应用ISS和NISS评估伴严重胸部损伤的多发伤患者并发症与救治结局

目的 探讨新的损伤严重度评分(new injury severity score,NISS)和ISS在评估伴严重胸部损伤的多发伤患者的并发症与救治结局中的应用价值.方法 采用简明损伤评分-2005(AIS-2005)对重庆市急救医疗中心2005年1月-2011年1月救治的1377例伴严重胸部损伤的多发伤患者资料(胸部AIS≥3分)进行回顾性分析.计算NISS和ISS,并分析其与死亡的相关性.结果 治愈率为93.2％,死亡率为6.8％,并发症发生率为28.5％.NISS值(r=0.569,P＜0.01)、ISS值(r=0.442,P＜0.01)分别与并发症发生率呈正相关,NISS值(r=0.693,P＜0.01)、ISS值分别与死亡率呈正相关(r=0.774,P＜0.01),其中NISS值与并发症发生率、ISS值与死亡率有更强的相关性.在并发症发生预测方面,NISS敏感性优于ISS,特异性不及ISS(P＜0.01),在死亡预测方面,ISS与NISS相当(P＞0.05).结论 NISS和ISS均能较好评价伴严重胸部损伤的多发伤患者的并发症与救治结局.利用NISS值预测并发症的发生,ISS值预测救治结局以尽可能提高预测的准确性.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

胸部创伤严重度评价与救治结局探讨

目的探讨以简明损伤定级标准（AIS）为基础的ISS与胸部创伤救治结局的关系。方法采用AIS-98最新修订本对我院1995年1月-2005年6月救治的3057例胸部创伤病例资料进行回顾性分析。结果总治愈率93．8％（2866／3057），病死率6．2％（191／3057）。死亡组ISS、GCS、修正创伤评分（RTS）、国人创伤严重度特征评分[ASCOT_CHINA]_生存概率（Ps）、创伤与损伤严重度评分（TRISS）_Ps、ASCOT_Ps与生存组比较，差异具有统计学意义（P〈0．01）。穿透伤病死率11．4％（75／655），显著高于钝性伤4．8％（116／2402）（P〈0．01），穿透伤组ISS值显著高于钝性伤组，但穿透伤组TRISS_Ps、ASCOT_Ps和ASCOT_CHINA_Ps明显低于钝性伤组。ISS值越高，RTS值越低，ASCOT_CHINA_Ps越低，病死率越高。ISSt〉20，病死率高达7．2％-28．8％；RTS≤6，病死率高达52．7％以上。TRISS和ASCOT准确性、特异性高，生存误判低，而ASCOT-CHINA灵敏度高，死亡误判低。结论以AIS-98为基础的ISS、TRISS、ASCOT、ASCOT_CHINA_Ps等方法评价胸部创伤或胸伤合并多发伤的严重度及其结局预测是可行的，TRISS、ASCOT和ASCOT_CHINA_Ps的各项预测性指标以及误判性指标趋于合理。     

创伤后多器官功能不全综合征

本文重点阐述创伤后多器官功能不全综合征（MODS）的高危因素、发生机制及普遍的临床特征、诊断指标、分期、预防与治疗。强调应重视MODS的本质及连续变化的过程，其早期变化具有极大的隐蔽性，也正是此期才是治疗的最佳时机；目前的诊断标准并不是治疗开始的依据，只要有产生MODS的诱因和倾向均应及早采取对策。因此，对MODS而言，最好的治疗莫过于预防，预防有事半功倍的效果。     

躯干贯通伤伴螺纹钢筋存留紧急手术救治成功1例

本文报告1例螺纹钢筋致躯干，纵隔，胸椎椎体贯通伤的紧急手术救治经过，综合性创伤科一体化救治，周密的手术方案，做好心肺大血管损伤，拔除钢筋时控制大出血等各种充分准备是成功获救的关键。     

羊水过少对胎儿生长发育影响的实验研究

作者报告利用17只兔胎仔于妊娠24～25天行子宫内胎儿外科手术,制作成尿路梗阻、羊水过少模型。通过对胎仔大体形态学观察和形态学测量,发现实验组羊水明显减少,兔胎仔大体形态也较对照胎仔瘦小,体重、肺重及肺重占体重的百分比也显著降低。提示羊水过少对胎仔发育具有明显影响,导致胎儿宫内生长迟缓和肺发育不全。     

CHANGES AND CLINICAL SIGNIFICANCE OF PLASMA ENDOTHE-LIN IN TRAUMA PATIENTS WITH HEMORRHAGIC SHOCK

ＣＨＡＮＧＥＳＡＮＤＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮＣＥＯＦＰＬＡＳＭＡＥＮＤＯＴＨＥ┐ＬＩＮＩＮＴＲＡＵＭＡＰＡＴＩＥＮＴＳＷＩＴＨＨＥＭＯＲＲＨＡＧＩＣＳＨＯＣＫＤＵＤｉｎｇ－ｙｕａｎ（都定元）１，ＧＡＯＪｉｎ－ｍｏｕ（高劲谋）１，ＷＡＮＧＸ...     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.     

开放式宫内胎儿外科手术：母体的处理和危险

胎儿显像技术的不断发展，使胎儿解剖畸形的产前诊断和胎儿外科手术矫治成为可能，母亲的安全是开展胎儿外科首先需要考虑的问题。对临床开放式宫内胎儿外科手术技巧，术后处理，母亲的结局和对母亲生殖潜力的影响进行了阐述。认为：胎儿外科手术涉及的母体安全是满意的，使用可吸收缝线关闭子宫切口，不影响母亲将来的生育力。     

后方医院救治61例地震伤员分析

目的探讨后方医院诊治地震伤员时应掌握的要点。方法对2008年5月由灾区前线医院转送重庆急救中心救治的61例汶川地震伤员的病例资料进行回顾性分析。结果 26例(42.6%)早期漏诊颅脑、胸和腹部损伤,在转入1小时～4天内补充诊断;2例延迟性血气胸和2例腹内脏器延迟性破裂及时发现和处理。11例下肢严重挤压伤和挤压综合征避免了截肢;6例伤口采样培养有梭状芽胞杆菌生长但未发生气性坏疽。除2例遗留截瘫外,其余全部治愈。结论地震伤员的后方医院处理,重点为对初期抢救中的漏诊和治疗不足及时发现和补救;警惕胸腹脏器损伤的延迟性破裂;肢体挤压伤注意防治挤压综合征和气性坏疽,彻底切除坏死肌肉组织可最大限度地避免截肢。