"优拓"敷料用于皮肤挫伤患者的效果观察

目的探讨优拓对皮肤挫伤的修复效果.方法于2001年12月～2002年7月将124例皮肤挫伤患者156处创面随机分为两组进行对照,观察组常规清创后创面用优拓覆盖,对照组常规清创后行传统干燥疗法.结果两组创面感染发生率无统计学差异(P＞0.05),创面愈合天数,观察组较对照组明显缩短(P＜0.01),且疼痛减轻.结论优拓对皮肤挫伤的愈合具有良好的促进作用.     

脊髓损伤后轴突导向分子表达及作用

成年哺乳动物脊髓损伤后轴突无法再生并与靶器官建立连接,与轴突生长抑制因子的产生,胶质瘢痕的抑制作用等有关.轴突导向分子在神经系统发育过程中,通过排斥或吸引作用指导神经元迁移及轴突导向性生长.近年研究显示,成年哺乳动物脊髓损伤后部分排斥性轴突导向分子在急性期表达明显增加,可能通过直接排斥及促进胶质瘢痕形成等在抑制轴突再生中起重要作用.该文就目前已发现的四大类重要的轴突导向分子(netrins、semaphorins、slits、ephrins)在脊髓损伤后的表达变化作一简要综述.     

多发伤并胰十二指肠损伤的临床诊断与处理原则

多发伤是指两个或两个以上解剖部位的严重损伤,多发伤合并腹部脏器损伤约58%,其中约有1%~3%合并胰十二指肠损伤,其发生率并不高,却是腹部最为复杂而严重的一类创伤,由于其位置深在,症状隐匿,实验室检查缺乏特异性,早期诊断困难,容易延误诊断或漏诊,给后期的治疗带来很大的困难。加上这类患者常常合并全身其他部位的严重损伤,在临床治疗决策上更为复杂和困难。现就多发伤合并胰十二肠损伤的临床诊断与处理原则作一些探讨。多发伤合并胰十二指肠损伤的诊断多发伤患者常常合并有头颅、胸心、脊柱、骨盆、四肢等部位严重的损伤存在,在腹部症状不…     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.     

人骨肉瘤外周血T淋巴细胞亚群和自然杀伤细胞免疫变化的研究

目的研究人骨肉瘤患者外周血T淋巴细胞亚群和自然杀伤细胞(NK细胞)的变化。方法采用流式细胞术对42例骨肉瘤、41例骨髓炎、34例健康者的外周血CD4 、CD8 、CD4 、CD4 /CD8 、CD3 、CD16 56均显著性低于骨髓炎患者和健康对照组(P<0.01),而CD8 则升高(P<0.05)。骨髓炎患者外周血CD4 、CD4 /CD8 、CD3 较健康人降低,CD8 则升高,但差异均无统计学意义(P>0.05),而CD16 56与健康对照组相比降低(P<0.05)。结论骨肉瘤患者细胞免疫功能明显降低;骨肉瘤患者的免疫抑制远较骨髓炎的强;骨肉瘤患者NK细胞的降低较骨髓炎患者明显多。流式细胞术可作为检测骨肉瘤患者免疫功能的有效方法。     

4 519例多发伤院内救治分析

目的研究多发伤患者的临床特点、治疗情况、并发症与预后的关系。方法回顾性分析我院4519例多发伤患者的致伤原因、治疗情况、并发症、死亡原因及与病死率的相关性。结果多发伤后致伤主要原因为道路交通伤(2410例,53.33%)、暴力伤(747例,16.53%)、坠落伤(575例,12.72%);主要受伤部位颅脑(2247例,18.71%)、腹部和骨盆损伤(2118例,17.64%)、胸部损伤(1853例,15.43%);主要并发症为休克(1497例,33.13%);后期主要致死原因为脓毒症合并多器官功能不全/衰竭(28例,82.35%),显著高于同时段其他致死原因(P<0.01)。结论多发伤致病因素复杂,临床病情、急救与诊断有其特点,并发症多,病死率高,一体化救治模式值得进一步探讨。     

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.     

严重多发伤患者血清肿瘤坏死因子—α,可溶性白介素—2受体 …

为观察血清肿瘤坏死因子（ＴＮＦ－α）、可溶性白介素－２受体（ＳＩＬ－２Ｒ）在严重氏发伤患者中的变化和临床意义,随机选择５７例严重多发伤（ＩＳＳ≥２５）患者,采用酶标法于伤后２４小时内、３天、７天和１３～１５天检测血清ＴＭＦ－α、ＳＩＬ－２Ｒ水平。发现５７例例患者治疗期间有１３例发生多器官功能失常综合征（ＭＯＤＳ（,ＴＮＦ－α和ＳＩＬ－２Ｒ在创伤组明显升高（Ｐ〈０．０５）,ＭＯＤＳ组更明显（Ｐ〈０．