以严重创伤作为唯一原因收治急诊科和急诊监护室患者的回顾性病例对照研究,通过单因素和多因素逻辑回归分析法对18个潜在影响严重创伤病死率的危险因素进行分析.结果 有343例严重创伤合并创伤后急性肺损伤患者收治于急诊科和急诊监护室,分析得出五个影响急性肺损伤病死率的危险因素是:(1)急性生理和慢性健康状况评分(acute physiology and chronic health evaluation,A-PACHE)Ⅱ评分,(2)创伤持续时间,(3)年龄,(4)胃肠返流,和(5)弥散性血管内凝血(disseminated intravascular coagulation,DIC),亦发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度.结论 APACHEⅡ评分和胃肠返流对急性肺损伤病死率的影响在创伤后的早期阶段.值得注意的是创伤持续时间和DIC对急性肺损伤的进展和病死率既有短期影响,又有远期影响.老龄患者(大于65岁)由于继发脓毒症和肺功能的恶化仍旧是影响病死率的独立危险因素.具备以上危险因素的患者应尽可能早的接受积极的支持治疗以阻止病情的恶化.     

因食用养殖活鲶鱼导致的七起急性中毒事件调查

2004年10月,浙江省部分地区连续发生7起因食用养殖活鲶鱼导致的急性中毒事件,先后共21人中毒。2004年10月10日,浙江省湖州市南浔区石淙镇鲶鱼养殖户起获一批革胡子鲶鱼,并通过中间商贩卖到杭州市、湖州市、德清县等地,11-12日期间,共有10组人群(家庭)购买食用,其中5户带卵烹饪的家庭共19人,进食鲶鱼的13人全部发生急性中毒,6人未进食鲶鱼未发生中毒;另5户家庭(16人)剖     

严重多发伤患者糠秕孢子菌性毛囊炎10例临床分析

目的 对严重多发伤患者糠秕孢子茵性毛囊炎的易患因素、临床特点和治疗效果进行临床分析。方法 去除诱因，局部和全身应用抗真菌药物治疗。结果 10例患者除1例因多脏器功能衰竭死亡外，均治愈，随访10个月以上无复发。结论严重多发伤患者常常具备糠秕马拉色菌致病的多种条件，是糠秕孢子菌性毛囊炎的高危人群，临床表现呈爆发性，但对抗真菌治疗疗效好，复发率低。     

浙江省8家医院创伤患者死亡危险因素分析

目的 探讨导致创伤患者死亡的危险因素以及改进创伤急救的措施.方法 整理2009年全年浙江省8所医院急诊室首诊的创伤患者的病例资料,结合创伤急救的各个环节,挑选可能导致患者死亡的相关因素,通过单因素和多因素Logistic回归分析方法,得到导致创伤患者死亡的独立危险因素.结果 2009年浙江省8所医院共有3 659名患者纳入了本次研究,其中死亡226人,病死率为6.18%.单因素分析结果提示,年龄、创伤机制、ISS评分、GCS评分、专业现场急救、转送途中气管插管、转送途中清创止血、入院时低血压、昏迷、急诊室胸腔闭式引流、急诊手术、ICU内中心静脉压监测和ICU内机械通气的患者死亡相关.多因素Logistic回归分析提示,GCS评分、ISS评分、机械通气、入院时低血压、年龄是患者死亡的独立危险因素,有效的专业现场急救是保护因素.结论 患者的伤情严重程度和年龄是影响患者结局的重要因素.加强院前急救,早期稳定患者伤情以及合理使用ICU内监护设施有助于进一步降低创伤救治的病死率.

Abstract：

Objective To explore risk factors in the mortality of casualties and to find a way to improve trauma emergency service. Method The possible factors likely related to the mortality of casualties were taken into account based on each stage of trauma emergency so as to find the independent risk factors by using univariate and multivariate analyses. Results A total of 3 659 casualties were enrolled in this study.Of them, 226 casualties died and the mortality rate was 6.18%. Following factors were related to mortality after univariate analysis: age, cause of trauma, injury severity score, Glasgow come scale come on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU and mechanical ventilation in ICU. After multivariate analysis, six factors were independently related to the mortality of casualties as follows: Glasgow coma scale, injury severity score, mechanical ventilation, blood pressure at admission, age and professional emergency treatment on the scene. Conclusions It has a great significance to investigate the risk factors of mortality for casualties. Severity of trauma and age were independently associated with the outcomes of trauma. Besides, improving prehospital care and stabilizing the trauma patients in early phase can further decrease the mortality.     

AO钢板内固定与Twin Tail TightRope内固定治疗Rockwood Ⅲ型肩锁关节脱位对比观察

目的 探讨AO钢板内固定与Twin Tail Tight Rope治疗RockwoodⅢ型脱位临床疗效及安全性差异。方法 选取RockwoodⅢ型肩锁关节脱位病例30例,采用入院时随机分组分为A组(15例)和B组(15例),分别采用AO钢板内固定与Twin Tail Tight Rope内固定治疗;比较两组病例围手术期指标,治疗后肩关节功能评分及术后并发症发生率等。结果 参照Constant-Murley评分系统标准进行疗效评定。B组病例手术切口长度、手术时间、术中出血量及等围手术期指标有明显差异,差异有统计学意义(P<0.05);B组病例治疗后肩关节活动度评分显著优于A组,差异有统计学意义(P<0.05);同时B组病例术后并发症发生率显著低于A组,差异有统计学意义(P<0.05)。结论 Twin Tail Tight Rope内固定治疗RockwoodⅢ型肩锁关节脱位具有微创、操作简便及术后恢复快等优势,可有效提高肩关节活动度,并降低术后并发症风险,是治疗该型损伤较为理想的方法。     

8例食用养殖活鲶鱼致急性中毒患者的临床分析

鲶鱼属鲶形目鲶科鲶属,头大嘴宽,尾圆而短,皮有黏质,无鳞,背部苍黑色,腹白色,上下颌有须,系热带亚热带淡水鱼类。因其经济价值高、生存能力强,近年来欧、美、非洲和我国各地多有养殖。但因食用鲶鱼导致急性中毒,国内外尚未见临床报道。2004年10月22日浙江省桐乡市共有8人因食用养殖的活革胡子鲶鱼发生急性中毒,报道如下。     

影响严重伤合并急性肺损伤患者病死率危险因素分析

Background It is important to study the factors affecting the clinical mortality of the severe multiple trauma population. The present study was aimed to identify the potential risk factors that could affect mortality rate of acute lung injury （ALl） in severely injured multiple trauma population and to investigate the effects of certain risk factors on the prognosis of different patient subpopulations.
Methods This is a follow-up study treating trauma as a single cause for emergency department （ED） and emergency intensive care unit （EICU） admissions. Patients identified with severe multiple trauma with early onset of ALl were enrolled from five trauma centers. Nineteen potential risk factors affecting the prognosis of ALl were examined by univariate and multivariate Logistic regression analyses to identify the ones that affected the mortality of these severe multiple trauma patients.
Results There were 687 multiple trauma patients with post-traumatic ALl admitted to ED and EICU during the study period. The six risk factors that affected the mortality with unadjusted odd ratios （ORs） and 95% confidence intervals （C/s） were Acute Physiology Score and Chronic Health Evaluation Score （APACHE） II score, Injury Severity Score （ISS）, duration of trauma, age, aspiration of gastric contents, and disseminated intravascular coagulation （DIC）. Specific risk factors also affected different patient subpopulations at different degrees （surviving beyond 24 hours, 72 hours, 28 days and with multiple blood transfusions and higher injury scores）.
Conclusions Factors of APACHE II score, ISS and aspiration of gastric contents that could predict the morality of AL may exist in the early stage of trauma. Duration of trauma long-term development and mortality of ALl deserve special and DIC that greatly affected and predicted the short- and attention. Elderly patients （aged beyond 65 years） were the independent risk factor for the secondary sepsis and deterioration of pulmonary function. Patients with these risk factors need aggressive supportive care as early as possible in order to prevent further aggravation.     

急性鲶鱼卵中毒21例临床分析

鲶鱼因其食用价值近年在我国各地多有养殖。2004年10月，浙江省杭州市、湖州市、德清县、桐乡市连续发生7起因为食用养殖活鲶鱼导致的急性中毒事件，共21人中毒，报告如下。     

损伤控制在多发伤合并腹部损伤救治中的应用

损伤控制(damage contral．DC)概念在1983年被首次提出，其主要针对腹部创伤患者的救治，具体为早期简化手术，复苏和二期确定手术三阶段治疗原则。随着当今社会经济的发展，交通伤等各种复杂致伤因素的作用下，多发伤为首的创伤大量出现，临床上多发伤合并腹部损伤的病例愈来愈多。我科近3年来充分贯彻损伤控制外科技术，将其由传统的单纯腹部创伤救治扩展到多发伤综合救治的角度，取得较好的治疗经验。     

胃癌RUNX3表达对凋亡与增殖细胞转换的影响及其预后价值

目的探讨胃癌RUNX3基因表达对细胞凋亡与增殖细胞转换[凋亡率与增殖率之比值(AI/PI)]的影响及其与胃癌预后的关系。方法应用免疫组织化学分析RUNX3基因的表达;应用流式细胞术分析胃癌细胞的凋亡率和增殖率;采用Kaplan-Meier限乘法计算生存率。结果在60例胃癌中RUNX3基因的阳性表达率为46.7%。胃癌细胞RUNX3基因表达与淋巴转移和远处转移有关(P<0.05)。胃癌细胞的AI/PI经频数分布表分析和检验均服从正态分布。胃癌细胞AI/PI范围显示为0.05~0.46,胃癌细胞AI/PI与淋巴转移和远处转移有关(P<0.05)。胃癌细胞中RUNX3和AI/PI的表达之间存在明显相关关系(r=0.39,P<0.05)。用Kaplan-Meier生存曲线经Logr-ank检验发现,RUNX3的阳性表达与生存相关(P<0.05)。结论RUNX3基因可能通过影响凋亡与增殖细胞转换而影响胃癌的发生发展;RUNX3基因检测可作为胃癌临床病理学特点和预后的指标。