991例胸部创伤的救治体会

胸部损伤伤情重，病情复杂，救治难度大。1987年6月至2003年2月，我院收治胸部损伤患者991例。现将其救治体会报告如下。     

结直肠损伤救治的进展与陷阱

以历次战争战伤救治经验为基础,结直肠损伤的救治不断变迁.另一方面,自上世纪80年代以来CT检查、损害控制策略等严重创伤救治进展对结直肠损伤的救治产生了深刻影响.本文系统阐述了结直肠损伤的临床表现、影像学和内镜检查等进展,列举了钝性伤者忽略结直肠损伤、被阴性体征或平卧位X线片误导、剖腹探查指征过严或术中遗漏等伤情评估陷阱.详细介绍了结直肠损伤是否分期手术、损害控制策略时结直肠损伤的手术方式和腹膜外段直肠损伤处理等紧急手术进展,列举了忽略大量晶体液复苏对结直肠吻合口的影响、未重视结肠损伤手术的技术细节和腹部切口的不当缝合等紧急救治时的陷阱.     

胸部穿透伤的临床诊治方法与效果分析

胸部穿透伤仍然是一个发生率高、伤情复杂的问题，如果诊断治疗不及时，伤情进展迅速，死亡率高。笔者收集本科1999年1月-2007年12月胸部穿透伤234例，总结分析如下。     

胸部高分辨CT在肺泡蛋白沉积症分级诊断中的应用价值

目的从胸部影像学角度探讨肺泡蛋白沉积症(PAP)的诊断分级,以指导治疗。方法对上海市肺科医院2000年1月至2010年12月收治的31例确诊PAP患者胸部高分辨CT(HRCT)进行分级,选择4个代表层面(主动脉弓、隆突、左或右下肺静脉汇合层面和膈上层面),病灶在这些层面的所占范围进行5级评分,结合临床症状、肺功能指标,建立一套PAP胸部HRCT诊断分级标准,根据诊断分级提出相应的治疗决策。结果 (1)按胸部HRCT病灶范围将PAP患者分为4级:1级(≤8分)3例;2级(>8～16分)12例;3级(>16～24分)6例;4级(>24分)10例。(2)PAP患者胸部HRCT评分与呼吸困难评分、症状总评分呈正相关(r=0.748、0.578,P均<0.01)。(3)PAP患者胸部HRCT评分与用力肺活量(FVC)占预计值%、第一秒用力呼气容积(FEV1)占预计值%、一氧化碳弥散量占预计值%及动脉血氧分压(PaO2)均呈负相关(r=-0.486、-0.376、-0.596、-0.444,P<0.01或0.05)。(4)结合胸部HRCT分级和PaO2将PAP患者分为4期:1期:HRCT分级1级伴PaO2≥8.0 kPa;2期:HRCT分级2级伴PaO2≥8.0 kPa;3期:HRCT分级3级伴PaO2≥8.0 kPa;4期:HRCT分级4级,或HRCT分级2～3级伴PaO2<8.0 kPa。(5)不同PAP患者胸部HRCT诊断分级建议:1、2期建议对症治疗及长期随访胸部HRCT;3期患者建议序贯肺泡灌洗或GM-CSF治疗;4期患者建议全肺灌洗。结论胸部HRCT诊断分级可以作为评估PAP患者病情严重程度的基础,并在此基础上选择合适的治疗方法,对临床上诊断和治疗PAP具有一定指导意义。     

516例胸部创伤的救治体会

为了进一步探讨胸部创伤的临床表现特征 ,总结救治中的体会 ,回顾性分析我院 10年间胸部创伤516例临床资料 ,重点分析血气胸、心脏穿透伤、气管支气管破裂、胸腹联合伤及合并多发伤救治中存在的问题。全组治愈 511例 ,死亡 5例 ,死亡率 1 0 %。血气胸的治疗强调及早胸腔闭式引流 ,心脏穿透伤和气管支气管破裂强调尽早开胸手术修补 ,对胸腹联合伤应果断采取抢救性手术 ,对合并多发伤者则应加强多学科协作以提高救治成功率     

基层医院严重多发伤1091例临床分析

为全面了解基层医院严重多发伤的原因、伤情及救治等情况,我们对1999年1月～2008年12月本院收治的1091例严重多发伤患者的临床资料进行了回顾性分析。     

重度胸部损伤182例救治体会

目的 探讨重度胸部损伤的诊断及救治方法,提高重度胸部损伤的抢救成功率.方法 对2000～2009年收治的182例重度胸部损伤的临床资料进行回顾性分析总结.结果　治愈160例,死亡22例,病死率为12.1%,死亡原因主要为合并其他重要器官损伤、术后急性呼吸窘迫综合征(14例)和多器官功能衰竭(8例).结论 重度胸部损伤(尤其是合并重度颅脑损伤、肝脾破裂大出血)临床特点为伤势严重、呼吸困难、循环紊乱、休克、低氧血症、意识障碍、病死率高.救治原则是尽快明确诊断,尽快恢复呼吸循环稳定,及早手术治疗,优先处理致命伤,积极防治并发症.     

颅脑损伤合并休克28例临床分析

颅脑损伤合并休克,伤情复杂,救治困难,病死率高。2000-2005年,我们共收治颅脑损伤合并休克患者28例。现分析其临床特点和治疗措施并报告如下。     

创伤性连枷胸39例救治体会

严重胸部创伤导致的多处肋骨骨折常伴有不同程度的反常呼吸及纵隔摆动,对呼吸、循环系统影响较大,救治不及时或处理不当易造成患者死亡。据报道,严重胸部创伤的病死率25％～50％。2005年1月～2009年3月,我院共收治胸外伤并连枷胸患者39例。现将救治体会报告如下。     

严重多发伤合并休克269例救治体会

严重多发伤患者常合并不同程度的休克,患者伤情重、病情复杂,易发生各种生理功能紊乱。1997年12月-2009年4月,我院共救治严重多发伤合并休克患者269例。现报告如下。     

New directions in virtual environments and gaming to address obesity and diabetes: industry perspective

Virtual reality is increasingly used for education and treatment in the fields of health and medicine. What is the health potential of virtual reality technology from the software development industry perspective? This article presents interviews with Ben Sawyer of Games for Health, Dr. Walter Greenleaf of InWorld Solutions, and Dr. Ernie Medina of MedPlay Technologies. Games for Health brings together researchers, medical professionals, and game developers to share information on the impact that game technologies can have on health, health care, and policy. InWorld is an Internet-based virtual environment designed specifically for behavioral health care. MedPlay Technologies develops wellness training programs that include exergaming technology. The interviewees share their views on software development and other issues that must be addressed to advance the field of virtual reality for health applications.     

Auditorium of the future: e learning platform

Principles of surgical training have not changed, but methods of training are evolving very fast. Online tools are being adopted in both knowledge and skills training for surgical residents. As a result, to evaluate the outcome of these tools, online assessment is also developing. Knowledge resources are very diverse ranging from lectures, webinars, surgical videos to three-dimensional planning and printing. Skills resources include virtual reality simulators, remote skills training and interdisciplinary teamwork. Assessment of E-learning tools can be performed using online questions, task-based simulations, branching scenarios and online interviews/discussions. In thoracic surgery, video assisted thoracic surgery (VATS) lobectomy simulator has been developed and it appears to be an important tool for minimally invasive thoracic surgery education. Training programs incorporate e-Learning in their curriculum and online training and assessment will become an important part of thoracic surgical training as well.     

虚拟现实技术结合注意力训练法促进脑卒中功能康复的研究

目的探究虚拟现实（VR）技术与注意力训练法相结合对脑卒中患者的功能康复及生活质量的影响。 方法选取2017年12月至2018年9月丽水市第二医院康复科门诊及住院的40例脑卒中偏瘫患者,采用随机数字表法将患者分为治疗组和对照组,每组20例。所有患者采用常规药物治疗,对照组采用传统康复训练结合认知训练（包括注意力训练）,治疗组患者在此基础上增加VR康复训练,每次训练30 min,1次/d,每周6 d,共持续8周。采用简易精神状态量表（MMSE）评分、Fugl-Meyer运动功能评分（FMA）、Barthel指数（BI）评分对2组患者干预前后的运动功能及日常生活活动能力进行评定比较。 结果2组患者治疗后与治疗前相比,MMSE评分、FMA评分和BI评分均有明显改善,差异具有统计学意义（P<0.05）;治疗组患者与同期对照组相比,MMSE、FMA和BI评分均显著提高,差异具有统计学意义（P<0.05）,生活质量明显优于同期对照组。 结论使用VR技术与注意力训练法结合对脑卒中偏瘫患者的功能康复效果显著,能够进一步提高患者的日常生活能力,改善生活质量。     

Role of virtual reality simulation in endoscopy training

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simula-tors and the long-term benefits of their use are also discussed.     

Uses of a dedicated 3D reconstruction software with augmented and mixed reality in planning and performing advanced liver surgery and living donor liver transplantation (with videos)

The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics, virtual surgery simulation and using the created scenarios in real-time surgery using mixed reality. In this article, we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver transplantation. Furthermore, we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.     

虚拟现实技术结合综合疗养康复对脑卒中患者上肢功能恢复的临床研究

目的观察虚拟现实(VR)技术结合综合疗养康复对脑卒中后上肢功能障碍的患者运动功能恢复的影响。方法将40例脑卒中后上肢功能障碍的患者随机分为2组,治疗组患者给予常规作业训练并进行VR技术结合综合疗养康复,对照组患者仅给予常规作业训练。观察两组患者治疗前后运动功能Fugl-Meyer评分、日常生活能力改良Barthel指数、患侧上肢肌力评分的变化情况。结果与治疗前相比,两组患者在治疗10周时Fugl-Meyer评分、改良Barthel指数、患侧上肢肌力评分均高于治疗前(P0.05),且治疗10周时,治疗组上述指标均明显高于对照组(P0.05)。结论 VR技术结合综合疗养康复可以显著改善脑卒中后上肢功能障碍患者的上肢运动功能、日常生活能力和上肢肌力,值得临床推广应用。     

虚拟现实技术应用于脑卒中康复治疗的研究现状及进展

虚拟现实技术自20世纪80年代问世至今,已融入经济、教育、娱乐甚至军事等各个领域,为用户提供各种逼真体验。虚拟现实可以为操作者提供身临其境的沉浸感,在反复场景交互中,使操作者强化互动中所带来的感官刺激及场景中功能的学习。在近年各种疾病的临床康复治疗中,虚拟现实凭借以上优势,日益得到重视并已广泛应用于运动、平衡及认知等康复治疗中。脑卒中后肢体运动功能康复一直是康复领域的难点及热点,本文对比传统康复手段,综述了虚拟现实技术对脑卒中患者康复的优势、特点和不足,并展望虚拟现实技术对促进脑卒中患者康复的前景。     

仿真结肠镜训练模式的优化研究

仿真结肠镜可用于结肠镜初学者的培训,但不同训练模式的优劣仍存在争议。目的：研究不同仿真结肠镜训练模式对建立结肠镜技能的作用,以发现最优化训练模式。方法：学员分为整体训练法（A组）、分段训练法（B组）、整体训练与关键阶段相结合法（C组）三组进行训练。训练结束后根据评分判断最适合结肠镜受训学员的训练模式。结果：三种训练模式在安全性和准确度方面无明显差异,C组在残气量、肠袢形成和操作时间方面具有明显优势。结论：整体训练与关键阶段相结合法是仿真结肠镜最优化的训练模式。     

Qualit?tsverbesserung von Koronardiagnostik und -intervention durch ?Virtual-Reality��-Simulation

Currently, more than 800,000 diagnostic procedures and 300,000 percutaneous coronary interventions are performed annually in 556 catheter laboratories in Germany. These numbers document the importance of training programs in interventional cardiology. However, this need is in sharp contrast to the time constraints for continuing medical education in Germany due to personnel and financial restrictions. A possible solution for this dilemma could be new training programs which partially supplement conventional clinical training by simulation-based medical education. Currently five virtual reality simulators for diagnostic procedures and percutaneous coronary interventions are available. These simulators provide a realistic hands-on training comparable to flight simulation in aviation.The simulator of choice for a defined training program depending on the underlying learning objectives could either be a simple mechanical model (for puncture training) or even a combination of virtual reality simulator and a full-scale mannequin (for team training and crisis resource management). For the selection of the adequate training program the basic skills of the trainee, the learning objectives and the underlying curriculum have to be taken into account. Absolutely mandatory for the success of simulation-based training is a dedicated teacher providing feedback and guidance. This teacher should be an experienced interventional cardiologist who knows both the simulator and the selected training cases which serve as a vehicle for transferring knowledge and skills.In this paper the potential of virtual reality simulation in cardiology will be discussed and the conditions which must be fulfilled to achieve quality improvement by simulation-based training will be defined.