胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

浅谈烧伤科临床带教体会

烧伤的临床教学有其特点，我们结合烧伤研究所实际，根据教学目的，按大纲要求对见习学员，实习学员和进修医生有针对性进行教学，取得较好结果。     

损伤控制外科技术在严重创伤急救中的应用

目的探讨损伤控制外科技术（DCS）在严重创伤急救中的应用效果。方法对2003年7月～2005年6月应用DCS救治的82例严重多发伤的临床资料进行回顾性分析。结果对82例严重多发伤均立即给予液体复苏、急诊手术控制出血和污染，待生命体征稳定后，再行确定性手术治疗。70例经应用DCS后，休克逐渐得到纠正，再次行确定性于术，经过顺利，情况良好。复苏期患者pH、体温、PT值与一般腹腔损伤病人相比，无显著性差异。本组70例痊愈出院，12例死于脑疝或多器官衰竭。结论对严重创伤病人，在复苏同时应尽快采用简单省时的手术控制出血和污染。病情稳定后再做相应的手术和治疗，可提高严重创伤的抢救成功率。     

循证护理在预防人工气道肺部感染中的应用价值?

目的：探索循证护理在预防人工气道肺部感染中的应用。方法选取建立人工气道患者32例循证护理患者为循证护理组,急诊建立人工气道39例常规护理患者作为常规护理组,比较分析两组患者肺部感染发生率,临床肺部感染评分(CPIS)、前降钙素原(PCT)、C-反应蛋白(CRP)的差异。结果循证护理组肺部感染发生率、CPIS 评分、PCT、CRP 分别为6.25%、(41.01±8.22)mg/L、(0.06±0.12)mg/L、(1.16±0.36)分,显著低于常规护理组,差异有统计学意义(P <0.05)。结论循证护理能有效地预防人工气道患者肺部感染的发生。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

严重烧伤后诊断心肌损伤若干指标的比较

目的：探讨ＴｎＴ、ＭＬＣ１和ＣＫＭＢ等反映心肌损伤的指标在严重烧伤后的变化规律。方法：利用大鼠３０％ＴＢＳＡⅢ度烧伤模型，动态观察伤后１、３、６、１２和２４小时血浆ＴｎＴ、ＭＬＣ１、ＣＫＭＢ、ＴＮＦ及心肌组织ＴＮＦ含量的变化。结果：烧伤后３￣６小时血浆ＴｎＴ、ＭＬＣ１、ＣＫＭＢ和ＴＮＦ即显著高于对照组，相关性分析表明ＴｎＴ、ＭＬＣ１、ＣＫＭＢ之间密切相关，且都与血将ＴＮＦ显著正相关。结论：ＴｎＴ、     

肌钙蛋白生化及其在创伤后心脏损害诊断中的应用

肌钙蛋白位于细肌丝上，在肌肉收缩和舒张过程中起重要作用，肌钙蛋白是心脏特异性抗原，其释放入血循环是心肌细胞损伤的敏感和高度特异的标志，对诊断创伤后心肌损害尤为适用。     

还原型谷胱甘肽辅助治疗急性重症胰腺炎前后血浆Ghrelin CRP IL-8和TNF-α浓度的变化

目的探讨还原型谷胱甘肽（GSH）辅助治疗急性坏死性胰腺炎前后血浆Ghrelin、CRP、IL-8和TNF．口浓度的变化。方法100例急性坏死性胰腺炎患者随机分为GSH辅助治疗组（A组,n=50）和一般治疗组（B组,n=50）。于入院时和治疗3天后进行APACHE-II评分;并在入院时、治疗1天和3天后,观察血淀粉酶、血脂肪酶、血浆Ghrelin、CRP、IL-8和TNF-α浓度的变化。另外选择门诊体检健康成年人为对照组（C组,n=50）。结果GSH辅助治疗组和一般治疗组患者APACHE．Ⅱ评分在治疗3天后均明显下降,GSH辅助治疗组下降更明显（均P〈0．05）。GSH辅助治疗组和一般治疗组患者血淀粉酶、血脂肪酶、血浆Ghrelin、CRP、IL-8和TNF-α浓度均进行性下降,且GSH辅助治疗组下降更明显（均P〈0．05）。结论GSH对SAP有辅助治疗作用。血浆Ghrelin、CRP、IL-8和TNF-α浓度与SAP病情严重程度相关。     

成功抢救高处坠落致胃脾膈疝1例

1临床资料 男,44岁,4 d前因工作不慎从28 m高处坠落,无昏迷,以多发伤--多发肋骨骨折、左胫骨骨折、左跟骨骨折、血气胸、第2、3、4腰椎横突骨折、腰3锥体1/3压缩性骨折,在当地医院治疗4 d,行胸腔闭式引流,引出血性液体200 ml.以胸腹部疼痛伴呼吸困难加重、进食呕吐转入我院.查体,神志清楚,血压134/80mmHg,心率100次/min,呼吸25次/min,左侧呼吸动度较右侧减弱,叩诊左侧下肺实音.