未来高原寒区作战对战伤救护的影响因素及对策

高原寒区作战防护条件差,多方向同时展开,伤员发生时间集中,空间分布点多面广,救护任务繁重;高技术兵器杀伤手段、致伤途径多样,伤类复杂,伤员救护面临许多困难;作战地区气候环境恶劣,疫情复杂,致病因素多,非战斗减员多,增加了救治量;远离战役后方,后送时间长。本文就高原寒区作战对战伤救护的影响因素进行分析,并提出相应的救护对策。     

绵阳震区地震伤员的伤情特点与受伤机制分析

目的：探讨地震灾害伤员的伤情特点和受伤机制。方法：回顾性分析汶川地震后我院收治地震伤员病例资料及绵阳震区的死亡病例资料。结果：压砸挤压是地震致伤的主要致伤机制,逃生不当所致坠落、扭挫、砸伤也有一定比例。结论：地震伤具有受伤机制多样、伤情复杂、多发伤比例高的特点,其中以压砸、挤压伤、机械性致伤为主。快速、科学、合理的现场救治及分级统一救治十分重要。     

群体伤的院内救治与管理

群体伤是指一种或一种以上的致伤因素造成的3人次以上的伤害。是突然发生的交通事故、工伤、爆炸及群体斗殴等引起的大宗伤员伤亡[1],群体伤具有发生突然、时间急、伤员多、伤情复杂抢救难度大、社会影响大等特点。我院近年来群体伤的救治呈现逐年上升趋势,其中以交通事故伤所占比例最高。根据我们的经验,在进行群体伤员救治时,对医护人员进行合理分工,明确相关职责,进行严密的救护组织管理,能有效缩短院内急救等待时间,是群体伤员抢救成功的根本保障。     

基层连队自救互救训练中存在的问题及对策

未来渡海登岛作战，战场环境恶劣，减员率高，医疗救护难度大，伤情伤类复杂，及时有效的火线抢救对挽救伤员的生命，减少致残率十分重要。从“一江山岛”登岛作战及英阿马岛战争中的伤员救治情况分析，官兵的自救互救是战伤救护的重要组成部分，为伤员的紧急救治和后续治疗创造条件。因此，基层连队开展扎实有效的自救互救训练，是军事斗争卫勤准备的一项重要内容。     

飞行员战伤的急救模式与策略

<正>新军事变革下的空中作战特点在作战环境、作战模式等方面出现的重大调整,必然导致战创伤救治发生新的变化。和第二次世界大战、朝鲜战争、越南战争相比,美军在伊拉克战争中第一次将死伤比降至10%[1]。但高科技空中战争更加残酷,伤情更加复杂,多发伤和复合伤的比例明显增加,尤其     

反空袭作战卫勤保障的特点及对策(摘要)

未来局部战争中,反空袭作战急促,空袭与反空袭在短时间内的战斗将异常艰巨和激烈。 1 反空袭作战卫勤保障的主要特点 1.1 战争以快节奏、突发为特征,救治任务重 反空袭作战中,敌我双方在较短的时间内,将在陆、海、空广阔领域展开激烈的较量与争夺,加之中远程精确制导武器的广泛使用和远程战略空袭,致使伤员在更为广阔的地域发生,重伤员比例增加。伤员伤情将呈现多样化,给救治机构带来困难。 1.2 战场情况复杂,伤员后送困难 高技术条件下空袭作战,由于敌人实施持续性纵深空袭和远程火力突击,作战地域扩大,前后方区别趋于淡化,交战双方形成犬牙交错的非线性战场,以往按照三区七     

利用病人ICD编码对战伤人员进行伤情分类研究

为了确保战争中医疗资源的充足，需要在伤情编码的基础上预计医疗资源的需求量。在用模拟仿真试验进行当前和未来战争资源投入方案设计中，有必要使用量化措施提高伤病员分流的精度。利用这种计算机辅助的运算法则可以方便地建立应对各种作战模式和不同方案的伤病员分流表。     

折叠式多功能担架车的研制

<正>在未来现代化战争中,随着高科技武器在陆海战场上的应用,各种火器伤发生的特点与中东战争及伊拉克战争有很大不同,空袭和精确制导武器、非致死性武器的使用造成群死群伤发生的概率大大增加,特别是海域作战可能有大批伤员需在沿海前沿阵地向后方转送,必将占用大量的战斗人员而严重影响战斗力。因此,以最少的人力快速安全转送阵地     

严重创伤的急救护理

创伤是由机械性致伤因子造成的人体结构连续性破坏。严重创伤常涉及心、肺、脑、肝、肾等重要脏器而危及生命,或因肢体损害而致残。随着科学技术的发展,工业、农业机械的应用范围扩大,汽车数量剧增,交通事故增多,创伤问题将对医学界提出巨大挑战[1]。1严重创伤的特点及救治原则1.1严重创伤的特点①多系统伤:系指三个以上脏器多个系统多处损伤,该类损伤大约占严重创伤的50%～70%[1]。②不同致伤工具致损伤程度有较大差异。③不同致伤方式有不同的伤情特点。1.2致伤因素分析致伤因素及受伤部位是初步评估伤员伤情轻重的第一步。受伤机体功能和…     

空中急救转运伤员流程设计

本文介绍了基于平、战时空中急救转运伤员的流程设计。根据未来战场的突发性和战伤伤员的复杂性,建立一个伤员安全、快速后送的医疗救治保障体系。通过对空中急救转运伤员的流程特点、设计要求、主要步骤的分析与探讨,提出一个符合突发事件和应急作战情况下的空中急救转运伤员的流程设计,为我军在未来战争中伤员医疗救护的卫勤保障和医院空中急救转运伤员体系建设提供了科学依据。     

Treatment of drug-induced thrombocytopenia

Estimates on the incidence of drug-induced thrombocytopenia range 5 – 40% in patients receiving heparin to < 1% with other causative agents. Systematically assessing drug-induced thrombocytopenia through a series of steps, each step providing additional evidence that the suspected agent is the true cause of thrombocytopenia, is the best way to identify the causative agent. Databases exist to aid in identification of the causative agent. Knowing which medications may be causative agents as well as which are not known to cause drug-induced thrombocytopenia, the aetiologies of drug-induced thrombocytopenia, signs and symptoms of thrombocytopenia and strategies to treat thrombocytopenia associated with specific agents will provide the clinician with the necessary skills to make proper medical decisions.     

Treatment of drug-induced thrombocytopenia

Estimates on the incidence of drug-induced thrombocytopenia range 5-40% in patients receiving heparin to < 1% with other causative agents. Systematically assessing drug-induced thrombocytopenia through a series of steps, each step providing additional evidence that the suspected agent is the true cause of thrombocytopenia, is the best way to identify the causative agent. Databases exist to aid in identification of the causative agent. Knowing which medications may be causative agents as well as which are not known to cause drug-induced thrombocytopenia, the aetiologies of drug-induced thrombocytopenia, signs and symptoms of thrombocytopenia and strategies to treat thrombocytopenia associated with specific agents will provide the clinician with the necessary skills to make proper medical decisions.     

Onychomycosis due to Aspergillus candidus: case report.

A patient is described who suffered from chronic fungal involvement of right great toe nail. Serial cultures of the removed nail demonstrated a non-dermatophyte, Aspergillus candidus, as the causative agent.     

A case of bullous pemphigoid ınduced by vildagliptin

Bullous pemfigoid (BP), an autoimmune disorder, can also be induced by some medications. Vildagliptin is a new drug used to treat diabetes mellitus (DM). Recently, a few cases of vildagliptin-induced BP have been described in the literature. We report a patient with BP in which vildagliptin was thought to be as a possible causative agent. The awareness of BP development risk during gliptin therapy can prevent unnecessary usage of systemic drugs with serious side effects.     

Transfer of cefmenoxime to lung tissue and thoracic muscle in thoracic surgery

Twenty patients who were performed pulmonary resection for the disease of the lung were administered 2 g of cefmenoxime (CMX) intravenously during the operation. The CMX levels in serum, lung tissue and thoracic muscle were measured by agar-well technique. The CMX levels in lung tissue and thoracic muscle were higher than the MIC80 of CMX for Klebsiella pneumoniae, Haemophilus influenzae and Streptococcus pneumoniae which were commonly as isolated causative organisms from the patients with pulmonary infection. These results indicate that CMX will be useful agent for the prevention and treatment of pulmonary infection.     

Pharmacokinetic and clinical studies of cefpirome in pediatric field]

We conducted a study on the pharmacokinetics and clinical application of cefpirome (CPR) in children. 1. A single intravenous injection of 20 mg/kg of CPR was given to a two-month-old boy, and the concentration of the drug in the blood was measured. Fifteen minutes after administration, the concentration was 53.3 micrograms/ml, and it gradually decreased thereafter, reaching a level of 5.18 micrograms/ml after 8 hours with a half-life in the plasma of 2.36 hours. 2. A single intravenous injection of 700 mg (50 mg/kg) of CPR and that of cefotaxime (CTX) were given to a girl with suppurative meningitis (3 years old, 14 kg, causative bacteria, Haemophilus influenzae), and concentrations of the drugs in plasma and cerebrospinal fluid after 1 hour were measured. On the second day of illness, the concentration of CTX in the plasma was 39.4 micrograms/ml and the concentration of desacetyl-CTX (D-CTX) was 25.2 micrograms/ml, while concentrations in the cerebrospinal fluid were 6.22 micrograms/ml (15.8%) for CTX and 3.94 micrograms/ml (15.6%) for D-CTX. On the third day of illness, concentration of CPR in the plasma was 59.3 micrograms/ml, while its concentration in the cerebrospinal fluid was 7.44 micrograms/ml (12.5%). 3. CPR was intravenously administered in daily dosages of 37.7-75.0 mg/kg in 2-3 portions for periods of 4-15 days to 2 patients with septicemia (causative bacteria, Klebsiella pneumoniae in 1 case and Escherichia coli in the other), 1 patient with bronchitis (K. pneumoniae), 9 patients with pneumonia (1 case of Staphylococcus aureus, 3 cases of H. influenzae, 2 cases of Haemophilus parainfluenzae, 1 case of K. pneumoniae + Pseudomonas cepacia, 2 cases of H. influenzae + Branhamella catarrhalis), 2 patients with cellulitis (1 case of S. aureus, 1 case, causative agent unknown), 1 patient with suppurative lymphadenitis (causative agent, unknown), 1 patient with staphylococcal scalded skin syndrome, 1 patient with renal abscess (causative agent, unknown), and 1 patient with a urinary tract infection (E. coli), for a total of 18 patients, with excellent results in 9 cases and good results in 9 cases, hence an efficacy rate of 100% was obtained. 4. As an accompanying side-effect, eruption was observed in 1 of the 18 patients, but when administration was discontinued, the symptom gradually receded, and it disappeared by the 4th day.(ABSTRACT TRUNCATED AT 400 WORDS)     

Adverse effects of drugs on the blood

Amongst adverse drug reactions blood dyscrasias are not frequent, but they may have serious consequences. Compared with Sweden, data from The Netherlands are scarce. It is to be expected that regular reports about the incidence of drug-induced blood dyscrasias may play an important role in general prevention.Blood dyscrasias may be caused by a variety of drugs, from many pharmacotherapeutic groups with diverse chemical structures and with all application forms. Metabolism and distribution may influence the activity of drugs.Drug-induced anaemias, including aplastic anaemia, are briefly discussed. Toxic and immune mechanisms may occur. The same holds with regard to the leucopenias. Drug-induced thrombocytopenia is mainly immunemediated (cytostatics being excluded as causative agents). In immune-mediated drug-induced blood dyscrasias often haptens must be formed. They can be formedin vivo in the liver or in the lymphocytes. In some cases they appear to be formed evenin vitro.Tracing the causative agent of a dyscrasia, be it a drug or some other substance, requires a series of investigations, comprising usage of the drug, serology and cell culture. Provocation tests are seldom justified. Distinct preventive measures can be taken to minimize the risk of blood dyscrasias: avoidance of risky drugs, awareness of the patient about early clinical signs and haematological control.     

Analysis of urinary metabolites of sulfur mustard in two individuals after accidental exposure

In July 2004, two individuals developed blisters after the destruction of a WWI-era munition. To determine the causative agent, urine samples were collected from both the highly blistered patient (patient 1; 6.5% of total body surface area) and patient 2, who had only one small blister. Their urine was analyzed for metabolites of known vesicants including sulfur mustard (HD), Lewisite (L1), and nitrogen mustards. The urine samples only tested positive for metabolites of HD. Additional metabolites were measured to confirm the exposure of sulfur mustard agent HD, including thiodiglycol (TDG), TDG-sulfoxide, and the bis-mercapturate of mustard sulfone. On day 2 after the exposure, patient 1 had a beta-lyase metabolite level of 41 ng/mL, and patient 2 had a level of 2.6 ng/mL. Detectable levels of the beta-lyase metabolite were observed in patient 1 for 11 days and in patient 2 for 7 days. Levels of TDG and both TDG and its sulfoxide measured together in the urine of patient 1 were found to be 24 ng/mL and 50 ng/mL, respectively, on day 2. The bis-mercapturate of mustard sulfone was detected in patient 1 (3.1 ng/mL) on day 2 but was not detected in samples taken on subsequent days.     

What do we want from proteomics in the detection and avoidance of adverse drug reactions

The incidence of severe adverse drug reactions is approximately 7% in hospital patients. In many cases the adverse event is difficult to predict or even explain on the basis of the known pharmacology of the causative agent. It is not infrequent in the context of multiple drug therapy, which complicates identification of the culprit. This can present a major problem in the management of chronic diseases such as tuberculosis or epilepsy. Pharmacogenetics offers one approach to reducing the incidence of drug-induced adverse reactions but has recognised limitations as a predictive tool and little role in diagnosis. Proteomics may have some predictive value but is likely to be of greater use in diagnosis-for example by recognising a drug signature in an accessible tissue. This may be possible on a blood sample or biopsy taken at presentation. Alternatively an in vitro assay that replaced rechallenging the patient with a drug would be helpful. The goal is to identify the causative drug permitting resumption of treatment with a safer alternative.