脊柱复合性损伤的救治风险与早期治疗

目的评估脊柱复合性损伤的特点和救治风险,探讨风险控制与最佳治疗的方法。方法采用AIS、ISS、TRISS及APACHEⅡ等评分方法对273例脊柱复合性损伤患者进行定量评价与救治分类,并依据伤后的损伤分级、参数评定及计量评分等指标进行量化分析和统计处理。结果颈椎合并伤115例,胸椎合并伤141例,胸腰椎合并伤294例,腰骶椎合并伤181例;患者的救治风险和脊椎伤的治疗选择或手术时机与其合并伤的解剖伤势及由此所构成的整体伤情密切相关(P<0.01或<0.05);高风险性伤员往往综合伤势严重,生存概率(Ps)趋低,并发症和死亡率高(P<0.01或<0.05)。结论脊柱脊髓损伤常合并有严重的多发伤,高危伤情不仅可增加其救治风险和脊柱伤的处理难度,且还易于丧失手术最佳时机。分类救治对伤员的风险控制和脊柱伤的专科治疗是有益的。     

549例胸部穿透伤的救治探讨

胸部穿透伤近年尤为常见，蒋耀光报告由20世纪90年代以前的19．3％猛增到90年代末的40．1％。主要是各种锐器和枪弹致伤。手术率明显高于胸部钝性损伤。现报告我院1990年1月～2002年4月收治的549例患者的诊治情况。     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

核糖核酸对创伤后早期肝功能损害的疗效观察

严重创伤尤其是多发伤,常常合并全身多脏器损害,其中肝功能损害比较常见,它不仅加重病情而且影响预后。笔者通过对肝功能指标的测定,对核糖核酸能否减轻创伤患者早期肝功能损害进行了对比观察,报告如下。 1 临床资料 1.1 一般资料 共30例患者,其中男19例,女11例,年龄15～63岁,平均36.7岁。交通事故受伤16例、坠落伤5     

钝性肾损伤肾切除因素分析

目的 探讨钝性肾损伤时影响肾切除的高危因素，以提高肾挽救率。方法 回顾性分析我院自1992年1月至2002年7月收治的226例严重钝性肾损伤患者的临床资料。结果 226例钝性肾损伤患者，保守治疗153例，手术治疗73例。其中肾切除术27例，术前平均输血633ml，平均损伤严重度评分(ISS)39．6分，入院时平均收缩压(SBP)85．4mmHg(1mmHg=0．133kPa)；肾部分切除术12例，术前平均输血487ml，平均ISS27．8分，入院时平均SBP99．7mmHg；肾修补术34例，术前平均输血262ml，平均ISS23．6分，入院时平均SBP112．3mmHg。结论 钝性肾损伤的严重程度与血尿的发生不相一致，切肾与延误治疗、肾损伤程度、术前输血量、ISS分值、入院时平均SBP和病理肾有关联。     

骨盆骨折的CT诊断和评价

目的探讨CT在骨盆骨折中的临床应用价值。方法收集15例X线平片未见或可疑骨盆骨折，但临床上有局部疼痛与挤压痛的患者行CT扫描检查。结果CT发现髋臼骨折4例，髂骨骨折10例，骶尾骨骨折2例，耻骨横形骨折2例。结论CT扫描在骨盆骨折的诊断优于X线平片，对制定治疗方案有重要的参考价值。     

BK通道对大鼠脑缺血再灌注损伤神经细胞内钙离子浓度及凋亡的影响

目的 观察BK通道对脑缺血再灌注损伤神经细胞内钙离子浓度([Ca2+]i)和对神经元凋亡的影响。方法 将108只SD大鼠随机分为假手术组(SS组,n=36)、脑缺血再灌注组(IR组,n=36)、脑缺血再灌注且脑室内Iberiotoxin(IBTX)处理组(IBTX组,n=36),分别比较各组在不同再灌注时间后神经功能缺损评分、脑梗死面积,利用激光共聚焦显微镜技术测定各组[Ca2+]i浓度,免疫组织化学和TUNEL法分别检测BK通道表达和神经元细胞凋亡。结果 IBTX处理组在再灌注24h后神经功能缺损评分为(2.17±0.44)明显高于IR组(1.83±0.42,P＜0.05);脑梗死体积(27.97±5.84)％明显大于SS组(22.83±4.74)％(P＜0.05);激光共聚焦显微镜结果显示:IBTX处理组24h点[Ca2+]i为(914.50 ±86.57) nmol/L较SS组(732.09 ±51.30) nmol/L明显升高(P＜0.01),TUNEL细胞凋亡检测显示IBTX处理组24h神经细胞凋亡率为(15.20±6.11)％,与IR组(10.49±1.91)％比较差异有统计学意义(P＜0.05),免疫组织化学结果显示缺血再灌注损伤后BK通道的表达增加,但组间比较差异无统计学意义(P＞0.05)。结论 在缺血状态下,BK通道对神经细胞具有保护作用,其机制很可能是通过降低神经细胞内钙离子浓度和减少细胞的凋亡。     

急性硬膜下血肿手术时机对预后的影响

目的 研究手术时机对急性硬膜下血肿预后的影响.方法 收集了202例接受手术治疗的急性硬膜下血肿患者,统计分析伤后2、4、6、8h等时间为界限的死亡率和功能生存率.结果 各个时间界限的死亡率和功能生存率差异无统计学意义,但是随着受伤至手术间隔时间的延长,死亡率呈现出逐渐增加、功能生存率逐渐降低的趋势.并且,死亡患者的受伤至手术时间要显著大于生存患者.结论 急性硬膜下血肿手术时机对预后有潜在的影响.符合有手术指征的患者,急性硬膜下血肿需要尽早手术清除血肿.     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

创伤早期液体复苏终极标准的监控与探讨

目的 研究创伤救治复苏的评价指标及影响因素,探讨创伤患者早期液体复苏的终极标准与监控效应.方法 选择符合本项研究条件且需接受液体复苏者149例,采用损伤严重度评分(ISS)和急性生理学及慢性健康状况评分(APACHE Ⅱ)对其组织损伤程度和伤后病情危害状况进行评价与分组,收集液体复苏前、复苏后及结束等不同时间段的心率、血压、血氧饱和度、血气、血乳酸及中心静脉血氧饱和度或混合静脉血氧饱和度等,并记录每小时尿量,对应时间段的碱缺失及氧合指数等,分别比较监控指标的组间差异、时间效应及并发症或与预后的关系等.结果 救治24 h实现终极标准的全身指标有127例,细胞指标有112例,两者平均恢复时间比较差异有统计学意义(P<0.05);各监测指标24 h均实现终点目标者与>24 h或死亡者的APACHEⅡ分值比较差异具有统计学意义(P<0.01);并发症或死亡组实现终极目标的时间明显高于对照存活组,组间差异均有统计学意义(P<0.05或P<0.01).结论 创伤患者早期液体复苏不仅在于恢复生命体征的稳定,更重要是在血流动力学恢复正常的基础上,及时纠正组织灌流和细胞氧合不足,作为创伤救治复苏的终点目标.