1162例严重胸部创伤的院前急救分析

目的：总结严重胸部创伤院前救治经验，提高院前救治水平。方法收集2009年1月～2014年12月经院前“120”现场救治后转入我院的严重胸部创伤（ AIS）≥3分患者病例资料1162例，其中男性827例，女性335例；年龄13～98岁，平均（45．3±10．8）岁。分析胸部损伤情况，院前、院内救治方法和救治结果等。结果1162例中，院前平均急救反应时间（46．52±17．33）min，平均急救时间（16．73±7．32） min。清除呼吸道异物31例，气管插管机械通气42例，紧急气管切开23例，张力性气胸减压25例，呼吸机正压通气纠正反常呼吸运动43例，纱垫填塞或包扎胸壁开放性伤口151例，呼吸心跳停止者现场进行徒手心肺复苏16例，胸部伤情未进行特殊处理者735例。本组死亡29例。结论院前快速准确判断，熟练正确急救为严重胸部创伤院内进一步救治创造机会和争取时间。     

大批量伤员院前和院内急救流程

如何组织对大规模爆炸伤、烧伤、挤压伤等危重伤员的院前和院内急救 ,是军队医院平时和战时面临的重要课题。为此 ,我们通过 4年来对 2 1批次2 0 3例各类事故伤员的急救 ,总结了一套院前和院内急救流程 ,不仅使院前、院内急救程序化 ,提高了救治成功率和救治质量 ,而且对现代战争中大批量伤员的急救具有借鉴和指导意义。1　院前急救流程院前急救 ,主要是现场急救和途中救治 ,是挽救生命 ,提高救治成功率的关键阶段。在这一阶段 ,我们主要建立了以下流程 ,并强调切实抓好流程的各个环节。1 1　接警与出救　开通“1 2 0”值班电话。值班员接…     

24例爆震伤的成功救治

总结抢救24例爆炸伤伤员的救治体会。认为重视院前急救、有效抗休克等是成功救治的关键。     

煤矿瓦斯爆炸伤院前急救独立模式

煤矿瓦斯爆炸伤是和平时期致伤能量巨大的严重复合性伤害[1].往往是突发性并造成众多人员伤亡.院前急救是非常关键的环节,因此完善院前急救模式对提高救治水平极其重要.笔者采取煤矿瓦斯爆炸伤院前急救独立模式(以下简称煤矿急救独立模式)对59例(生存者)煤矿瓦斯爆炸伤患者进行院前救治,取得比较满意的效果.     

四肢爆炸伤临床救治的研究进展

爆炸性武器在现代战争中的大量应用，不仅使当前火器伤的伤情结构发生了明显改变，同时也使伤情特点发生了明显的变化，从而使爆炸伤的救治变得更为困难和复杂。与一般火器伤相比，爆炸伤显然更为严重（局部组织严重毁损，全身反应剧烈）。为了对爆炸伤的救治有一个初步的认识，本文从四肢爆炸伤的临床救治出发，简要综述其主要的研究进展。     

重型颅脑战创伤战场救治模式

对重型颅脑伤员，采用团救护所与专科医院两级救治模式，实现团救护所、医疗后送、专科医院救治“一体化”。根据“早期建立稳定的通气与循环、快速后送、尽早手术”的救治原则，把专科医院院前救治重点前伸至团救护所和后送过程中，完成早期确定性救治：（1）建立由团救护所完成的院前救治方案；（2）专科医院派出救治小分队前伸至团护救所；（3）专科医院在后送卫勤分队中配置机载与车载两个急救单元，在后送过程中继续完成上述救治工作。     

胸部火器伤588例救治体会

本组胸部火器伤588例,均为1979～1984年9个医疗单位收治的伤员。我们总结其特点及救治规律,以便为提高战伤救治水平提供参考。1　临床资料1.1　一般情况　588例中,大多数为男性;年龄18～25岁,占88%。枪弹伤331例,爆炸伤257例。合并腹、头、四肢损伤182例。死亡18例。1.2　致伤原因及伤情1.2.1　枪弹伤　331例,其中贯通伤269例(81.3%),盲管伤62例(18.7%)。伤情:血胸、气胸和(或)血气胸117例,创伤湿肺43例,异物残留31例,肋骨骨折81例,膈疝12例,心脏伤5例,气管伤2例,食管伤1例。1.2.2　爆炸伤　257例,其中盲管伤223例(86.8%),贯通伤31例(12.1%)…     

院前急症救治586例分析

近年来，随着急诊医学的快速发展，基层院前救治已日益为人们所重视。本文回顾我门诊部586例院前急症救治病例，其中88例为急重症，498例为急诊；死亡3例，好转181例，安全转送402例，分析部队营区院前救治患者的疾病谱，探讨院前急救之规律，从而最大限度地降低院前死亡率，提高院前急救工作质量，报告如下。     

基层医疗机构在创伤救治体系中的定位与思考

基层医疗机构具有数量多、覆盖范围广、距人民群众近的特点。本文通过分析国内创伤救治体系的现状,对比国内外基层医疗机构在创伤救治体系中的定位,得出基层医疗机构在创伤科普和预防、严重创伤院前急救与转运、轻度创伤的救治、创伤康复指导中的独特优势,并从健全制度规范、加强人才培养、加强信息化建设、优化院前救治流程提出对策措施,旨在优化我国创伤救治体系,提高我国创伤救治的能力,实现医疗资源配置效益的最大化,惠及更多创伤患者。     

烧伤病人长途转运过程中医疗急救连续性的研究

目的:探讨如何确保烧伤病人长途转运过程中医疗急救的连续性.方法:对我院烧伤科近7年来140例烧伤病人院前医疗急救处置经验进行总结,从电话接诊、出发前准备、转运前评估及治疗、转运过程中的医疗处置、入院前准备等5个环节入手,确保救治的连续性.结果:做好5个环节的工作,能够确保救治工作的连续性,提高烧伤病人院前处置的质量及救治的成功率.结论:烧伤病人院前医疗急救处置中,电话接诊、出发前准备、转运前评估及治疗、转运过程中的医疗处置、入院前准备等5个环节工作是确保烧伤病人治疗连续性的关键.     

Blast injuries: a case report

In the past, blast injuries were associated strictly with war and catastrophic industrial accidents. Unfortunately, these injuries are on the front lines of each ED and EMS system in the form of pipe bombs and terrorist plots. Domestically and internationally, the incidence of blast injuries is sporadic and infrequent. The injuries often are the result of fireworks--10,000-12,000 ED visits annually for this reason.(1)     

Adolescent butterfly swimmer with bilateral subluxing sternoclavicular joints

Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed.     

Long-term outcome of knee and ankle injuries in elite football

To estimate the risk and evaluate the long-term outcome of knee and ankle injuries in former national team elite football, 69 players were randomly selected, followed by clinical and stress radiographic examinations. Thirty-nine players (49 knees) had had knee injuries and 29 ankle injuries (35 ankles). The median time from injury until study examination was 25 years. The knee injuries were tears of the medial collateral ligament (MCL) in 24 cases combined with rupture of the anterior cruciate ligament (ACL) and meniscus lesions in three. Meniscus lesions had occurred in 17 cases including three combined with ACL and MCL and another two with ACL ruptures. Isolated rupture of the ACL had occurred in four cases. The ankle lesions were in 26 of 35 cases ruptures of the lateral ligaments. In all, 12 players had completely stopped football and three had changed occupation. Signs of arthritis were present in 63% of the injured knees and in 33% of the injured ankles. The incidence of arthritis in the group of 17 uninjured players was 26% in the knee and 18% the ankle. In elite football players knee and ankle injuries seem to have a serious long-term outcome, but also uninjured players have a higher risk of developing arthritis than the normal population.     

92例胸腹联合伤临床分析

目的 探讨胸腹联合伤的诊断及治疗特点。方法 总结经手术证实的胸腹联合伤92例，其中开放性损伤41例(44．57％)，以锐器刺伤为主；闭合性损伤51例(55．43％)，以交通伤多见。分析不同原因的损伤类别及不同临床症状与手术方式。结果 92例中，术前明确有膈肌破裂42例(45．65％)；88例在第一次手术中发现膈肌破裂，并予以修补(95．65％)，4例未探查膈肌而漏诊(4．35％)；死亡13例(14．13％)。结论 胸腹联合伤是一种特殊类型的损伤，伤情复杂、严重，死亡率高。诊断应根据受伤机制和出血量判断，特别注意避免漏诊膈肌损伤。治疗原则为先处理胸部损伤，后处理腹内脏器损伤。     

Epidemiology,clinical characteristics and severity of gradual onset injuries in recreational road cyclists: A cross-sectional study in 21,824 cyclists - SAFER XIII

ObjectivesPrevalence, clinical characteristics and severity of gradual onset injuries (GOIs) in cyclists are poorly documented. We determine the prevalence, anatomical regions/sites affected and severity of GOIs among entrants in a community-based mass participation event.DesignCross-sectional study;SettingCape Town Cycle Tour;ParticipantsRace entrants.Main outcome measuresOf 35,914 entrants, 27,349 completed pre-race medical questionnaires. We studied 21,824 consenting cyclists (60.8% of entrants). Crude lifetime prevalence, retrospective annual incidence, anatomical region/sites, specific GOI, tissue type and GOI severity is reported.ResultsThe lifetime prevalence of GOIs was 2.8%, with an annual incidence of 2.5%. More common anatomical regions affected by GOIs were lower limb (43.4%), upper limb (19.8%), and lower back (11.5%). The knee (26.3%), shoulder (13%), and lower back (11.5%) regions were mostly affected. The most common GOI was anterior knee pain (14.2%). Of the GOIs, 55% were in soft tissue. 50% of cyclists reported symptom duration >12 months, and 37.3% of GOIs were severe enough to reduce/prevent cycling.Conclusion2.5% recreational cyclists report a GOI annually. >50% of GOIs affect the knee, lower back and shoulder. GOIs negatively affect cycling. Risk factors related to GOIs in cyclists need to be determined to develop and implement prevention programs.     

Calpain抑制剂Ⅰ对大鼠脑非断离性轴索损伤继发断离的影响

目的　研究Calpain抑制剂Ⅰ对非断离性轴索损伤 (NDAI)继发断离的影响 ,探讨NDAI的治疗途径。　方法　将 16只雄性SD大鼠随机分为Calpain抑制剂Ⅰ组和对照组各 8只 ,液压冲击致大鼠脑弥漫性损伤 ,比较两组伤后 2 4 ,72h胼胝体区、间脑中脑区、桥脑延脑区和小脑区肿胀轴索及轴索球最大密度变化。　结果　大鼠致伤后 ,NF6 8免疫组化显示肿胀的轴索及轴索球。伤后 2 4h ,Calpain抑制剂Ⅰ组桥脑延脑区、小脑区肿胀轴索及轴索球最大密度明显减少 (P <0 .0 1) ;伤后 72h ,Calpain抑制剂Ⅰ组小脑肿胀轴索及轴索球减少 (P <0 .0 5 ) ,而胼胝体区、间脑中脑区、桥脑延脑区变化不明显 (P >0 .0 5 )。　结论　Calpain抑制剂Ⅰ可减轻NDAI的继发断离 ,主要是减少损伤较轻的NDAI的继发断离。     

高能战斗部致绵羊胸部伤的实验研究

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～ 2 40m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 6 7% (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 5 7%和 31% ;在 30只有胸部破片伤的动物中 ,肺冲击伤、肋骨骨折、大量胸腔积血 (>10 0 0ml)及胸腹联合伤的发生率分别为80 %、33%、2 7%和 33% ,心脏被直接击中的概率为 33 %。　结论　破片击中胸部的概率高 ,胸壁穿透伤多 ,伤情严重 ,伤后多迅速死亡。胸部严重毁损、心脏破片伤、多脏器受损以及快速失血是其主要死亡原因。     

单核吞噬细胞在创伤性非断离性轴索损伤继发断离的作用

目的 观察单核吞噬细胞在创伤性非断离轴索损伤(NDAI)继发断离的作用，探讨NDAI继发断离的机制。方法 液压冲击脑损伤SD大鼠55只，采用全鼠脑连续矢状冰冻切片去磷酸化神经丝蛋白轻链(NF68)和单核吞噬细胞标记抗原(ED1)组化双标及NF68组化电镜染色，光镜电镜观察，计数肿胀轴索及轴索球。结果 伴有血管损伤的冲击区皮质及部分胼胝体主要是断离性轴索损伤，轴索碎片呈NF68杂染，早期即有ED1阳性细胞浸润；远离冲击区的基底节区、脑干、小脑无血管损伤，主要是NDAI，伤后3～12h出现NF68阳性反应的肿胀轴索和轴索球，7～14d毛细血管周边出现ED1阳性细胞，21～28d除肿胀轴索和轴索球外，部分神经元NF68阳性反应，ED阳性细胞广泛浸润。结论 延迟的NDAI继发断离与中枢吞噬细胞免疫反应密切相关。