腹部创伤126例诊治分析

目的 进一步提高腹部创伤的诊治水平，降低救治失败率，为临床提供腹部创伤救治的措施和方法。方法 回顾性总结分析1998年至2003年收治的126例腹部创伤救治的临床资料。结果 126例中，男101例，女25例，年龄最小2岁，最大78岁，多为18～35岁。手术治疗89例，非手术治疗37例。痊愈90例，死亡15例，占11．9％，其中多器官功能衰竭障碍综合症（MODS）7例，失血性休克5例，感染性休克2例，循环衰竭1例。死亡者均为3处以上多脏器损伤，ISs评分61～75分之间的4例均死亡。结论 腹部创伤的围手术期的正确处理是提高救治成功的关键，可供临床参考采用。     

人工血管移植修复腰椎间盘髓核摘除后髂总动脉损伤:病例分析

背景:国内外文献报道腰椎间盘手术并发腹部大血管损伤发生率较少,可一旦发生病情危急,抢救及处理不当可导致患者死亡或肢体功能障碍。目的:探讨腰椎间盘髓核摘除致腹侧大血管损伤的发生原因、诊断及防治措施。方法:复习1例腰椎间盘髓核摘除致髂总动脉损伤的诊断及防治措施。结果与结论:患者L4/5椎间盘突出症行L4、L5右侧椎板减压髓核摘除导致髂总动脉损伤,通过及时诊断、采取外科干预及人工血管移植,抢救成功。大血管的损伤与手术操作、解剖、病理等因素有关,对于术中不能明确原因的椎间隙渗血伴有术中血压突然下降提示可能有大血管的损伤;准确诊断及迅速采取外科干预是抢救生命的关键。     

13例大血管损伤手术治疗体会

目的 总结手术治疗大血管损伤的经验。方法 对13例大血管损伤患者进行手术治疗。结果 12例治愈,1例术后窒息死亡。结论 手术修复大血管损伤是抢救患者生命和保全肢体的关键。抗休克应与手术同时进行。术前备血应充足。手术应在吸引器引导下按解剖层次进行。切忌盲目止血,以免损伤神经,肌腱和腺体组织。吻合或修补血管时,要将血管游离充分,减小血管两端张力,防止术后发生管腔狭窄或血栓栓塞等并发症。     

10例心脏大血管创伤的早期救治

目的探讨心脏大血管创伤的早期诊断及治疗经验。方法回顾急诊手术治疗10例心脏大血管创伤的临床资料,分析穿透性损伤和钝性损伤的临床特点,以及早期诊断及治疗特点。结果全组死亡1例,死亡率10%（1/10）。9例痊愈出院。结论心脏大血管创伤应早期准确诊断,加强对急性心脏压塞和休克的处理,紧急剖胸手术是救治成功的关键。     

大血管损伤前急救与手术治疗体会

大血管(大动脉或静脉)损伤出血十分凶猛,如不能有效地控制出血和快速输血抢救,伤员仍易发生失血性休克甚至死亡。1994年至2002年间我们共收治17例,共20条大血管损伤,除1例因术后呕吐误吸窒息死亡外其余被治愈,现通过回顾性病案分析结合文献学习,将其院前急救和手术治疗体会进行报告。     

创伤性休克230例诊治分析

目的 探讨进一步提高创伤性休克的诊治水平。方法 回顾性总结1999年1月～2004年12月我院急诊科230例严重创伤病人，对患者年龄，创伤严重程度评分，伤后就诊时间，是否手术，输液输血量等因素进行统计分析。结果 230例严重创伤病人中抢救成功率为71．3％，创伤病死率为28．7％。结论 严重创伤、重度休克、长时间低血压、非正确休克复苏是影响休克治疗效果的主要因素。早期实施确定性抢救手术，可以有效地提高创伤性休克的救治效果。     

外科手术中大血管意外损伤的救治(附34例报告)

目的探讨外科手术中大血管意外损伤的救治经验。方法回顾分析34例术中大血管意外损伤的经验,研究其原因、特点、救治方法。结果34例中血管吻合5例(14.7%),自体静脉移植7例(20.6%), 人造血管移植1例(2.9%),血管修补9例(26.5%),血管结扎6例(17.7%),压迫等保守治疗4例(11.8%), 无法处理或未来得及处理术中死亡2例(5.9%)。输血800～15200ml,平均2862ml。结果本组死亡 6例(17.7%),截肢1例(2.9%),手术成功修复27例(79.4%)。结论 (1)手术中大血管意外损伤,可引起严重并发症和造成严重后果。(2)人为因素是主要原因,提高医生的警觉性及手术技巧,规范操作可有效地降低发生率。(31)损伤以单纯的动脉损伤为最多见,单纯静脉损伤次之,因此治疗以修补为主,静脉移植次之。(4)患者常常并发较严重的原发病,为避免顾此失彼,多脏器的兼顾与多科室问的协调在救治中较为重要。     

高海拔地区重型颅脑损伤的急诊手术治疗

目的探讨高海拔地区重型颅脑损伤的急诊手术救治方法及疗效。方法本组40例重型颅脑损伤患者GES评分小于8分，均行开颅手术清除血肿、挫灭脑组织清除、内减压、去骨瓣减压及相关专科治疗。结果恢复良好20例（50．0％）；轻度残疾9例（22．5％）；重度残疾6例（15．0％）；植物生存2例（5．0％）；死亡3例（7．5％）。结论对于重型颅脑损伤病人的救治，应争分夺秒，有手术指征的急诊手术尽可能地减少副损伤。术后观察、药物治疗及合并伤的治疗可以有助于降低二次脑损害的发生。早期进行高压氧治疗，有助于改善患者脑缺氧及脑水肿，促进患者康复。     

抢救心脏贯穿伤并发急性心包填塞的手术配合

心脏贯穿伤多由锐器、火器等损伤前胸引起,当并发急性心包填塞时可因心源性休克导致伤员死亡,因此必须积极救治,及时手术是抢救成功的首选方法。1986～1996年间,我们手术室共接4例,经手术抢救而获治愈。现结合病案分析和文献学习将手术室配合的     

腹部闭合性损伤急诊急救体会

目的 分析腹部闭合性损伤的特点,总结分析腹部闭合性损伤的急诊救治方法.方法 回顾性分析过去4年我院急诊收治的112例腹部闭合性损伤病人临床资料.结果 本组112例患者中有101例康复出院,11例死亡.结论 腹部闭合性损伤病情隐蔽性强容易漏诊误诊,病情变化快致残率和死亡率也极高,而按急、危、重的原则及时进行诊断和抢救,能够有效的挽救患者生命,提高治疗效果.     

Abdominal trauma revisited.

This article retrospectively reviews 258 consecutive abdominal trauma admissions who required laparotomy from July 1985 to June 1989 at a level one urban trauma center to define the population at risk, the patterns of injury, and the resulting morbidity and mortality. The findings were compared with a series of 252 abdominal trauma patients reported in 1974 by one of the authors. The majority of injuries in this series were gunshot wounds (GSWs) (47%), followed by stab wounds (SWs) (43%) and blunt abdominal trauma (10%). Males predominated, and 96% of patients were black. Major vascular system injury was the primary cause of death. Prompt evaluation, resuscitation, and operative intervention are mandatory in all abdominal GSW patients. More than half of those patients with major vascular system injury did not present in shock but had a high associated mortality.     

心脏穿透性损伤的外科处理要点：附8例报告

为了提高对于心脏穿透性损伤的诊断与治疗的认识,我院自1994年12月～1997年10月救治心脏穿透伤8例,均为男性,年龄15～35岁,平均23.5岁,伤后至手术时间最短30分,最长9小时.来院时均有血压下降及心音遥远,8例均在抗休克治疗后紧急进行开胸手术,采用2～O Prolene线连续缝合或带心包片缝合心脏裂口.2例二次手术修补室缺.其中2例因心脏停跳时间大于5分钟,术后出现脑死亡,其余6例均存活,说明心脏穿透性损伤虽然死亡率高,但若采取紧急有效的措施,多数是能获救的.     

Challenges in the management of pancreatic and duodenal injuries.

A retrospective analysis of 44 consecutive patients with pancreatic or duodenal injuries admitted to an urban trauma center over a 6-year period was undertaken. Thirty-three patients had pancreatic injuries, including eight with combined duodenal injuries. Eleven patients had duodenal injuries. The mean age was 28 years, and 93% of the patients were male. Penetrating abdominal trauma accounted for the majority of injuries. Class I pancreatic injuries were the most common (55%), followed by those with class III (21%) and class II (18%). The majority (55%) of pancreatic injuries were managed by drainage with or without suturing; distal pancreatectomy was used in 39% of patients. Duodenal injuries were managed by primary repair in 50% of cases and pyloric exclusion/diverticulization techniques were used in 20% of cases. The mean first 24 hours transfusion requirement was 6.8 packed red blood cells. Complications were common, occurring in 61% of patients surviving longer than 24 hours. Intraabdominal abscess developed in 31% of all patients, 42% of whom required relaparotomy. Pancreatic fistulas occurred in 16% of patients with pancreatic injuries. Six patients died, 83% within 8 hours of admission, all as a result of gunshot wounds. Increased mortality was seen in patients with higher blood transfusion requirements, higher penetrating abdominal trauma index, shotgun wounds, the need for pancreaticoduodenectomy, hypotension on admission, and the presence of an associated major vascular injury. We conclude that early operation and efficacious control of hemorrhage is of prime importance in decreasing the mortality rate associated with these injuries.(ABSTRACT TRUNCATED AT 250 WORDS)     

经腹膜后间隙抢救骨盆骨折大出血的解剖研究及临床应用

目的　探讨髂腹股沟入路腹膜后间隙的解剖要点及在抢救骨盆骨折大出血中的应用。  方法    37具国人尸体标本左右两侧髂腹股沟入路显露腹膜后间隙,观测血管、输尿管走行关系及肠系膜下动脉和输尿管、睾丸（卵巢）动静脉的前移距离。并临床应用该入路抢救12例骨盆骨折大出血患者,男10例,女2例。  结果    腹膜后间隙内腹主动脉、下腔静脉、髂总动静脉等紧贴盆壁与壁腹膜间有腹膜外脂肪相隔;肠系膜下动脉、睾丸（卵巢）动静脉与壁腹膜之间有致密结缔组织连接,易随壁腹膜掀起,输尿管上部与壁腹膜有连接,下部连接松弛;在L4椎体平面肠系膜下动脉可前移19.3 mm,睾丸（卵巢）动静脉可前移26.4 mm(右)和28.0 mm(左);输尿管可前移37.0 mm(左)和41.0 mm(右)。临床应用该入路抢救12例骨盆骨折大出血患者,术中对腹主动脉临时压迫阻断控制出血,抢救休克,修复或结扎损伤血管,复位固定骨折。11例成功,1例死亡;无血管、神经再损伤发生。  结论    经髂腹股沟腹膜后间隙入路手术可充分显露盆腔大血管,对腹主动脉临时压迫阻断可快速控制出血,纠正休克,提高了骨盆骨折大出血抢救成功率,是救治骨盆骨折大出血的理想入路。     

Surgical repair for abdominal aortic aneurysm concomitant with iliac arterial disease using InterGard? Quadrifurcated

InterGard? Quadrifurcated [InterVascular S.A. (MAQUET Cardiovascular), La Ciotat, France], a knitted quadrifurcated prosthetic graft, is useful to simplify the procedures for patients with abdominal aortic aneurysm concomitant with iliac arterial disease. From March 2008 to April 2010, 59 patients underwent abdominal aortic aneurysm repair in our department. InterGard? Quadrifurcated was used in 22 patients (37.3%). All patients were male with a mean age of 72.1 ± 12.1 years (range from 45 to 90 years). Four were emergency cases. Nineteen patients had common iliac arterial lesions, and 19 patients had internal iliac arterial lesions. In addition to abdominal aortic aneurysm repair, reconstruction of bilateral internal iliac arteries was performed in 4 patients, reconstruction of unilateral internal iliac artery in 15 (right 6, left 9), and internal mesenteric artery in 13. There was one hospital death due to nonocclusive mesenteric infarction. There were two complications, which were intestinal perforation and intestinal obstruction. All of these three cases were emergency cases. Computed tomography scan 1 week after operation showed that all reconstructed grafts were patent. Although patients with abdominal aortic aneurysm concomitant with iliac arterial disease had many preoperative comorbidities, surgical results with InterGard? Quadrifurcated were satisfactory. It is useful to simplify the procedures for these patients.     

体外循环在心脏及大血管损伤急救中的应用

目的临床评价体外循环（CPB）在心脏及大血管损伤急救中的应用和疗效。方法从2003年7月至2010年12月我院急诊应用CPB技术救治创伤所致心脏及大血管破裂患者11例。其中3例为创伤所致心脏穿透伤,3例为创伤所致颈部大血管损伤,4例为肾癌根治术中下腔静脉破裂,1例为肺叶切除术中肺静脉破裂。结果全组死亡1例（9.1%）,为颈部刀刺伤及无名动脉,术前已经出现失血性休克和心跳骤停;其余患者均顺利康复出院。结论准确的判断,及时有效的术前处理,尽早建立CPB,加强CPB管理,可有效提高创伤所致心脏及大血管破裂的救治成功率。     

烧伤24批131例治疗分析

目的通过对24批131例成批烧伤病人临床资料进行回顾性分析,探讨有效的治疗方法,以提高其治疗率。方法选择1998年10月～2004年12月收治的成批烧伤24批131例,对其治疗效果及死因进行分析。结果131例中治愈111例,放弃治疗4例,死于吸入性损伤者7例,死于其他并发症者9例。结论在成批烧伤的救治中,强有力的组织领导是救治成功的重要保证;及时、有效的休克复苏是救治的牢固基础;维持有效的呼吸功能和加强创面处理、防治烧伤侵袭性感染是救治的重要环节。     

脑死亡致肺损伤家兔热休克蛋白70的表达与作用

背景：脑死亡供体已成为当前器官移植的主要来源。研究有效的方法与手段,保护供体器官,提高器官质量至关重要。 目的：观察热休克蛋白70在脑死亡状态致肺损伤中的作用。 方法：60只家兔随机均分为3组,即正常对照组：不行手术;假手术组：行股动脉插管、气管插管及颅骨钻孔置管术,不行颅内加压脑死亡术;脑死亡组：行股动脉插管、气管插管、颅骨钻孔置管及颅内加压脑死亡术,呼吸机维持脑死亡状态。各组均在术后2,4,6,8 h记录动脉血压及心率的变化。苏木精-伊红染色光镜观察肺脏结构改变,RT-PCR和免疫组化检测各组肺脏热休克蛋白70的mRNA及蛋白表达。 结果与结论：脑死亡组较假手术组血压与心率尚未发现显著变化(P > 0.05)。假手术组各时间点肺脏组织损伤不明显。2-6 h内,随着时间延长,脑死亡组家兔肺脏损伤逐渐加重(P < 0.05),但8 h出现一定程度好转。热休克蛋白70 mRNA与蛋白表达呈时间依赖性增高(P < 0.05),始于2 h,于8 h最高。结果证实,热休克蛋白70可能介入脑死亡状态诱导的肺脏损伤,发挥自身防御性保护作用。     

Pneumatic colonic rupture accompanied by tension pneumoperitoneum

Rupture of the colon caused by high pressure compressed air is a rare, unique and traumatic intra-abdominal injury. As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injuries from its improper use. Recently we experienced a case of pneumatic rupture of the sigmoid colon accompanied by tension pneumoperitoneum, which caused respiratory distress. The patient's respiration was very rapid with the rate of 44 breaths per minute. On arterial blood gas analysis, pH was 7.40, pO2 68 mmHg, pCO2 44 mmHg, and SaO2 90%. Chest X-ray film showed marked pneumoperitoneum and an elevated diaphragm. The respiratory distress was severe and required immediate relief by emergency decompression peritoneocentesis before surgical intervention consisting of the serosal tear repair, colonic rupture colostomy and abdominal cavity irrigation. A follow up operation 2 months later for colostomy repair completed the patient's recovery.