高能战斗部致绵羊胸部务的实验研究

目的 研究高能战斗部（ＨＥＦ）致胸部伤特点和规律,为胸部爆炸伤的救治提供原则和依据。方法 用电启动的方式引爆ＨＥＦ,将４５只绵羊布放于距爆心３０～２４０ｍ处,致伤时测量冲击波超压和破片速度,致伤后进行病理解剖观察。结果 胸部破片伤的发生率为６７％（３０／４５％）,伤后即刻死亡率为７３％;损伤类型以盲管伤和贯通伤为主,分别为５７％和３１％;在３０只有胸部破片伤的动物中,肺冲击伤、肋骨骨折、大量胸腔积     

胸部爆震伤致纵隔气肿的诊断与治疗

目的探讨胸部爆震伤致纵隔气肿临床特点、诊断与治疗要点,提高对其认识及处理。方法回顾性分析厦门大学附属东南医院2012年1月—2018年12月收治14例胸部爆震伤致纵隔气肿患者的临床资料,男性12例,女性2例;年龄18~65岁,平均47.0岁;炸药爆炸伤6例,煤气爆炸伤3例,烟花爆竹爆炸伤2例,高压锅爆炸伤3例;受伤至入院时间为30min^4h。全组病例入院后即明确诊断为纵隔气肿和多发伤,胸部CT示游离气体聚集于纵隔胸膜内结缔组织,患者均出现不同程度胸闷、胸痛,其中出现呼吸困难5例,咳嗽、咯血2例,恶心、呕吐1例。结果14例纵隔气肿中行纵隔引流术7例,胸腔闭式引流术5例,末行引流术2例;开胸探查止血5例,气管修补2例,食管破裂修补1例,非手术治疗6例[其中体外膜肺氧合(ECMO)支持治疗2例]。结果中未说明。死亡1例,其余病例痊愈出院,随访2个月无纵隔气肿再发。结论胸部爆震伤伤情复杂,常合并纵隔气肿,早期有效诊断并及时发现严重的张力性纵隔气肿及纵隔器官损伤,进行有效的干预治疗措施可以显著提高患者的治疗效果。     

严重胸部伤合并颅脑伤的特点与救治

报告１９６４年５月～１９９４年５月收治的资料完整的胸部和颅脑合并损伤４４例，按损伤严重度评分（ＩＳＳ）法，ＩＳＳ值≥２０，就损伤特点与救治原则进行讨论。临床资料一、一般资料本组４４例，男３５例，女９例，年龄１７～７６岁。汽车致伤３２例，摩托车致伤４例...     

火器致胸部穿透伤1例救治分析

介绍1例由枪击所致双胸腔双肺和纵隔穿透伤,在紧急抗休克的同时,经胸骨正中切口,同时修补双侧肺叶,术后加强营养,积极抗感染,抢救成功,未留任何脏器功能不全的后遗症。     

胸部多发伤的临床治疗

探讨胸部多发伤的诊断和急救。认为及时准确判断伤情,早期诊断,自体血回输,紧急手术是抢救复杂性胸部创伤的关键。     

胸部开放伤后海水浸泡致急性肺损伤的实验研究

探讨海水浸泡胸部开放伤致急性肺损伤的特点,为研究救治方案提供依据。方法：实验动致伤后随机分为单纯胸外伤组（ｎ＝１０）和海水浸泡组（ｎ＝１０）。海水浸泡组动物于伤后置入人工配制的海水中,于伤前及入水后０．５、１、２、３和４ｈ取向测定ＴＮＦ。和ＩＬ－１β变化,同时监测血液动力学、呼吸系统和动脉血气变化。活杀或死后立即取肺标本行光镜和电镜检查。单纯胸外伤组除不浸泡海水外处理同海水浸洮 组。结果：浸泡组死     

135例胸部穿透伤治疗的体会

胸部穿透伤在胸外科较为常见。随着治安事件增加,胸部穿透伤有增多的趋势。1993年1月～1998年12月我院共收治胸部穿透伤135例,现将诊治体会报告如下。临床资料1　一般资料本组男110例,女25例;年龄12～73岁,平均年龄30.6岁。致伤原因:刀戳伤111例,枪弹伤22例,(其中手枪2例、防爆枪5例、砂枪15例),牛角顶伤2例。损伤部位:左胸上部32例,左胸下部45例,右侧胸部伤39例,双侧胸伤7例,胸背部损伤10例,颈胸贯通伤2例。临床主要表现为气胸46例、血胸89例(其中血气胸36例)。肋骨骨折33例,皮下气肿32例,休克72例,呼吸困难98例,异物残留20例(多为砂枪弹),…     

胸部刀刃穿透伤112例临床分析

目的 总结胸部刀刃穿透伤临床特点、诊断及处理的临床经验。方法 对1995～1999年我科收治的112例胸部刀刃穿透伤临床诊治情况进行分析。结果 早期明确诊断109例,漏诊3例。闭式引流98例、胸穿19例,手术治疗52例,其中开胸27例、开腹25例。治愈105例,死亡5例。结论（1）胸部刀刃穿透伤合并伤多、伤情重、变化快、休克发生率高;（2）迟发性血气我、膈肌破裂、腰背部伤早期易漏诊;（3）刀刃所致的胸腹联合伤,漏诊或手术处理不当易发生胸腔感染;（4）手术率高,早期救治得当预后好。     

胸部钝器伤与锐器伤临床特点比较

目的比较胸部钝器伤与锐器伤不同临床特点,探讨相应的处理方式。方法对132例胸部钝器伤和50例锐器伤患者的临床资料进行回顾分析,并比较两者的不同表现和处理特点。结果钝器伤患者治愈128例,死亡4例,其中2例死于双侧严重肺挫伤,2例死于多系统损伤所致的多脏器功能衰竭。锐器伤治愈48例,死亡2例,其中1例在急诊手术的麻醉过程中死亡,1例在术后第2d死于多脏器功能衰竭。结论钝器伤患者大部分通过保守治疗及胸腔闭式引流可以达到治疗目的,而锐器伤患者肋间血管损伤及肺裂伤多见,且易伴发心脏大血管损伤、膈肌破裂及腹腔脏器损伤,开胸探查指征应适当放宽,特别是伴有呼吸、循环功能障碍倾向者,在抗休克的同时应尽早开胸手术。     

Traumatic injuries: imaging of thoracic injuries

Chest trauma is one of the most important causes of death, in particular in individuals under the age of 40 years. The mortality rate for chest trauma, often related to motor vehicle accidents, is approximately 15.5%; it increases dramatically to 77% with associated shock and head injury (Glasgow scores of 3-4). The accurate diagnosis of pathologies consequent to blunt chest trauma depends on a complete knowledge of the different clinical and radiological manifestations. The first diagnostic approach is classically based on chest X-ray often carried out on supine position at the hospital admission. A CT study must then be performed in all chest trauma patients in whom there is even the smallest diagnostic doubt on plain film. In particular, spiral CT (SCT) assumes a fundamental role in the demonstration of mediastinal hemorrhage and direct signs of aortic lesions. At present, SCT is routinely part of a diagnostic evaluation which also includes scans of the brain and the abdomen in polytraumatized patients. Magnetic resonance is the ideal method for visualizing diaphragmatic lesions. Furthermore, recent reports have demonstrated the high diagnostic value of MR in evaluating aortic injuries. The purpose of this article is to review the most common radiological patterns related to chest trauma.     

兔胸部火器伤后血浆肾上腺素和去甲肾上腺素的变化

目的 了解兔胸部火器伤血浆中肾上腺素（epinephrine,E)和去甲肾上腺素（norepinephrine,NE)变化规律及在伤后应激反应中的作用。方法 将24只家兔随机分为：单纯胸腔贯穿伤组（Ａ组）、假致伤组（Ｂ组）和正常对照组（Ｃ组）。射击前Ａ、Ｂ组右颈总动脉及右颈外静脉插和、C组耳中动、静脉头皮针穿刺接八8道生理记录仪测压。伤前5min、伤后5,30min,1,3,6,12,24h取动脉血2ml离心出血浆,采用高效液相色谱仪（high-performance liquid chromatography,HPLC)与电化学分析（electrochemical detection,ED)检测E及NE含量。结果（１）A组E及NE于伤后30min达伤前4.13和3．45倍,分别于伤后1,3h降至最低点,为伤前2.57和0.47倍,于6h达二高峰,为伤前4.14和3．68倍,24h后降至伤前水平;B、C组E及NE比较,差异无显著性意义（P＞0．05）。（2）A组动、静脉压致伤瞬间（2ms内）升高,平均达伤前的1．8和6．8倍,迅即下降至伤前水平,随后缓慢下降,分别于伤后30,5min降至最低点（伤前的0．63和0．25倍）,之后缓慢回升,6,12h接近伤前水平;B、C组动、静脉压比较,无统计学意义（P＞0．05）。结论 兔胸部火器伤后血浆中E和NE均显著升高;二者浓度变化主要源自创伤后失血及组织损伤,且与伤情轻重关系密切,可作为胸部火器伤后早期伤情程度的判断标准。     

高性能战斗机飞行员特技飞行后臂痛一例

一、临床资料 患者,男性,32岁,高性能战斗机飞行员,总飞行时间1800 h,平素健康,能适应空中生活,抗荷耐力良好,新进连续综合特技课目飞行.第2架次着陆后向航医诉说双臂疼痛.检查见双臂内侧皮下散在瘀斑性小出血点,面积约10 cm×20 cm.询问该飞行员并查看飞行参数记录仪示:飞行员空中反复暴露于3～9 G的加速度下,持续时间5～7 s.     

胸部DR双能量减影与DR胸片及胸部CT吸收剂量对照研究

目的:探讨胸部DR双能量减影(DES)与DR高千伏X线摄影、DR亚高千伏X线摄影、胸部常规CT扫描以及低剂量胸部CT扫描被检者X线吸收剂量之间的差异,从剂量学角度阐明胸部影像学检查程序.方法:72例患者采用DR双能量减影、DR高千伏X线摄影以及CT扫描.DR双能量减影采用140 kV、320 mA,60 kV、500 ...     

成批烧冲复合伤患者的临床救治

目的总结烧冲复合伤的临床特点及救治经验。方法2005年6月7日收治一批5例烧冲复合伤患者,烧伤面积达总体表面积(TBSA)的80%～97%[(89.6±7.2)%],其中Ⅲ度面积达TBSA的75%～92%[(83.4±7.3)%],所有患者已行气管切开。对这些患者病情变化特点进行总结,动态测定部分凝血功能指标的变化。对1例死亡患者的病理组织进行了检查。结果除1例入院时已并发脓毒性休克于入院后23 h死亡外,其余4例均救治成功。入院时5例患者均有心、肝、肺、胰腺等多器官功能障碍,尤以肺脏损伤为重。死亡患者心、肝、肺等器官出现了严重的冲击伤病理变化。本组血小板均明显降低,凝血功能明显异常,使用低分子量肝素钙抗凝治疗,5 000 U/次,2～4次/d静脉给予后凝血功能得到改善,未发生弥漫性血管内凝血。2例呼吸功能不全、低氧血症的患者,给予呼吸机支持,采用保护性通气策略,加用低水平呼气末正压通气,短时间内给予纯氧纠正低氧血症。尽早封闭烧伤创面,所有患者于入院后12～16 h分别行四肢和胸腹部切削痂和异体皮微粒皮移植手术,一次封闭创面(55±8)%。患者异常升高的血、尿淀粉酶、血脂肪酶在使用大剂量乌司他丁(60万U/次,4次/d)治疗后恢复至生理水平。结论烧冲复合伤伤情重,多器官功能严重受损,临床过程复杂,凝血功能明显异常。正确判断伤情,尽早封闭创面,审慎使用抗生素,积极抗凝治疗,注重营养支持与代谢调理,强化胰岛素治疗,及时有效地行脏器功能支持与保护是救治成功的关键。     

爆炸冲击波致肢体周围大血管损伤的病理学研究

目的 观察爆炸冲击波致肢体周围大血管造成损伤的病理特点,为四肢战伤救治、预防并减少并发症提供理论依据. 方法 将18只家兔采用随机数字表法分为三组,每组6只兔,均匀布放于距爆心1,2,3 m处,电启动引爆离地面60 cm高的液体炸药制作冲击伤动物模型.用美国PCB公司生产的压力传感器测定冲击波的物理参数,致伤后对兔股动脉血管进行大体形态、组织学及免疫组织化学观察. 结果 股动脉血管内皮细胞剥脱;血管平滑肌细胞间隙增大呈疏松状;血管的弹力纤维有明显的断裂,屈曲变形;部分血管壁全层断裂或部分断裂,导致出血.Tunel染色、荧光显微镜下观察,在血管内皮层、中间平滑肌层、血管外膜中见大量的凋亡细胞.结论爆炸冲击波瞬时作用对肢体周围大血管损伤严重,在冲击伤救治中应引起足够的重视.     

Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases

AIM: To determine the usefulness of multidetector-row CT (MDCT) with multiplanar reformatted (MPR) images in the sagittal and coronal plane in diagnosing acute right hemidiaphragmatic rupture. MATERIALS AND METHODS: Twelve patients were identified who received chest and abdominal MDCT after major blunt trauma diagnosed with right diaphragmatic injury. Sagittal and coronal reformations were performed in all cases. The images were retrospectively reviewed by two experienced radiologists for signs of right diaphragm injury, such as direct diaphragm discontinuity, the "collar sign", the "dependent viscera sign", and intra-thoracic location of herniated abdominal contents. RESULTS: Of the 12 cases of right hemidiaphragm rupture, diaphragm discontinuity was seen in seven (58%) cases, the collar sign in five (42%), the dependent viscera sign in four (33%), and transdiaphragmatic herniation of the right colon and fat in another. Two variants of the collar sign were apparent on high-quality sagittal and coronal reformations. The first, termed the "hump sign", describes a rounded portion of liver herniating through the diaphragm forming a hump-shaped mass, and the second, termed the "band sign," is a linear lucency across the liver along the torn edges of the hemidiaphragm. The hump sign occurred in 10 (83%) patients and the band sign in four (33%). CONCLUSION: MDCT is very useful in the diagnosis of right hemidiaphragm injury caused by blunt trauma when sagittal and coronal reformatted images are obtained, and should allow more frequent preoperative diagnosis.     

高性能战斗机飞行员脊柱损伤与退变及其临床意义

目的 概述关于高性能战斗机飞行员脊柱损伤与退变研究概况。资料来源与选择国内外近二三十年来相关文献报道。资料引用 相关文献19篇。资料综合 对脊柱生物力学及临床实验研究、脊柱X线平片研究、脊柱局部CT扫描的研究、临床症状学分析等诸方面问题都做了详细论述。结论 高性能战斗机飞行员工作环境具有加速脊柱(尤其是颈椎)退变的作用。但是，高性能战斗机飞行员脊柱提前退变的实际临床意义仍然不是十分清楚。     

颅脑爆震伤后兔脑内代谢变化的磁共振波谱研究

目的 利用磁共振波谱技术探讨颅脑爆震伤后不同时间段脑局部代谢变化.方法 新西兰大白兔45只采用随机数字表法分为对照组(10只)和创伤组(35只),采用600 mgTNT当量纸雷管在创伤组兔脑上方约6.5 cm垂直距离爆炸,于伤后1,6,12,24 h、3,7,14 d用磁共振波谱技术观测动物存活情况,并检测脑损伤区病理及磁共振波谱表现,观察乙酰天门冬氨酸(N-acetylaspartate,NAA)/肌酸(creatine,Cr)、胆碱(choline,Cho)/Cr在爆震伤后随时间发展的演变过程.结果 创伤组兔存活时间在7 d以上,病理及常规MRI示脑挫伤病灶;NAA/Cr均值在损伤后1 h明显下降,持续至伤后24 h,24 h后义上升,7 d后再次下降.Cho/Cr均值在损伤1 h后即明显升高,12 h后下降,3 d后义逐渐升高.结论 磁共振波谱技术可反映兔颅脑爆炸伤不同时间段局部组织的代谢变化,为了解爆雀伤后局部组织变化情况及判断组织损伤类型提供理论依据.

Abstract：

Objective To evaluate the regional cerebral metabolic changes in different episodes by magnetic resonance spectroscopy (MRS) after explosive brain injury in rabbits. Methods Fortyfive New Zealand white rabbits were randomly divided into eight groups, ie, normal control group( 10 rabbits) and trauma group (35 rabbits). The explosive injury in trauma group was induced by explosion of 600 mg TNT equivalent of paper detonators at 6.5 cm above the rabbit brain. The rabbits in trauma group was divided into 1,6, 12, 24 hours, 3, 7, 14 days subgroups (6 rabbits per group). The survival rate was observed at different time points after explosive injury. The MRS was used to detect the regional cerebral metabolic changes including N-acetylaspartate (NAA)/creatine (Cr) ratio and choline(Cho)/Cr ratio as well as evolution of blast injuries over time. Results The rabbits survived for overseven days in the trauma groups, with typical brain contusion manifested by pathological and conventional MRI. Compared with the normal control group, the NAA/Cr ratio was markedly decreased at one hour after injury, slightly rose again at 24 hours and fell again after seven days. The Cho/Cr ratio was markedly increased at one hour after injury, slightly fell again at 12 hours and rose again at three days after injury.Conclusions MRS can manifest the regional cerebral metabolic changes of rabbits with explosive injury at different time points and hence provide a theoretical basis for understanding the local tissue changes and determining the type of tissue damage after blast injury.