皮肤伸展术在创伤修复重建外科中的应用

目的观察验证皮肤伸展器的可行性及临床应用效果。方法采用周黎安自行设计的针爪结合的皮肤伸展器,在皮肤缺损创缘行皮肤伸展术,治疗烧（创）伤肉芽创面、供皮瓣创面及肿瘤切除后的缺损共３４例。结果该装置使用时间为１５～７２０分钟,可分别在术前、术中及术后三个不同阶段使用。随访１６例,时间为６～１２个月,效果均满意。结论此种针爪结合的皮肤伸展器对创伤及其它原因造成的皮肤软组织缺损的创面闭合有积极意义,是一种行之有效的治疗方法。     

多发伤后血清细胞因子水平的动态观察

目的 检测多发伤后血清中各种细胞因子的水平,探讨其意义。方法 研究对象为多发伤创伤病人２０例。于伤１－７天,每日采空腹血样,用双抗体夹心酶联免疫法分别检测血清中肿瘤坏死因子,白细胞介素１β,６及粒细胞集落刺激因子,并进行了动态观察。结果 多发伤组ＴＮＦ－α,ＩＬ－２,ＩＬ－６明显高于对照组,而且在伤情严重的病人中ＴＮＦ－α和ＩＬ－２升高更为明显,Ｇ－ＣＳＦ的升高与严重感染有关。,     

肾损伤的CT诊断及其临床价值

目的 评价肾损伤的检查方法,探讨ＣＴ诊断和分类的临床价值。材料与方法 对７０例肾损伤ＣＴ表现作回顾性分析。结果 ７０例中左肾损伤３９例,右肾３０例,双肾１例,ＣＴ表现为肾影增大３０例（４２．９％）,肾轮廓不规则１５例（２１．４％）,肾包膜下血肿４３例（６１．４％）,肾内血肿３５例（５０．０％）,肾周积血２９例（４１．４％）,肾节段性梗塞８例（１１．４％）,轻度肾实质挫伤４例,（５．７％）,肾撕裂或     

外伤性硬膜下积液临床分析

目的 探讨外伤性硬膜下积液的发病机理、临床表现、诊断和治疗。方法 CT扫描确诊,钻孔引流,清除血肿和积液。结果 36例中,痊愈28例,轻度残废2例,死亡6例。结论 尽早CT确诊,根据病情手术与保守治疗相结合,是抢救成功的关键。     

闭合性跟腱断裂超声和磁共振诊断的比较研究

目的：探讨闭合性跟腱断裂的超声和磁共振表现特点,比较两种检查方法的敏感性、特异性和准确性。材料与方法：有跟腱部位闭合性外伤史并均行跟腱超声和磁共振检查30例。经临床和手术证实跟腱完全或部分断裂11例(病例组),跟腱无断裂19例(对照组)。着重观察闭合性跟腱断裂的超声和磁共振表现特点,并用诊断试验分别评价其诊断价值。结果：跟腱断裂的超声表现为跟腱较强回声不连续声像,断端间不均质回声或无回声区。磁共振表现为肌腱增粗、腱内信号增高、腱束连续性中断和腱周积液。超声诊断闭合性跟腱断裂的敏感性、特异性和准确性分别为73％、84％和80％,MR／分别为91％、95％和93％。结论：从临床诊断价值的角度来看,磁共振检查比超声检查具有更多的优势。     

早期人纤维蛋白原治疗创伤性凝血病的临床研究

目的 探讨早期给予人纤维蛋白原对创伤性凝血病患者的临床疗效及相关因素影响.方法 选取2017年10月至2018年10月诸暨市人民医院收治的167例严重创伤患者作为研究对象,根据TIC诊断标准最终选择符合条件的80例凝血病患者,将其分为对照组和试验组,每组各40例,其中对照组按照常规TIC治疗指南进行治疗,试验组在对照组...     

声导抗测试结合鼓膜摄像在外伤性鼓膜穿孔诊断中的应用

目的 探讨声导抗检测结合鼓膜摄像在外伤性鼓膜穿孔诊断中的应用价值.方法 回顾性分析南京市第二医院门诊2019年4月-2020年4月接诊的37例(共44耳)外伤性鼓膜穿孔患者的临床资料.接诊时详细询问患者病史,采用声导抗检测和/或鼓膜摄像检查.按照检测方法分鼓膜摄像组与联合组(声导抗检测联合鼓膜摄像),对比两种检查方法在...     

A qualitative study to identify opportunities for improving trauma quality improvement

Background

Quality improvement (QI) is a central tenant of trauma center accreditation in most countries, but its effectiveness is largely unknown. We sought to explore opportunities for improving trauma QI.

Methods

We performed a qualitative research study using grounded theory analyses of interviews with medical directors and program managers from 75 verified trauma centers sampled from the United States (n = 51), Canada (n = 14), and Australasia (Australia and New Zealand [n = 10]) to explore experiences with trauma QI activities and identify opportunities for improvement.

Results

Most trauma centers indicated that they perceived trauma QI to be important and devoted personnel for QI (data entry, data analyst, educator, nurse practitioner). Programs identified 5 principal opportunities to improve trauma QI: (1) ensure resource adequacy (human resources, registry maintenance, financial support, institutional support), (2) encourage stakeholder participation (engagement, communication, coordination), (3) ensure clinical relevance, (4) incorporate evidence-based tools, and (5) require provider and QI program accountability.

Conclusions

Quality improvement programs exist as accreditation requirements in most centers. However, trauma QI practices depend on a range of local and regional factors, and concrete opportunities for improvement that address impact and sustainability exist.     

湿润烧伤膏棉片贴补治疗外伤性鼓膜穿孔的疗效观察

目的观察湿润烧伤膏(Moist Exposed Burn Ointment,MEBO)棉片贴补法治疗外伤性鼓膜大穿孔的临床疗效。方法对武汉市汉口医院2010年1月-2014年12月收治的35例外伤性鼓膜大穿孔患者在耳内镜下行MEBO棉片贴补治疗,每3 d换药1次,治疗1个月后观察穿孔感染情况及愈合情况。结果 35例患者中32例完全愈合,愈合率为91.4%,平均愈合时间为(11.7±2.7)d。治疗过程中,5例患者出现感染,感染率为14.3%,感染患者中3例未愈合。结论 MEBO棉片贴补法治疗外伤性鼓膜大穿孔疗效显著,愈合时间短,愈合率高,感染率低,且无严重并发症,值得临床推广应用。     

Endovascular management of traumatic arterial emergencies: A single center retrospective study

Objectives: To present our experience in delivering endovascular therapies for emergent vascular traumas with various vascular structures. Methods: Between September 2013 and February 2018, patients who underwent endovascular intervention due to penetrating, blunt and iatrogenic arterial traumas were analyzed, retrospectively. Demographic data, trauma site, mechanism of injury, angiographic findings or arterial injury patterns, treatment methods, and outcomes were recorded. Results: A total of 30 patients were included. The mean age of patients was 39 years (range: 15-87 years). Arterial trauma locations were in the compressible area with a rate of 43％ (n=13) and in the noncompressed area with a rate of 57％ (n=17). Mechanisms of injuries were blunt [53％ (n=16)], penetrating [17％ (n=5)], and iatrogenic [30％ (n=9)]. The most common indication for endovascular treatment was blunt noncompressible injury (n=12). Methods used for treatment were stent-graft (46％, n=14) and coil embolization (54％, n=16). Immediate success was obtained in all procedures. The mean follow-up duration was 5 months (range: 1-12 months). Conclusions: Endovascular treatments performed in traumatic arterial emergencies are effective and minimally invasive with very low complication rates even in hemodynamically unstable patients.