高原创伤失血性休克有效液体复苏量和限量的实验研究

创伤失血性休克是战 (创 )伤伤员早期死亡的主要原因之一 ,有报道 32 .6 %～ 5 9.5 %的伤员因失血休克死亡。抗休克的成功为其他治疗提供了必要前提 ,而快速输液、补充血容量是救治失血性休克的关键措施。有关平原战 (创 )伤休克的液体复苏及原则已有大量研究[1 - 3 ] ,但对高原创伤失血休克液体复苏量 ,以前研究很少。笔者在高原现场用新进高原大鼠研究了创伤失血性休克的有效液体复苏量和限量。一、材料与方法1.药品试剂及仪器设备 :乳酸林格液由本院所药剂科提供 ,心功能分析仪由上海第二军医大学研制 ,大鼠由本校动物中心提供。2 .方法 …     

院前骨髓腔穿刺输液在创伤失血性休克急救中的应用体会

探讨骨髓腔穿刺输液在创伤失血性休克患者院前急救中的作用,院前骨髓腔穿刺输液在创伤失血性休克患者院前急救中有积极作用,可以作为创伤失血性休克病人浅静脉不能建立时的一种有效的替代手段使用。     

循证护理在高原地区创伤失血性休克手术救治中的应用

目的：解决高原地区创伤失血性休克患者在手术救治中出现的主要护理问题。方法：将循证护理的方法运用于高原地区创伤失血性休克患者的救治手术中,针对患者的健康及转归影响较大的护理问题,总结出有效的护理干预措施。结果：经F过循证护理56例高原地区创伤失血性休克的手术患者,休克逐渐得到纠正,有效减少了并发症,提高了手术救治的成功率。结论：循证护理应用于高原地区创伤失血性休克患者的手术救治中是行之有效的护理方法。     

创伤休克早期救治新观念与新方法

战创伤已成为现代社会一大公害,其死亡率已跃居疾病谱的第三位,创伤失血性休克(traumatic hemorrhagic shock,THS)为战创伤的重要并发症,占战创伤早期死亡的近50％[1].近年来,针对战创伤早期救治提出了许多新的治疗理念和措施,包括限制性(低亚)液体复苏(limited/hypotensive fluid resuscitation)、损伤控制复苏(damage control resuscitation,DCR)、早期血管活性药物应用等.     

高原创伤失血性休克猪七氟醚摄取量变化研究

目的:探讨高原创伤失血性休克猪七氟醚摄取量变化,为高原创伤失血性休克患者临床使用七氟醚提供依据和指导.方法:选取10只雄性巴马香猪,采用随机数字量表法分为对照组和创伤合并35％失血量组(休克组)各5只.采用容量控制性失血方法建立创伤失血性休克模型,休克组创伤后10min内匀速放出35％全身血容量,对照组不创伤不放血.使...     

损伤控制复苏在严重多发伤合并创伤失血性休克救治中的应用

目的 探讨损伤控制复苏(damage control resuscitation,DCR)在抢救严重多发伤合并创伤失血性休克患者中的应用价值.方法 回顾性分析采用DCR救治严重多发伤合并创伤失血性休克患者27例(DCR组),并与传统正压液体复苏治疗的32例患者(对照组)的结果进行比较.观察乳酸清除时间、凝血功能、DIC发病率及病死率等.结果 采用DCR救治严重多发伤合并创伤失血性休克患者疗效良好,乳酸清除时间短,凝血功能恢复快,DIC发病率及病死率显著降低,与传统正压液体复苏疗法比较,差异有统计学意义.结论 采用DCR能够明显提高严重多发伤合并创伤失血性休克患者的生存率,同时也为其他类型休克患者的复苏抢救提供了新的思路.     

冻干血浆与人血白蛋白在战创伤休克救治中的应用

冻干血浆和人血白蛋白在战创伤休克治疗中发挥着举足轻重的作用。冻干血浆是由健康人血浆根据血型按照一定比例混合经灭活病毒和冷冻干燥制成,其成分与新鲜冰冻血浆基本相同,对于战创伤休克、烧伤等具有良好的治疗效果,也是各国军方的研究热点。随着病毒灭活技术的不断进步,冻干血浆的安全性不断提高,已经在军队应用,在特殊情况下可以民用。白蛋白是血浆中含量最多的蛋白,具有维持血浆胶体渗透压、结合并输运血液中小分子物质等生理功能。目前上市的人血白蛋白包括血浆来源和重组来源两种,二者在分子组成、结构及生理功能上基本一致,在人体内的耐受性、安全性及药物代谢动力学等方面也没有明显差别。尽管人血白蛋白在休克救治中的作用曾存在争议,其在失血性休克、烧伤等的治疗中发挥着不可替代的作用。随着技术的不断进步,冻干血浆和人血白蛋白的质量将不断提高,更加安全、高效、经济,更加适用于战场环境。     

海水浸泡对失血性休克并腹部开放伤实验大鼠肿瘤坏死因子α及肠道热休克蛋白HSP-70的影响

目的探讨海水浸泡失血性休克并腹部开放伤对实验大鼠血浆肿瘤坏死因子α(TNFα-)和肠道热休克蛋白HSP-70水平变化的影响。方法建立失血并腹腔海水浸泡伤动物模型。实验大鼠随机分为对照组(n=6)、失血创伤组(n=14)、失血创伤海水浸泡组(n=14),失血创伤组为单纯失血性休克并腹部开放伤,失血创伤海水浸泡组将动物致伤后置入人工配置的海水中,于伤前和浸泡后30m in及1,1.5,3 h取血测定TNFα的变化,取肠道组织测定HSP-70的表达。结果失血创伤海水浸泡组血中TNFα较失血创伤组伤后明显升高并且高峰出现时间明显提前,肠道损伤病理变化明显重于失血创伤组,肠道组织中HSP-70含量在创伤早期显著升高,后又明显降低。结论TNFα-的过度表达在失血性休克并腹部开放伤后海水浸泡的病理生理变化中起重要作用,肠道组织细胞中HSP-70的异常表达在肠道组织细胞的应激反应机制中,可能有重要的意义。     

限制性液体复苏对治疗失血性休克的研究进展

创伤、手术、严重感染等是外科危重患者最常见的问题,很多会引起有效循环血容量不足或休克,在外科休克中,失血性休克已被公认为是效循环血量不足的典型代表,而且失血性休克又是临床上最为常见的极危重症之一,严重者可导致死亡。液体复苏已经成为失血性休克在临床中的重要治疗措施之一。     

颅脑创伤合并失血性休克的临床分析

目的探讨颅脑创伤合并失血性休克的发生率、处理方法及预后情况,提高临床预后及疗效。方法总结520例颅脑创伤患者的临床资料,回顾性分析合并失血性休克患者的临床表现、治疗及预后情况,总结TBI合并失血性休克的发生率及不同时间段的主要死亡原因。运用χ2检验等统计学方法,探讨性别、年龄、入院GCS评分、血压、脉搏、受伤至到达医院时间等相关危险因素。结果 520例颅脑创伤患者中有44例(8.46%,44/520)合并失血性休克,其中男性27例,女性17例;平均年龄(38.26±9.25)岁。交通事故是最常见的致伤原因(68.18%,30/44例)。格拉斯哥昏迷评分(GCS)3~5分16例,6~8分17例,8~12分11例。随访1个月25例(56.82%)患者死亡,其中24h内死亡10例,24h后15例。结论颅脑创伤合并失血性休克较为少见,但死亡率高。早期和后期主要死亡原因存在差异。早期(24h内)死亡原因为失血性休克,后期(72h后)主要为颅脑损伤,临床上应予以足够重视,早发现、早治疗,以争取获得最佳的治疗效果。     

Civilian versus military trauma dogma: who do you trust?

Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. A review of historical as well as current vivilian and military data is presented for four trauma topics (military antishock trousers, wound debridement, colon wounds, fluid resuscitation) in which civilian and military principles have clashed. The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.     

Use of simulation technology in Australian Defence Force resuscitation training

Realistic training of health personnel for the resuscitation of military casualties is problematic. There are few opportunities for personnel to obtain the necessary experience unless working in a busy emergency or trauma environment. Even so, the specific nature of military trauma means that many aspects of casualty management may not be adequately covered in the civilian domain. This paper discusses the use of advanced simulation technology in the training of military resuscitation teams. Such training has been available to members of the Australian Defence Force (ADF) for two years.     

快速输注3:2:1胶体液救治创伤失血性休克的效果观察

目的观察3:2:1胶体液对创伤失血性休克患者的救治效果。方法2000年8月—2006年3月,对80例创伤合并失血性休克患者利用3:2:1胶体液进行救治。在输液前后观察血压、脉搏、呼吸、血乳酸、二氧化碳结合力等指标的变化。结果输入3:2:1胶体液后患者血压、脉搏、呼吸等生命体征明显改善(P<0.05),血乳酸下降及二氧化碳结合力水平上升(P<0.05)。结论创伤失血性休克患者早期快速输入3:2:1胶体液可显著提升患者血容量,改善机体代谢,安全效高。     

Simulated aeromedical evacuation does not affect systemic inflammation or organ injury in a murine model of hemorrhagic shock

Hemorrhagic shock is a primary injury amongst combat casualties. Aeromedical evacuation (AE) of casualties exposes patients to a hypobaric, hypoxic environment. The effect of this environment on the host response to hemorrhagic shock is unknown. In the present study, we sought to determine the effect of simulated AE on systemic inflammation and organ injury using a murine model of hemorrhagic shock. Mice underwent femoral artery cannulation and were hemorrhaged for 60 minutes. Mice were then resuscitated with a 1:1 ratio of plasma:packed red blood cells. At 1 or 24 hours after resuscitation, mice were exposed to a 5-hour simulated AE or remained at ground level (control). Serum was analyzed for cytokine concentrations and organs were assessed for neutrophil accumulation and vascular permeability. Mice in the simulated AE groups demonstrated reduced arterial oxygen saturation compared to ground controls. Serum cytokine concentrations, neutrophil recruitment, and vascular permeability in the lung, ileum, and colon in the simulated AE groups were not different from the ground controls. Our results demonstrate that mice exposed to simulated AE following hemorrhagic shock do not exhibit worsened systemic inflammation or organ injury compared to controls. The data suggest that AE has no adverse effect on isolated hemorrhagic shock.     

Incidence of SLAP lesions in a military population

OBJECTIVES: SLAP (superior labrum anterior and posterior) lesions are a recognised cause of shoulder pain and instability. They can occur following a direct blow, biceps traction and compression injuries, and are commonly seen in overhead athletes. Military personnel are physically active and often subjected to trauma. We assessed the incidence of SLAP lesions within a military population presenting with shoulder symptoms. METHODS: A retrospective review, of all shoulder arthroscopies performed by a single surgeon between June 2003 and December 2004 at a district general hospital serving both a military and civilian population, was undertaken. The presentation and incidence of SLAP lesions were recorded for both military and civilian patients. RESULTS: One hundred and seventy eight arthroscopies were performed on 70 (39.3%) military and 108 (60.7%) civilian patients. The average age was 42.3 (range 17-75), 50 females and 128 males were included. Indications for arthroscopy included pain (75.3%), instability (15.7%), pain and instability (7.9%), or "other symptoms" (1.1%). 39 SLAP lesions (22%) were found and grouped according to the Snyder classification--20.5% type 1, 69.3% type 2, 5.1% type 3, 5.1% type 4. Patients with a history of trauma or symptoms of instability were more likely to have a SLAP lesion (p<0.0001). The incidence of SLAP lesions in the military patients was 38.6% compared to 11.1% in civilian patients (p<0.0001). After allowing for the increased incidence of trauma and instability in the military, SLAP lesions were still more common in the military patients (p<0.001). CONCLUSIONS: There is a higher than average incidence of SLAP lesions in military patients compared to civilian patients. They tend to present with a history of trauma, as well as symptoms of pain and instability. Given the high incidence in military personnel, this diagnosis should be considered in military patients presenting with shoulder symptoms, and there should be a low threshold for shoulder arthroscopy.     

失血性休克复苏及监测指标研究进展

创伤、失血性休克是一古老的临床研究课题。不仅在平时常见，更重要的是与战伤救治密切相关。尽管近10年来取得了一些进展，但复苏时机、复苏目标、液体种类的选择、复苏后继续生命支持以及监测技术等仍是临床以及研究人员面临的重大挑战。本文将就近年来有关上述问题的最新研究进展进行分析和讨论，以期提高对该复杂综合征的认识，为今后的研究提供帮助。     

Surgical workload from an integrated UK field hospital during the 2003 Gulf conflict

AIMS: This paper reports the surgical experience of a UK reserve field surgical hospital during military operations in Iraq during March and April 2003. Particular reference is given to the integration of the surgical specialities, consultant led and multidisciplinary teamworking in the treatment of military and civilian casualties from all sources and of all causes. METHODS All surgical workload data was collected prospectively for the warfighting (Phase One) and specialist referral (Phase Two) phases of the operation. Standard military and Red Cross protocols were used for all injuries and microbiology studies were undertaken for penetrating ballistic injuries. Operations were classified by anatomical region; upper or lower limb; head and neck; thoracic; abdominal, including genitourinary; ophthalmic; and burns, and by whether they were primary; secondary planned or secondary unplanned. RESULTS: A wide range of patterns of wounding arising from combat and non-combat related military and civilian trauma and burns were seen and treated. 323 operations were performed. There were 116 operations in phase one and 207 operations in phase two. There were 160 primary procedures (new patients), 146 secondary planned and 17 unplanned procedures (range one to eight procedures per patient). Close integration of general, orthopaedic, plastic, maxillofacial, ophthalmic and neurological surgeons and general and ITU anaesthetists allowed the delivery of a range of specialist treatment to a heterogenous patient population, including children as young as 6 months and a lady in the advanced stages of pregnancy. CONCLUSIONS: Patterns of wounding in casualties surviving to reach specialist field hospital care were similar to those reported in other high intensity conflicts. A consultant led, multidisciplinary approach with field intensive care facilities allowed combined, staged and safe surgery for complex, multi-organ and multi-limb trauma in an austere environment.     

烧伤12批187例救治的总结分析

目的：总结分析成批烧伤救治的最佳工作程序,提高早期多数量伤员的伤情判断和处理能力,使救治工作准确有序的按计划进行。方法：①伤员原地救治;②伤员转送外地救治;③伤员原地和转送并举。结果：烧伤12批187例治愈161例,其中112例恢复原工作,32例生活完全自理,并且有一定的工作能力,17例生活不能自理。死亡26例,其中休克期9例,感染期17例。结论：成批烧伤早期救治的环境条件和伤情判断分类均很重要,尽早建立救治的工作程序,才能保证每名伤员救治措施落实,也可随时发现伤员病情变化,及时对症处理。避免在忙乱中延误病情而影响救治效果。     

An audit of resuscitation and anaesthesia during Operation 'Safe Haven'.

The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P < 0.05). ICV patients recovered more quickly than with HTCV (P < 0.05), but were significantly older and heavier (P < 0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only 127 pounds. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.