不同致伤参数对兔胸部撞击伤后心血管损伤的影响

目的：探讨不同致伤参数对兔胸部撞击伤后心血管系统伤情的影响。方法：采用兔胸部撞击伤模型，设置不同的致伤参数，观察其对心血管系统损伤程度和死亡率的影响。结果：驱动压力越大，心血管系统损伤程度越重；撞击面积增大，心血管系统损伤程度并不随之加重；收缩末期撞击对心脏的损伤较重，舒张末期撞击对大血管系统的影响较大；死亡率与驱动压力、撞击面积成正比；舒张末期撞击死亡率上升。结论：致伤参数不同，对胸部撞击伤后心     

颅脑和胸部撞击伤发生机制研究

目的：介绍自制的各种生物撞击机，总结以往颅脑和胸部撞击伤发生机制方面的研究成果，以便为颅脑和胸部撞击伤的防治提供理论依据。方法：应用自行研制的生物撞击机,给犬、兔、大鼠等动物造成不同类型的撞击伤，并进行颅脑和胸部撞击伤发生机制的研究。结果：（1）制成几种生物撞击机和颅脑、胸部撞击伤模型。（2）证实原发颅脑撞击伤的主要原因是外力作用于颅脑后形成的剪切应力所致。（3）继发性颅脑伤是因血管损伤、炎症损伤和兴奋性氨基酸增多致神经元钙离子内流等因素所致。钙通道阻断剂尼莫地平和血管扩张药物伊洛前列素（Iloprost) 均有抗损伤作用。（4）胸部损伤与胸腔内应力传播有关，黏性损伤标准可作为最有效的伤情指数。结论：原发颅脑和胸部撞击伤是由于体内应力传播和应力集中所致。继发性损伤与血管损伤、过度炎症反应和兴奋性氨基酸增多致使神经元钙内流增强有关，相应的拮抗措施有明显的抗损伤作用。     

爆炸性胸部创伤伤情特点分析

目的　研究胸部爆炸伤的伤情特点及规律 ,为胸部爆炸伤的救治提供原则和依据。方法　按爆炸源和致伤动物之间的距离不同 ,30只家兔随机分为 4组 ,观察破片、冲击波对胸壁、肺脏、心脏和周围其它脏器的损伤情况。结果　胸部破片伤和冲击伤的发生率分别为 73 3%和 10 0 % ,伤后即刻死亡率为 30 0 % ,心脏破裂、肋骨骨折、胸腔积血和胸腹合并伤的发生率分别为 10 0 %、5 0 0 %、5 6 7%、5 3 3%。结论　破片和冲击伤是胸部爆炸伤的主要致伤因素 ,以多发伤和复合伤多见 ,伤情重而复杂 ,早期死亡率高 ,加强胸部爆炸伤的防护和早期、现场救治是提高存活率的关键。     

小型动物重症胸部创伤模型撞击装置

目的 设计制作小型动物撞击装置,并以此为基础建立了大鼠重症胸部创伤模型.方法 自行设计制作小型生物撞击装置,测量撞击速度的误差以及撞击中心点的圆周误差.将成年雄性SD大鼠84只,随机平均分配到A、B、C、D、E、F、G共7组,用自行设计制作的小型生物撞击装置撞击致伤.A组为对照组,进行假撞击;其余各组以不同的撞击速度和胸廓压缩比为撞击条件:B组(3 m/s,20%),C组(3 m/s,40%),D组(6 m/s,20%),E组(6 m/s,40%),F组(9 m/s,20%),G组(9 m/s,40%);定位于右腋前线第3、4肋间进行水平状态准静态撞击.大鼠撞击前、撞击后2 h、撞击后12 h,分别进行动脉血气分析.撞击后12 h处死所有大鼠,开胸判断伤情并评分后取出肺脏,右肺损伤区域取材行病理学检查.结果 该撞击装置的撞击速度误差＜4%,撞击中心点圆周误差＜3mm.大鼠撞击后一般表现为:血压、心率即刻下降,然后迅速恢复或超过伤前水平;呼吸暂停,之后出现浅快呼吸.动脉血气分析提示:撞击后B、C组大鼠出现低碳酸血症;D、E、F组大鼠出现低碳酸血症合并低氧血症,其中E组大鼠变化最为明显且持续时间较长.大鼠胸部伤情判断评分发现:A组(0分),无胸部损伤;B组(1.50±0.52)分、C组(1.92±0.67)分、D组(2.58±0.67)分,创伤均轻微,12 h内无死亡;E组(4.08±0.90)分,创伤较重,12 h死亡率为33.33%;F组(3.08±0.79)分,创伤较轻,12 h死亡率为8.33%;G组(5.25±0.62)分,创伤极重,12 h死亡率为83.33%.病理检查见损伤区域肺组织结构破坏明显,肺泡内广泛出血,肺泡间质水肿,炎症细胞的浸润.结论 该动物撞击装置撞击参数控制准确,重复性好.以撞击速度6 m/s、胸廓压缩比40%为撞击条件,建立的大鼠胸部创伤模型可以模拟临床所见的重症胸部创伤患者的典型病理生理过程,稳定可靠,适用于撞击所致的胸部重症创伤及其继发性损伤反应的相关研究.     

预制破片致兔胸部爆炸伤的实验研究

目的：研究预制破片铝制雷管致兔胸部爆炸伤的伤情特点及规律，为制定胸部爆炸伤的救治原则提供实验依据。方法：用电启动方式引爆预制破片铝制雷管，将32只家兔置于距雷管5，8，10，12，15cm处，致伤前后常规观察生命体征及破片，冲击波对胸壁，肺脏和周围组织脏器的损伤情况，结果：伤后即刻死亡率为46．9％，各组死亡率有明显差异，冲击波主要靶器官为肺脏，破片伤发生率为62．5％，以盲管伤为主，常合并肋骨折及肋间血管损伤，心肌挫伤，肝脾，胃肠破裂。结论：胸部爆炸伤伤情复杂，死亡率高，伤后易致以肺功能衰竭（ARDS）为主的多脏器功能衰竭，破片伤致失血性休克和冲击伤致急性肺功能损伤是伤后早期死亡的主要原因。     

超声在胸部撞击伤尸体检验的初步研究

目的：利用动物模型探索超声在胸部尸体检验中的价值。方法：健康新西兰兔16只,在BIM-I型竖直生物撞击机下,采用850g,直径40mm的钢柱撞击胸部,撞击中心在第4,5肋间心前区,模拟胸部钝性伤;撞击后对未立即死亡动物超声进行心脏左室壁厚度测量、左室血流动力学评估、肋骨骨折情况、心包及胸腔积液检查、气胸检查;撞击后死亡动物仅行气胸检查、肋骨骨折、胸腔及心包腔积液检查;未死亡动物过量麻醉剂处死,所有动物死后进行尸体解剖,与超声结果比对。结果：撞击后未立即死亡动物室间隔平均增厚1.21mm,左室后壁平均增厚1.13mm,具有统计学意义（p＜0.001）;左室射血分数FS值平均降低7.2%,EF值平均降低10.2%,具有统计学意义（p＜0.001）,心包积血、胸腔积血及肋骨骨折的超声诊断结果与尸体解剖结果比对,Kappa值＞0.75,诊断结果一致性较好,死后有肺挫裂伤者可探及气胸声像图。结论：超声可对胸部撞击损伤后进行评估,对心包及胸腔积血和肋骨骨折较为敏感,在尸体检验中有一定的应用价值。     

胸部急性钝性损伤CT表现

随着自动化交通工具使用的日益广泛,急诊胸部外伤、尤其是钝性外伤的发生率及其致死、致残率也明显升高[1].按照损伤由外向内的顺序,胸部损伤大致分为胸壁损伤、胸膜腔损伤、肺损伤、膈损伤及纵隔内损伤;其中纵隔内损伤又大致分为纵隔积气、气道损伤、血管损伤以及较少见的食管和心脏损伤等.     

胸部损伤271例的护理观察

胸部损伤是常见的外科急症,轻者仅有胸壁损伤,重者可伤及病人的心、肺、大血管、食管等重要器官,还可发生气胸、血胸、肺组织出血、呼吸道阻塞等并发症,从而引起呼吸循环障碍,严重时可导致死亡。因此,在抢救     

64层螺旋CT对胸部创伤的诊断价值

目的探讨64层螺旋cT对胸部创伤的诊断价值。方法回顾性分析我院近年来收治的124例胸部外伤患者经64层螺旋CT进行诊断的临床资料。结果本组124例胸部创伤患者经cT检查：肺损伤63倒,包括肺挫伤41例,肺撕裂伤15例,气管支气管损伤7例;肺外损伤61例,包括胸膜损伤26倒（血胸12例,气胸8例,血气胸6例）,纵隔损伤7例（纵隔积气5例,积血2例）,胸壁损伤28例（肋骨骨折22例,胸骨骨折6例）。结论64层螺旋cT作为胸部创伤诊断的主要手段,具有扫描速度快,敏感性高的特点,在急诊创伤的急救过程中必将发挥重要的作用。     

胸部损伤的影像诊断分析

目的探讨274例胸部损伤病例的影像诊断资料,总结胸部损伤的检查要点,鉴别诊断,注意事项等,更好地为临床治疗提供科学准确的影像诊断。方法通过胸部平片、旋转透视法、CT等综合分析胸部损伤的影像特点。结果胸部外伤首选的检查方法是透视下点片,必要时可加胸部的转动透视,这是临床诊断中最佳选择;CT在胸部损伤检查中,因密度分辨率高,层次分辨率高能清晰观察肺部损,而且CT对显露胸椎体椎管内情况较常规胸部平片更有优势,对于危重患者应首选CT检查。结论根据胸部患者的不同病情,科学合理地综合运用各种不同的影像诊断方法,会为临床治疗提供准确可靠的影像诊断资料。     

An experimental study of chest compression during chiropractic manipulation of the thoracic spine using an anthropomorphic test device

Purpose

Chiropractic manipulation of the thoracic spine may induce chest deformations in the anterior-posterior direction. Yet, few studies have examined the biomechanical response of the chest associated with these manipulations. Consequently, an experimental analysis was undertaken to quantify chest compressions resulting from chiropractic thoracic spine manipulations and to estimate amount of risk for injury.

Methods

A 2-part study approach was used with a Hybrid III anthropomorphic test dummy. In part 1, the dummy was positioned prone on a chiropractic table and subjected to thoracic spine manipulation by 2 experienced doctors of chiropractic. Chest compressions were quantified in the anterior-posterior direction. Manipulation forces were self-selected, with “typical” and “maximum” efforts examined. In part 2, the dummy was positioned beneath a force-instrumented mechanical piston device. Using the piston, chest compressions were induced with magnitudes identical to those recorded during chiropractic manipulation as well as magnitudes sufficient to induce injury. In all trials, force measurements were recorded.

Results

Thoracic manipulations incorporating the typical and maximum efforts by the chiropractors resulted in maximum chest compressions attaining 1.8% and 4.5% of total chest depth, respectively. According to previously developed correlations between chest compression and injury severity defined using the Abbreviated Injury Scale (AIS), maximum chest compression measured during this study was only 22.7% of the compression required for greater than 10% risk of an AIS 1 injury. Abbreviated Injury Scale 1 level injuries are graded as minor severity and correspond to sternum contusion or fracture of a single rib.

Conclusions

Results from this preliminary study showed that maximum chest compression during thoracic spine manipulation corresponded to minimal risk of AIS 1 level injuries.     

Role of thoracoscopy in acute management of chest injury

PURPOSE OF REVIEW: To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. RECENT FINDINGS: Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. SUMMARY: The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.     

The chest wall in acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: There has recently been renewed interest in the chest wall during mechanical ventilation, related to lung-protective ventilation strategies, as well as in the role of abdominal pressure in many facets of critical illness. The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome. RECENT FINDINGS: In mechanically ventilated patients with acute lung injury, intra-abdominal pressure is an important determinant of chest wall compliance. With elevated intra-abdominal pressure, the compliance of the chest wall and total respiratory system is decreased, with a relatively normal compliance of the lungs. The lung compression effects of increased intra-abdominal pressure may lead to a loss of lung volume with atelectasis. An appropriate level of positive end-expiratory pressure is necessary to counterbalance this collapsing effect on the lungs. Also, the stiff chest wall results in a lower transpulmonary pressure during positive-pressure ventilation. SUMMARY: As chest wall compliance may have important clinical implications during positive-pressure ventilation, the physiology of this effect should be considered, particularly in patients with acute lung injury and increased abdominal pressure.     

Correlations between quality indexes of chest compression

BACKGROUND:

Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice.

METHODS:

Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System.

RESULTS:

The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate.

CONCLUSION:

It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.KEY WORDS: Cardiopulmonary resuscitation, Chest compression, Quality indexes, Correlation     

Myocardial contusion in blunt chest trauma: A ten-year review

A retrospective review was undertaken of 169 patients admitted to an Intensive Therapy Unit with a major chest injury to determine the incidence, clinical features and outcome of patients with myocardial contusion. This injury occurred in 29 (17%) patients, of whom 24 (83%) had significant cardiovascular complications and five died as a direct result of the injury. The interval between injury and diagnosis was 3.2±2.3 days (mean±SD) from injury and in six patients the diagnosis was made only at necropsy. Increased awarenness of myocardial contusion is required for earlier diagnosis and prevention of complications.     

胸部刀刺伤合并膈肌破裂的救治

介绍２５例胸部刀刺伤合并膈肌破裂。本组胸部刀刺伤多发生在胸部左侧，全组８５％的患者有合并伤。给予急诊处理和手术治疗，除２例死亡外，其余２３例治愈。作者就胸部刀刺伤合并膈肌破裂的特点、临床诊断、急救治疗等问题进行了讨论。并认为：胸部伤多发生在左侧与左侧胸腔内有重要器官心脏，在格斗时易成为攻击目标以及大多人右手持械有关。在野战条件下，对胸部穿透伤伴有腹部症状的伤员，均应视为胸外伤合并膈肌破裂救治