严重多发伤的救治

严重多发伤是急诊常遇到的严重问题，是现代人类的主要死因之一。在美国创伤已成为死因第四位，在欧美等国家创伤成为40岁以下人口死亡的第一原因。2002年我国交通事故死亡11．6万人。近年来，建筑业、交通业的发展，自然灾害、公共卫生事件、事故灾难、社会安全事件不断发生，导致严重多发伤发病率有明显增高趋势，脊柱脊髓损伤常是多发伤的一部分。随着社会发展、生活水平提高以及“以人为本”思想的确立。社会对创伤急救的要求也不断提高．殷切希望获得快捷、及时、有效的救治。进一步认识、研究严重多发伤，提高其救治成功率，降低死亡率、致残率．是急救医学、创伤外科和骨科面临的一个重要课题。     

严重多发伤患者的急救配合及临床护理

目的总结分析严重多发伤患者急救配合和临床护理措施,提高患者生存率。方法回顾分析60例严重多发伤患者的临床急救配合与护理资料。结果 60例严重多发伤患者中3例抢救无效死亡,余57例(95.00%)患者经有效的急救和护理之后均得到救治。其中治愈41例,好转16例。结论严重多发伤患者病情严重且复杂,有效的急救配合和护理是提高生存率的关键。     

多发伤中腹部伤的处理原则

多发伤中腹部伤的处理原则重庆急救医疗中心（６３００１４）陈维庭多发伤至今尚无一个被公认的定义，一般认为凡伤及两个或两个以上部位，且至少有一处伤危及生命者称为多发伤。但这一定义亦无量化标准。１９９３年召开的我国首届多发伤学术会议建议，将多发伤定为凡同一...     

第8届全国创伤外科学术研讨会通知

为了促进创伤外科学术交流与发展,展示创伤外科近年来的新进展、新成果,加强此专业领域内全国同仁之间的经验交流,由《创伤外科杂志》编辑部主办,中华医学会创伤学分会创伤急救与多发伤学组、     

急诊评估及护理对多发伤患者抢救存活率的影响

目的 探讨对多发伤患者进行急诊伤情评估后及时给予急救护理干预对抢救存活率的影响。方法 选择佛山市第一人民医院急诊科2010年1月－12月采用ABCDEFGHI伤情评估后给予急救护理干预的124例多发伤患者为实验组,与本科2009年1月－12月未采用ABCDEFGHI伤情评估程序即进行抢救的108例多发伤患者为对照组,对两组多发伤患者的抢救存活率进行比较分析。结果 两组抢救前受伤原因、受伤部位、受伤情况的构成比无显著性差异(P > 0.05);但实验组死亡10例,抢救存活率为91.90%;对照组死亡19例, 抢救存活率为82.40%,实验组抢救存活率明显高于对照组(X2 = 4.7913,P = 0.0290)。结论 对多发伤患者进行ABCDEFGHI伤情评估后再进行急救护理,能明显提高其存活率,说明该伤情评估对提高多发伤患者的抢救存活率具有一定的价值,值得临床推广应用。     

四肢多发性骨折及其合并伤的急救与护理

我院近二年来共收治四肢多发性骨折及其合并伤４２例,现将急救及护理报告如下。临床资料本组４２例中,男２３例,女１９例。年龄最小６岁,最大７１岁。交通事故伤２５例,坠落伤５例,塌砸挤压伤１２例。４２例中共有１０８处骨折,其中２处骨折２７例,３处骨折６例,４处骨折９例。合并伤１５例,其中颅脑损伤４例,肋骨骨折并血气胸６例。肝破裂２例,脾破裂３例。并发症２３例,其中休克１９例,脂肪拴塞４例。开放性骨折３８例,闭合性骨折４例。急救与护理一、多发性骨折及其合并伤首先要“全、快、早”。此病伤因复杂,伤情严重。…     

严重多发伤患者的急救配合及护理体会

目的探讨严重多发伤患者的急救配合和护理措施。方法收集2015-06—2017-02安阳市灯塔医院收治的85例严重多发伤患者,对其急救护理临床资料进行回顾性分析。结果 85例患者中82例患者生命体征平稳并成功进入下一步综合治疗。救治成功率为96.47%。结论严重多发伤患者的病情严重而复杂,科学合理的急救配合及护理能提高救治率,降低致残率及致死率,有利于改善患者的预后。     

急救模式下创伤控制性手术治疗严重多发伤的效果分析

目的探讨急救模式下创伤控制性手术治疗严重多发伤的效果。方法对60例严重多发伤患者行一体化急救模式及创伤控制性手术,回顾性分析患者的临床资料。结果存活患者51例,病死患者9例。就诊时间≤1h的患者病死率(8.1%)低于就诊时间1h的患者(30.4%),差异有统计学意义(P0.05)。存活患者ISS评分相比病死患者低,差异有统计学意义(P0.05)。结论急救模式并行早期创伤控制性手术,对严重多发伤患者具有较好的救治效果,可显著降低并发症发生率及病死率,有助于提高患者生存率,改善患者预后,值得在临床上推广应用。     

多发伤救治模式探讨

目的交通事故与工伤事故与日俱增,多发伤的发生率也在逐渐增加。多发伤病人发生突然、伤情复杂、病情进展快、死亡率高,故多发伤的急救是各医院医师面临的一个重大问题,对其救治模式的探讨也在不断进行着。本文将对多发伤的分科分诊救治模式、一体化救治模式以及我院的以创伤急救中心为主导的救治模式做一个简单分析。     

一体化治疗提高抢救成功率

创作目前已成为世界一大公害,其中造成死亡或后遗症的大多为多发伤。多发伤病情重、发展快、并发症多,快速而有效的抢救措施和对病情全局的把握是抢救成功的关键。据不完全统计,在所有外伤病人中多发伤占40%. 患者的死亡率为10%,其中合并骨盆骨折的死亡率达到了50%。台州医院急救中心医护人员有76名。该中心依靠一支富有战斗力的急救团队,实施一体化抢救模式。2006年以来每年平均救治360余名严重多发伤和复合伤病友,抢救成功串为     

慈溪市道路交通意外伤害调查

本文对我市1988年1月～1994年12月道路交通意外伤害进行了流行病学调查分析。5968起车祸中,受伤人数达6815人,死亡560人,伤亡人数逐年呈台阶状上升。肇事的主要责任者中驾驶员占66％,骑自行车者占10.2％,行人占11.5％,其它原因占12.3％。通过调查分析,认为要减少道路交通事故及其所致的伤亡,关键是要提高全民的交通安全意识。笔者就此提出全面综合治理的六点建议。     

Epidemiological characteristics of expressway traffic trauma in 2 040 cases

Objective： To evaluate the epidemiologic characteristics of expressway traffic trauma in 2 040 cases in Zhejiang Province. Methods: The data of 2 040 cases of expressway traffic trauma taken from Zhejiang Provincial Expressway Traffic Bureau were analyzed with computer techniques. Results: A total of 2 040 persons were injured in 7 963 expressway traffic accidents in Zhejiang Province from January 1999 to December 2001. Among them, 435 persons died (mortality, 21.3 % ) and 1 605 were injured. The economic losses were over 170 million yuan RMB. The accidents caused by human factors accounted for 84.9% (vehicle drivers accounting for 79.2% ), which mainly included improper measures (20.4%), steering failure ( 17.7% ), insufficient longitudinal space ( 15.9% ) , overspeed drive ( 12.5 % ) , fatigue drive ( 6.4 % ), loading violation (5.9 % ) and careless drive ( 6.3 % ). Mechanical troubles and other factors took up 15.1%. There existed obvious uneven distribution among various regions. Jiaxing and Shaoxing were the sections with high incidence of accidents. The accidents mostly happened at 12:00-18:00, but the causing-dead ones most concentrated at 0:00-6:00. The main victims were young and middle-aged people (accounting for 72.3%), but accident-stricken children and elderly persons ( over 70 years old ) took up higher mortalities ( 30.2 % and 40.7 %, respectively). Conclusions: The number of expressway traffic accidents and the economic losses are increasing year by year, with obvious uneven distribution at different places, different time and under different weather conditions. To reduce the accident frequency, it is important to strengthen the enforcement of traffic regulation, to balance the system of “person-vehicle-road”, and to improve the safety consciousness of people.     

Spinal cord injury

The annual incidence of acute spinal cord injury in the UK is 15–40 cases per million. More than half these injuries are the result of road traffic accidents, with falls, industrial accidents, sports or violence making up most of the remainder. Violent injury accounts for only a small percentage of cases in this country. The typical patient is male (male to female ratio is 4:1) and young (peak incidence is at 20–40 years). The initial mechanical trauma leads to injury of the neural elements, this is the primary injury. Blood vessels are damaged, axons disrupted and neural cell membranes broken. The spinal cord swells and is compressed in the spinal canal. Ischaemia occurs when the cord swelling exceeds venous blood pressure. This leads to failure of autoregulation of blood flow. The ischaemia leads to a release of toxins from neural cells triggering a secondary injury. The main goal in the management of spinal cord injuries is to prevent secondary injury.     

Analysis and identification of the hidden relationships between effective factors in the mortality rate caused by road accidents: A case study of Fars Province, Iran

Purpose: An analysis and identification of the hidden relationships between effective factors in the mortality rate caused by road accidents in Fars Province of Iran to prevent and reduce traffic accidents in the future. Methods: This cross-sectional study was conducted to integrate all the pervious researches performed on mortality rate of road traffic accidents in Fars Province from March 21, 2013 to March 20, 2017. In order to reveal the relationships between the factors affecting mortality rates of road traffic accidents, the data regarding road traffic accidents extracted from resources such as Legal Medicine Organization, Traffic Police, Accident & Emergency Department, as well as Department of Roads and Urban Development of Fars Province, then cleaned and the applicable attributes embedded in the data all aggregated for further analysis. It should be noted that the data not related to Fars Province were deleted, the data analyzed, converted and the aggregation between various attributes identified. The aggregation between these different attributes as well as the FP-growth algorithm and two indexes of support and confidence calculated and interesting and effective rules extracted. In the end, several accident-provoking factors, the degree of consecutive and interdependence of each one in road accidents identified and introduced. The statistical analysis was conducted by using Rapid Miner software. Results: Of the 6216 people dead due to road traffic accidents, 4865 (79.02%) were male and 1292 (20.98%) were female, 59 of them have no clear gender. The largest portion of people died of road traffic accidents belonged to married and self-employed men who collided with motorcycles in autumn. Moreover, young individuals (aged 19e40 years) with secondary educational level who died of accidents in summer at 12:00 a.m. and then 5:00 p.m. in outer city main roads of Kazerun-Shiraz, then DarabShiraz, Fasa-Darab and in within-city main streets had the highest mortality rates. Among women, the middle-aged group (aged 41e65 years) followed by young-aged group (aged 19e40 years) with elementary educational level and then illiterate accounted for the highest mortality rate of road traffic accidents. The automobiles involved in accidents included Pride, Peugeot 405, Peykan pickup, Samand, Peugeot Pars, other vehicles and motorcycles. Conclusion: The high mortality rate of illiterate and low-literate in various age groups indicates that educational level plays a crucial role as a factor in road accidents, requiring related organizations such as Traffic Police and Ministry of Education to take necessary measures and policies.     

Eleven Years of Liver Trauma: The Scottish Experience

The aim of this population based study was to assess the incidence, mechanisms, management, and outcome of patients who sustained hepatic trauma in Scotland (population 5 million) over the period 1992–2002. The Scottish Trauma Audit Group database was searched for details of any patient with liver trauma. Data on identified patients were analyzed for demographic information, mechanisms of injury, associated injuries, hemodynamic stability on presentation, management, and outcome. A total of 783 patients were identified as having sustained liver trauma. The male-to-female ratio was 3:1 with a median age of 31 years. Blunt trauma (especially road traffic accidents) accounted for 69% of injuries. Liver trauma was associated with injuries to the chest, head, and abdominal injuries other than liver injury; most commonly spleen and kidneys. In all, 166 patients died in the emergency department, and a further 164 died in hospital. The mortality rate was higher in patients with increasing age (p < 0.001), hemodynamic instability (p < 0.001), blunt trauma (p < 0.001), and increasing severity of liver injury (p < 0.001). The incidence of liver trauma in Scotland is low, but it accounts for significant mortality. Associated injuries were common. Outcome was worse in patients with advanced age, blunt trauma, multiple injuries and those requiring an immediate laparotomy.     

交通事故医疗急救点的设置与经验分析

目的：探讨在城郊结合部交通事故多发路段事故伤员应急救援管理模式。方法：对我院2001年6月～2004年6月在桂林郊区设立“交通事故急救点”三年来,在医疗点的设置、人员配备方面和救治经验进行总结。结果：医疗队的设立,提高了对交通事故的快速反应能力,伤员等待救治时间平均为8min,伤员死亡率为7．9%(64/809例)。与此同时,医疗队本身的野战救护能力也得到了很大的提高。结论：在交通事故频发的城郊结合部设立医疗急救点,是提高交通伤救治能力,减少事故伤员死亡率的有效方法之一。     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Epidemiology of patients admitted to a major trauma centre in northern India

Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northem India. Methods： An observational study of 748 patients chosen by random assortment was carried out over a peri- od of 1 year （August 2008 to July 2009）. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results： Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6：1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries （94.92%） were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common （40.3%）. Most spinal cord injuries were caused by falls from height （51.09%）. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than up- per limb fractures. Conclusion： Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and plan- ning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.     

Epidemiology of traffic crash mortality in west of Iran in a 9 year period

Purpose: In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods: In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results: Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion: The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.     

Tree collisions in road traffic accidents - mechanism and pattern of injury

INTRODUCTION: In Germany, the county of Mecklenburg-Vorpommern has got the highest frequency of traffic accidents. 42 % of all deadly injured car accident victims in Mecklenburg-Vorpommern sustained a tree collision. Aim of this study was to analyze tree collisions regarding typical pattern and severity of injury. METHODS: During an on-going prospective, non-interventional accident survey within a defined area of the county of Mecklenburg-Vorpommern tree collisions with minimum one victim sustaining a Maximum Abbreviated Injury Scale of 1-6 injury were analyzed. RESULTS: In between January 2001 and June 2004 287 accidents were documented. 19 % (54) were tree collisions. 81 % of drivers were male. 36 of 54 tree collisions (67 %) occurred on straight roadways. The mean ISS was 31.3 (SD +/- 29.8), 30 % (23) of the passengers died. 70 of 78 individuals sustained more than one injury. With that, the combination of head- and chest trauma was most frequent and associated with the highest injury severity. DISCUSSION: Especially tree collisions lead to severe trauma. Interestingly, most accidents did occur on straight roadways.