高原火器伤感染特点的实验研究

本文报告高原地区(海拔3658m)火器伤感染特点,通过32条犬动物试验研究证实,高原火器伤感染的细菌临界标准数量要高于平原地区才引起伤口感染,感染时限明显延长,光镜下发现组织挫伤区范围大,损伤重,震荡区损伤亦较平原重。这些现象与高原地区特定的地理环境有关。     

临床问答

问题1:高原火器伤有何特点解答:高原大气压低,空气密度较平原减少,枪弹、弹片等投射物飞行阻力小、速度快,击中组织时造成的损伤重。在海拔3658m高原和351m平原进行的动物实验表明,高原火器伤坏死组织清除量、伤道容积、出入口面积均大于平原。由于高原日照时间长、紫外线辐射强度大,气温低,不利于细菌生长,高原创伤感染发生率较平原低。高原火器伤除局部损伤重以外,高原环境机体耐受力差,血液粘滞度大,微循环差,易加重伤清,休克发生早,进展迅速,持续时间长;脑水肿发展迅速,消退缓慢,昏迷时间长,颅内高压症明显;因高原缺氧,胸部火器伤后,呼…     

问题1：高原火器伤有何特点

解答：高原大气压低，空气密度较平原减少，枪弹、弹片等投射物飞行阻力小、速度快，击中组织时造成的损伤重。在海拔3658m高原和351m平原进行的动物实验表明，高原火器伤坏死组织清除量、伤道容积、出人口面积均大于平原。由于高原日照时间长、紫外线辐射强度大，气温低，不利于细菌生长，高原创伤感染发生率较平原低。     

高原火器伤感染特点及其防治的研究

高原火器伤感染特点及其防治的研究雷明全李恩平我院地处海拔３６５８ｍ，大气压６５．２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），氧分压１３．６ｋＰａ。高原地区创伤病人需氧菌感染率低，清创时限比平原地区延长，且伤口愈合良好。笔者给拉萨地区杂种狗造成后肢软组织火器...     

高原习居与空运犬颅脑火器伤脑水肿的比较

高原习居与空运犬颅脑火器伤脑水肿的比较６１００８３成都成都军区成都总医院张捷，胡威夷，黄茂清，曾凡俊严利春，曹力，何毅，刘丛军关键词创伤和损伤，脑水肿，血脑屏障，肺水肿中国图书资料分类号Ｒ６５１．１５高原地区空气中氧气含量明显低于平原地区，海拔３６５...     

高原火器伤伤道细菌数量测定的分析

本文在不同时限观察了拉萨地区火器伤狗伤道挫伤区每克组织细菌数量、达到感染的临界细菌数量及时限。结果表明:高原细菌生长速度较平原慢,感染细菌的临界数量为3.8×10~8±14个菌,感染时限为48.8±9.4h。分析了高原与平原的差异是由于大气压低,寒冷,空气干燥、紫外线强所致。     

现代战时颌面部火器伤观察与护理

颌面部是战时最易致伤的部位.颌面部火器伤多以伤势复杂,损伤面广、损伤后污染重,盲管伤多为特点,症状主要表现为：出血、肿胀、语言功能、视功能障碍及呼吸困难等,颌面部伤主要威胁是窒息、出血及感染.伤情重时,可累及相邻器官和脑组织,危及生命.因此颌面部火器伤后进行紧急救治,实施有效的病情观察与护理,对及时挽救伤员生命,提高战伤治愈率,最终保持部队战斗力,起到关键作用.     

高原战创伤的特点及其救治

高原地区大气压和氧分压低,该地区发生的战创伤有其自身的一些特点。笔者就高原战创伤休克、感染和火器伤、冲击伤、烧伤的特点及其救治原则作一概述,并加以展望。     

肢体火器伤与全身反应救治

战伤是指在作战过程中,由杀伤性武器直接或间接造成的机体损伤。在现代战争条件下,火器伤仍是最主要的致伤类型。战伤与平时创伤有许多共性,但也有其特殊性。从致伤原因看,战伤属于创伤的一种特殊类型。现代战伤的特点是伤类多、伤情复杂、伤口污染严重。1创伤弹道学枪弹伤时肌组织吸收高速投射物能量所形成的瞬时空腔是造成组织挫伤的重要原因,从病理形态学上可将火器伤伤道分为原发伤道区(A区)、挫伤区(B区)和震荡区(C区)。A区可作为估计瞬时空腔的依据;B区范围为0.2~0.6cm,是投射物能量侧传导和瞬时空腔脉动时的挤压与牵拉作用形成的失活组织区,以肌纤维坏死、大量白细胞浸润、坏死的肌纤维之间可夹杂正常肌原纤维为特征,超微结构可见该区肌原纤维“Z”线排列紊乱,呈阶梯状结构改变,此区早期界限不易确定,一般需2~3天后出现炎症分解时才能确定损伤范围,其宽度与组织的黏滞性和弹性、致伤物的种类及伤道部位的不同而有差异;C区主要是肌原纤维变性、略显肿胀和血液循环障碍,含水分越多的组织和器官形成的震荡区也越宽。在高原地区,由于空气稀薄、密度低,枪弹的初速增加,同等弹丸在高原比平原速度快、撞击能量大,造成的伤腔及组织损伤更为严重[1]。2局...     

紫外线与高原地区白内障发病的分子机制

白内障为全世界首位致盲眼病,高原地区白内障发病率明显高于平原,流行病学调查和实验研究证实长期慢性的紫外线辐射与年龄相关性白内障的发生密切相关。本文对相关流行病学调查、紫外线对晶状体上皮细胞的损伤、晶状体蛋白质组学的研究现状等方面的文献进行了分析综述,以探讨紫外线与高原地区白内障发病的分子机制。     

1216名部队干部战士艾森克个性问卷调查研究

利用艾森克个性问卷对802名平原部队干部战士和驻西藏高原的414名干部战士进行了测试,并将结果同国人常模青年组进行对照分析,发现部队组的E分和N分都非常显著高于国人常模,P分显著低于国人常模。高原部队组N分显著低于平原部队组,P分显著高于平原部队组。驻守高原时间≥2年组E分非常显著增高,P分显著增高于驻守高原时间<2年组。针对部队干部战士的心理特点,以做出有的放矢的心理保健。     

颅脑穿透伤清创术后伤部细菌学的临床分析

本文对火器性颅脑穿透伤早期清创术后68例可疑感染的伤部,作了临床细菌学检查及分析。培养出细菌61例,共检出菌种17种。金黄色葡萄球菌最多,未检出气性坏疽菌属、无芽胞厌氧菌及破伤风杆菌。本文讨论了伤口检出的细菌与致伤火器,早期清创,机体抵抗力,抗生素应用的关系。强调了早期清创术后防治感染的重要性。     

CT findings in fire arm injuries of the pelvis. Personal experience

PURPOSE: We investigated the yield of CT in firearms wounds with pelvis involvement by evaluating the CT features of pelvis, bone walls, and associated injuries, if any. CT plays a major role, while conventional radiography remains an important integration in the workup of pelvis bone injuries. MATERIAL AND METHODS: We report a retrospective series of pelvis gunshot wounds studied with CT in a 5-year period; the patients were all men, with a mean age of 38 years (range 18-56). When only the pelvis was involved, CT was performed from the transverse umbilical plane to the pubis, in order to include the continuous abdomen. We used an intravenous contrast agent to study the aorta and its iliac branches, pelvic vessels, active hemorrhagic effusions and bladder filling. RESULTS: Penetrating firearms wounds were found in 21 cases and perforating ones in 7. In the penetrating wounds, the bullet course was most frequently (75%) stopped by the pelvic bones, with retention and CT visualization within muscular and bone structures. The incidence of bone injuries, especially crash wounds, was high, with 18 cases (64%). In both types of wounds with anterior course, we demonstrated bladder perforation in 2 cases, vascular damage in 2 and perforation of intestinal loops in 6. DISCUSSION AND CONCLUSION: Paradoxically, pelvic bone fractures may be "protective" for the pelvic content; however the involvement of large arteries and veins and multiple perforations of intestinal loops are no less dangerous than the upper abdominal wounds. CT is an important diagnostic tool that permits accurate and prompt evaluation of pelvic organs such as intestine, bladder and bone structures. Thus, CT permits prompt assessment of pelvic structures involvement by firearms wounds, which provides the clinician with useful imaging findings of bullet damage.     

急进高原前后战士无氧阈的调查研究

报道60名新兵空运进驻3680m 前后通气无氧阈(ATGE)测定结果。受试者进入高原初期,负荷运动达无氧阈时,负荷功率和摄氧量均降低,心率升高;达最大负荷运动时,负荷功率,摄氧量和心率均降低,通气量升高。进驻高原前后各参数均存在显著性差异(P<0.01)。研究认为,ATGE 是很有价值而可靠的心肺功能评价指标,尤以 ATGE(负荷功率)最为敏感,其次为 ATGE(Vo2)。     

湿润烧伤膏治疗感染性皮肤坏死的体会

目的：探讨湿润烧伤膏(MEBO)治疗7例感染性皮肤坏死的治疗效果。方法：采用暴露疗法，用湿润烧伤膏涂擦创面，每日4～5次，同时必须静脉使用有效的抗菌素。结果：治疗7天后创面新鲜肉芽开始增生，2周后基本愈合，其中2例因创面较大而行点状皮片移植术。所有病人痊愈出院。结论：湿润暴露疗法治疗感染性皮肤坏死的疗效确切，无感染及瘢痕形成。     

Liver trauma due to penetrating lesions: miscellanea, personal case series, clinical and CT findings

PURPOSE: Penetrating liver wounds are related to many causes and rank second after blunt abdominal and liver trauma. We will report the clinical and radiological findings of our personal series of patients with penetrating trauma, especially by firearms and stab and cut wounds. We will also try to define the diagnostic workup of these traumas, which is especially based on CT signs of liver damage and associated changes and which is of basic importance for following treatment, both surgical or conservative. MATERIAL AND METHODS: In the last seven years we retrospectively reviewed 31 cases of penetrating liver trauma. The patients were 19 men and 12 women, ranging in age 18 to 73 (mean 42), with penetrating liver injuries from firearms (16 patients) and stab (9 cases) wounds; 6 patients had injuries from different causes. Abdominal CT was carried out in emergency with the CT Angiography (CTA) technique in all patients. In the patients with suspected chest and abdomen involvement CT was performed from the mid-chest for accurate assessment of diaphragm and lung bases and to exclude associated pleuropulmonary damage. RESULTS: Penetrating liver wounds were caused by firearms in 70% of cases, by stabbing in 12% and, in the extant 18%, by other causes such as home accidents, road and work traumas, and liver biopsy. In our series, the liver was most frequently involved, especially by firearms wounds; in our 16 cases the most frequent injuries were hemorrhagic tears. We found bullets in the liver in 6 cases. In one case of home accident the patient wounded himself while slicing bread with a long knife, which cut into the anterior abdominal wall and tore the anterior liver capsule, as seen at CTA. DISCUSSION AND CONCLUSIONS: Penetrating wounds to liver and abdomen are less frequent than those to the chest. In the past decade the use of CT has changed the diagnostic and therapeutic approach to such injuries completely, decreasing the resort to explorative laparotomy and hepatorrhaphy. Indeed, CT provides a clear picture of the extent and severity of damage, which permits to choose a conservative treatment in case of intraparenchymal hematomas and lacerocontusive foci without hemoperitoneum, which can be followed-up with physical and CT examinations. Moreover, Helical CT could provide the early diagnosis of active bleeding in the peritoneum and of focal bleeding in the liver, thus permitting prompt hepatorrhaphy or targeted hepatectomy. A diaphragm injury suspected at CT should always prompt the surgeon to intervention, especially when hemothorax, lung base pneumothorax, large liver hematoma or tear of the liver dome are associated. Finally, subdiaphragmatic free gas indicates gut perforation associated with liver damage, in which case surgery is necessary too.     

Fatal head injuries from firearms

Summary Autopsy findings in 270 fatal head injuries from firearms are reported, including 243 suicides and 27 homicides. The most frequent weapon used for both groups were shot guns which are easily available in Norway. For suicides the most favored sites were right tempoparietal, frontal, and mouth. Twenty-six percent of the victims from homicides had multiple wounds in their head. Suicide by firearms showed marked male predominance, whereas the sex ratio for homicide was rather equal between the two sexes.     

湿润烧伤膏治疗80例皮肤创面的临床效果

目的：观察湿润烧伤膏（MEBO）用于皮肤各种创面的治疗效果。方法：本组80例病人全部使用MEBO治疗，根据创面情况分别采取湿润暴露疗法和湿润包扎疗法。结果：80例病例中〈5cm创面愈合时间平均为10天，〉5cm的15天，15cm以上的为30天，创面愈合时间缩短，组织修复较快。结论：MEBO治疗外科创面疗效显著。     

烧伤感染病原菌的DNA微阵列检测研究

目的观察DNA微阵列检测烧伤感染病原菌的灵敏度和特异度。方法分别采用DNA微阵列法和常规培养分离鉴定法对不同含菌量的菌液进行检测,比较二者鉴定病原菌的灵敏度;采用微阵列法检测经常规方法鉴定明确的烧伤感染病原菌62株,观察二者的阳性符合率和阴性符合率;采用上述两种方法检测103份烧伤创面分泌物标本,观察其符合率。结果与常规方法相比,DNA微阵列检测烧伤创面细菌具有快捷、高通量的优势,鉴定单一菌株的灵敏度比常规方法高10~100倍,鉴定已知菌株与常规方法的阳性符合率和阴性符合率均为100%;在检测103份烧伤创面分泌物时,DNA微阵列除鉴定出常规方法鉴定出的所有菌株外,还检出了一些常规方法未检出的菌株。结论与常规方法相比,DNA微阵列检测烧伤感染常见病原菌的符合率和灵敏度均达到较高水平,具有良好的临床应用前景。     

眼部主要战伤伤谱初步研究

目的　研究现代常规战争中眼部战伤的发生规律和特点 ,了解现代眼战伤伤谱 ,以更好地加强平战时眼部伤的救治。方法　调研有关现代战争的眼战伤资料 ,对所收集的数据进行统计分析。结果　初步总结出现代战争眼部战伤的主要发生规律、特点以及致伤因素。结论　现代战争眼部主要战伤伤谱为 :(1 )眼球穿通伤 ;(2 )眼球穿通合并眼球异物伤 ;(3)眼球钝挫伤 ;(4 )眼附属器的外伤 ;(5 )眼烧伤。