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。     

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。     

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。     

延迟快速复苏对烧伤休克犬氧代谢的影响

目的探讨在烧伤休克延迟复苏情况下,快速补液对机体氧代谢的影响.方法利用犬40%TBSAm度烫伤模型,进行烧伤休克延迟复苏的实验研究,24只狗被随机分为烧伤对照组(伤后不补液,观察至动物死亡);延迟均匀复苏组(烧伤6h后开始复苏,将Eans公式第一个24h计算量[2(电解质与胶体各1mL)×烧伤面积(%)×体重(kg)十基础需要量(50mL/kg)]在伤后7-24h内均匀静脉输入第二个24h液体用量和种类[1(电解质与胶体各0.5mL)×烧伤面积(%)×体重(kg)十基础需要量(50mL/kg)],均匀输入);延迟快速复苏组(烧伤6h后开始复苏,液体用量和种类与延迟均匀补液组一致,不同之处在于伤后7-9h内即将第一个24h液体总量的一半快速静脉输入,其余在伤后9-24h均匀静脉输入;第二个24h液体用量和种类同延迟均匀复苏组).观察伤前、伤后2、6、8、12、24、36和48h氧供(DO2)、氧耗(VO2)、氧摄取率(O2ext、碱缺失(BD)和乳酸(LA)的变化.结果烧伤对照组伤后12-36h内全部死亡(12-24h死亡5只,24-36h死亡3只),其余两组休克期内(48h)全部存活.烧伤后氧供显著下降,氧摄取率大幅增加,复苏后氧供、氧耗增加,氧摄取率有所下降,尤以快速补液组明显.烧伤后BD、LA大幅升高,复苏后逐渐降低,尤以快速补液组明显,但伤后48h两组仍显著高于伤前.结论烧伤后氧供减少,氧耗也下降,复苏后氧供增加,氧耗也相应增加,且随补液快慢而变化,表明烧伤后动物的确存在"病理性氧消耗依赖”关系.伤后机体显著提高了对氧的摄取和利用,当代偿不能满足组织有氧代谢对氧的需求量时,无氧酵解增强及大量乳酸产生.对照组乳酸和碱缺失水平持续上升,复苏组尤其是快速复苏后显著下降,表明快速复苏能够迅速补充血容量不足,维护血流动力学稳定,显著改善组织的氧供,减少组织的无氧代谢,减轻脏器损害,而达到防治烧伤休克的目的.     

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.     

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。     

伤后即行切痂对烧伤大鼠心肌损伤的防治作用

目的探讨早期一次性切痂对烧伤后心肌损伤的防治作用。方法建立30% TBSAⅢ度烧伤大鼠立即切痂模型,动物随机分为正常对照组、未切痂组和切痂组,于伤后1,3,6,12和24h 检测血浆肌钙蛋白 T(TnT)和肿瘤坏死因子(TNF)等指际。结果烧伤后3h 血浆 TnT 即显著升高,伤后6h 血浆 TNF 显著高于伤前,心肌组织中 TNF 也在伤后12h 显著升高。未切痂组与切痂组比较,伤后1～3h 未切痂组 TnT、TNF 略低于切痴组,烧伤6h后,未切痂组 TnT 显著高于切痂组,烧伤12h 后,未切痂组 TNF 显著高于切痂组。TNF 与 TnT 存在显著正相关关系。结论 TNF是引起烧伤后心肌损伤的重要因素,且与心肌损伤程度密切相关。伤后即行一次性切痂可以减少炎症介质的生成和释放,这可能是其对烧伤后并发心肌损伤具有防治作用的机理之一。     

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、