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1.
机械性创伤患者血清sIL—2R的变化及其临床意义   总被引:1,自引:1,他引:0  
目的研究机械性创伤患者伤后血清可溶性白细胞介素2受体(sIL-2R)的动态变化及其与创伤评分的关系,探讨其机制及临床意义.方法机械性创伤患者50例,按创伤评分标准分成轻度、重度、极重度3组.对其中25例患者进行了12d的动态观察,全部患者于伤后24h内采血,动态观察组再于3、5、7、9、12d各采血1次.血清sIL-2R采用ELISA法测定.结果创伤后24h内各组sIL-2R明显高于正常值(P<0.05),动态观察各组sIL-2R呈波动性先升后降的变化,轻度患者高峰值先于重度、极重度患者出现,sIL-2R的血清含量与创伤程度呈正相关(r=0.306,P<0.05).结论sIL-2R可作为判别创伤严重程度的灵敏指标,它的升高说明创伤患者的机体免疫功能呈抑制状态.  相似文献   

2.
Objective: To study the changes of serum level of soluble interleukin-2 receptor (sIL-2R) in patients with mechanical trauma and the relationship between sIL-2R serum level and injury severity score (ISS), and to explore the mechanism of changes and clinical significances of sIL-2R. Methods: According to the criterion of ISS, 50 patients with mechanical trauma were divided into mild degree group, severe degree group and extremely severe degree group. Twenty-five of those were dynamically observed for 12 d. Blood samples of all the patients were obtained within 24 h, and ond3,d5,d7,d9 and d 12 in dynamically observed patients. The serum concentration of sIL-2R was assayed by ELISA. Results: Level of sIL-2R was significantly higher in patients with trauma than that in healthy persons within 24 h (P<0. 05). Dynamical observation showed curving changes of sIL-2R with increasing in early stage and decreasing later. The climax of sIL-2R appeared earlier in mild group than that in severe degree group and extrem  相似文献   

3.
严重创伤后血清β—内啡肽与PMNs上CD18,CD54分子含量的 …   总被引:1,自引:0,他引:1  
目的 探讨严重创伤病人血清β-内啡肽(β-end)及外周血多形核粒细胞(PMNs)CD18、CD54含量变化。方法 65例严重创伤病人按ISS分为两组,ISS≥20分组(n=36),ISS〈20分组(n=29)。使用放射免疫分析技术和流式细胞术分别检测65例严重创伤病人入院时,伤后1、3、7d血清皮质醇、β-end浓度和PMNs上CD18、CD54的平均荧光通道变化,11例健康志愿者为对照组。结果  相似文献   

4.
目的:采用meta分析的方法评估高/低比例(≥1∶2/<1∶2)输注血浆及红细胞对创伤后需大量输血救治患者的疗效。方法系统性检索CochraneLibrary、Pubmed、Web of science、EMBASE,时间为2009年1月~2016年4月。由2名研究者独立进行文献筛选、质量评价和资料提取,采用Revman5.3进行统计分析。观察指标包括患者24 h及30 d死亡率、24 h生存率。结果纳入5篇文献,共计1024例患者,两组创伤严重程度评分无统计学差异。结果显示,高比例组患者24 h死亡率明显降低(OR0.35,95%CI[0.25,0.48],P<0.00001);高比例组患者30 d死亡率仍明显低于低比例组(OR0.55,95%CI[0.41,0.75],P=0.0001);高比例组患者24 h生存率也显著提高(HR2.34,95%CI[1.46,3.73],P=0.00001)。结论输注高比例血浆及红细胞可显著降低创伤后需要大量输血救治患者短期和长期死亡率,提高患者短期生存率。  相似文献   

5.
目的观察创伤患者血乳酸水平的变化及其在预测创伤严重程度及预后中的作用。方法连续收入ICU的创伤患者92例,在入院时即行血乳酸测定及创伤严重度评分(ISS评分),按ISS分值分成3组,同时按预后分为死亡组及存活组。结果血乳酸水平随着ISS分值的增高而升高,各分值组间比较差异有统计学意义(F=45.76,P〈0.01);创伤患者死亡组血乳酸水平与ISS评分显著高于存活组(t=6.89、t=8.60,P〈0.01);血乳酸水平与ISS评分呈显著正相关(r=0.829,P〈0.01)。结论创伤患者血乳酸水平与ISS评分呈正相关关系,可应用于预测创伤患者的严重程度及预后。  相似文献   

6.
OBJECTIVES: To examine the nature, severity and outcomes of injuries sustained from ladder falls. DESIGN: Retrospective survey of medical records. PATIENTS AND SETTING: Patients who presented after a fall from a ladder to the emergency department of a tertiary hospital in Melbourne, Victoria, between January 1994 and December 1997. MAIN OUTCOME MEASURES: Demographic characteristics; height and mechanism of fall; injury site and Injury Severity Score (ISS); rate of hospital admissions. RESULTS: 163 patients presented after ladder falls. They were aged 2.5 to 86 years (mean age, 48 years); 83% were male, and 78% were injured in non-occupational settings. Almost half the accidents (43%) were caused by ladder instability (ladder sliding from position or tilting sideways). Most patients had mild or moderate injuries (usually of the extremities), but 13% had an ISS > or = 16 (indicating severe trauma), usually with head, chest or spinal injuries; 42% were admitted to hospital. Multiple regression analyses showed that ISS increased signficantly with height of fall and age (P< 0.05 for both), although a substantial amount of variation was not attributable to these variables. Likelihood of hospital admission increased linearly with increasing ISS to an ISS of 8 and remained high thereafter. CONCLUSIONS: Ladder falls resulted in significant morbidity, with men undertaking non-occupational activities comprising most of those injured. New strategies to encourage safe ladder use are needed.  相似文献   

7.
目的探讨急性创伤患者血清皮质醇和ACTH水平的变化特点。方法58例创伤病例通过刨伤严重度评分(ISS)分为轻伤组(38例,ISS〈16分)和重伤组(20例,ISS16分),伤后24h内留取血标本,测定血清皮质醇和ACTH水平。结果重伤组24h内血清皮质醇和ACTH水平均明显低于轻伤组(P〈0.05)。结论在急性创伤患者中,肾上腺皮质功能不全有较高的发生率,测定伤后24h内血清皮质醇水平有助于判断病情轻重。  相似文献   

8.
目的 探讨入院时不同程度创伤严重度评分(injury severity score,ISS)骨折患者的严重创伤者生存概率(probability of survival,PS)、全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)发生率、平均动脉压(MAP)、血红蛋白(Hb)、红细胞压积(HCT)、白细胞总数(WBC)、中性粒细胞百分比(NEUT%)、血小板计数(PLT)、平均血小板分布宽度(PDW)、平均血小板体积(MPV)、大血小板比率(PLCR)、纤维蛋白原(Fbg)、总蛋白(TP)、白蛋白(ALB)、尿素氮(UREA)、血肌酐(Scr)的变化及意义.方法 回顾分析2001 ~ 2005年骨折患者226例,根据ISS分为轻度创伤组(ISS<16分)、中度创伤组(ISS16~24分)和严重创伤组(ISS≥25分).利用TRISS法统计每个患者的严重创伤者生存概率(PS).对轻度创伤、中度创伤与严重创伤组间PS、SIRS发生率及入院后MAP、血常规、凝血、生化指标进行比较.结果 中度创伤组MAP、Hb、MPV、PLCR、Fbg、TP、ALB低于轻度创伤组,WBC、NEUT%、SIRS发生率、Scr高于轻度创伤组;严重创伤组MAP、PS、HCT、Fbg、TP、ALB低于中度创伤组,WBC、NEUT%、SIRS发生率高于中度创伤组,MAP、PS、Hb、HCT、MPV、PLCR、Fbg、TP、ALB均低于轻度创伤组,WBC、NEUT%、SIRS发生率、UREA及Scr高于轻度创伤组,差异有统计学意义.骨折患者Scr与ISS评分(r=0.273,P =0.000)、WBC(r =0.310,P=0.000)呈正相关,与PS(r =-0.202,P=0.003)、PDW(r =-0.165,P =0.018)、MPV(r =-0.193,P =0.005)、PLCR(r =-0.185,P=0.008)、Fbg( r=-0.172,P =0.017)、TP(r =-0.275,P=0.000)和ALB(r =-0.197,P=0.004)呈负相关.结论 中度创伤组血压、血红蛋白、血小板体积、Fbg、血浆蛋白显著降低,WBC、NEUT%、SIRS发生率、Scr显著升高,严重创伤组除上述变化外,PS显著降低.Scr随ISS、WBC增加及PS、PDW、MPV、PLCR、Fbg、TP、ALB降低而升高,中度创伤组、严重创伤组肾功能发生改变,对骨折患者应加强肾功能检测.  相似文献   

9.
The Trauma Score as a triage tool in the prehospital setting   总被引:2,自引:0,他引:2  
Implementation of a regional trauma care system requires a field triage tool that identifies the severely injured patient and transports him to a trauma center, while preserving the flow of minimally injured patients to community hospitals. We prospectively tested the Trauma Score (TS) as a field triage tool and evaluated its accuracy against that of the Injury Severity Score (ISS), calculated after the patients' injuries were fully defined. During an 18-month period, 1106 patients admitted to the trauma center at San Francisco General Hospital had a TS determined in the field (TS1) and on arrival at the emergency department. A TS1 of 14 or less defined a subgroup of 222 patients in whom 93% of the deaths occurred. Using an ISS of 20 or more as an indicator of life-threatening injury, we determined the predictive value of TS1. There were 66 false-negatives (ISS, greater than or equal to 20; TS1, 15 or 16) and 107 false-positives (ISS, less than 20; TS1, less than or equal to 14). Using a prehospital TS of 14 or less as an indicator of serious injury, only 20% of a major urban trauma population would qualify for diversion to a trauma center.  相似文献   

10.
目的:探讨伤员创伤严重度与药品消耗之间的关系,为客观地描述战时药材需求和需求分布提供一种有用的方法。方法:运用简明损伤严重度评分法(AIS-ISS)和反映药物利用的约定日剂量(DDD),研究“两山”作战中后方医院收治伤员的伤势和药品(抗感染药物)消耗的规律。结果:建立了战伤严重度ISS值和抗感染药品消耗DDD数的数学模型,其关系式为:Y=16.99ln X-0.53,决定系数r2=0.663 7,P<0.01。在ISS的一定范围内,抗感染药的使用频度随伤势的严重度增加而加大,且随着伤势的进一步加重,抗感染药物的使用有一个饱和的趋势。 结论:解决了对伤员伤势难以量化的限制,对于揭示后方医院战伤救治药品消耗的一般规律具有实际意义。本方法具有使用方便、可操作性强的优点。  相似文献   

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