创伤性失血性休克的急救护理

目的 研究探讨创伤性失血性休克的急救护理措施.方法 回顾性分析我院2008年1月～2010年6月急诊救护车接来的120例创伤性失血性休克病人的急救护理情况.结果 经急救护理64例送ICU进一步治疗,33例病情稳定后送手术室实施必要的手术,18例抢救稳定后送普外科进一步保守治疗,5例ICU抢救无效死亡.结论 运用合理有效的抢救程序能够明显降低休克病人的病死率,为后期的治疗打下坚实的基础,提高治疗效果和生存率.     

创伤性休克与全身性炎症反应

Trauma is the NO.1 cause of death in persons under the age of 45 and the No.3 cause of all deaths.Many trauma patients die of multiple organ failure(MOF),induced by systemic inflammatory re-sponse syndrome(SIRS). This paper reviesw the relations of traumatic shock with systemic inflammation.     

创伤性休克病人粒细胞表面Mac—1,CD18的表达

本研究用单克隆抗全间接免疫荧光标记测定了创伤性休克时，多形核粒细胞（ｐｏｌｙｍｏｒｐｈｏｎｕｃｌｅａｒｌｅｕｋｏｃｙｔｅｓ，ＰＭＮｓ）表面Ｍａｃ－１，ＣＤ１８的表达，结果表明，创伤后ＰＭＮｓ表面Ｍａｃ－１和ＣＤ１８表达有下调趋势。     

创伤性休克患者的手术室抢救及手术配合

随经济的发展,生活水平的提高,创伤已逐渐成为社会的一大公害[1]。平时严重创伤多由于交通事故,爆炸和高处坠落等所致,美国的一项调查表明,1678例交通事故伤员占65%[2]。     

54例重度休克麻醉评估

198 6年到 1998年间我们处理重度休克麻醉病例共 5 4例。现将体会报告如下。1　临床资料5 4例中外创伤出血性休克 44例 ,其中男性 38例 ,女性6例 ,年龄 12～ 61岁。麻醉前 SBP在 10 .64k Pa以下 ,平均脉压 1.33k Pa以上者 40例 :脉压不清者 4例 ,死亡 4例。创伤出血性休克分类见表 1。表 1　创伤出血性休克分类受伤部位例数成活死亡颅脑损伤 40 4腹部外伤 1313四肢脊柱外伤 1818胸外伤 99伴有中毒性休克者 15例 ,其中男性 12例 ,女性 2例 ,年龄 5 3～ 61岁 ,麻醉前 SBP均在 10 .64k Pa以下 ,平均脉压1.33k Pa以上。中毒性休克分类见表 2…     

创伤性休克186例急救护理体会

创伤性休克是急诊救治工作的重要急症.是由于人体突然遭受严重创伤发生的有效循环血量锐减所致.其病情发展迅速抢救治疗稍有延误和不慎,可危急患者生命.及时、有效的采取措施,协助医生,严密观察病情变化.争分夺秒的抢救患者,可提高抢救成功率.     

创伤性休克186例急救护理体会

创伤性休克是急诊救治工作的重要急症。是由于人体突然遭受严重创伤发生的有效循环血量锐减所致。其病情发展迅速抢救治疗稍有延误和不慎,可危急患者生命。及时、有效的采取措施,协助医生,严密观察病情变化。争分夺秒的抢救患者,可提高抢救成功率。     

创伤性休克患者急诊抢救手术的配合及体会

创伤性休克患者常常不仅有呼吸、循环功能障碍,而且还常合并腹腔脏器破例、穿孔、大出血等紧急、危重情况,具有处理困难、死亡率高的特点。绝大多数的此类患者为了赢得抢救时间从急诊直接送进手术室。因此手术室护士必须熟练掌握各种抢救措施,争分夺秒地与麻醉、手术医生紧密配合,术中充分准备,抢救及时,措施得当,是保证手术顺利进行,抢救生命的关键。我院2013年1月~2014年7月共对65例创伤性休克患者进行及时的、有预见性的抢救手术及护理,抢救成功率达98%。现将手术配合及体会总结如下。     

创伤性休克的新概念

创伤性休克是临床常见的急症性危象,病情危重、进展快速、处置难度大。对其病理生理机制和临床救治的研究始终是医学研究的重点。本文就近年来在创伤性休克方面的新概念和新理念进行了分析和综合,旨在"抛砖引玉" ,促进我国的休克救治水平进一步提高。     

环孢素A对严重创伤失血性休克大鼠的治疗作用

目的观察环孢素A(CsA)对创伤失血性休克大鼠的治疗作用。方法采用144只健康成年SD大鼠,分为正常对照组、休克对照组、乳酸林格氏液(LR)复苏组、CsA 1 mg/kg、5 mg/kg和10 mg/kg组。建立创伤失血性休克模型后,观察不同剂量CsA治疗对休克动物的存活时间和24 h存活率的影响,同时通过股动脉和左心室插管测定血流动力学指标,观察CsA对大鼠平均动脉血压(MAP)、左心室收缩压(LVSP)、左心室舒张末压(LVEDP)、左心室压力最大上升/下降速率(±dp/dtmax)和心率(HR)的影响。结果 CsA(5 mg/kg和10 mg/kg)可明显提高创伤失血性休克大鼠的存活时间和24 h存活率。休克后大鼠血流动力学指标包括MAP、LVSP、±dp/dtmax和HR都显著降低,LR复苏可使各项指标有所回升,但显著低于正常对照组;CsA(5 mg/kg和10 mg/kg)可明显升高LVSP和±dp/dtmax,在复苏2 h时明显高于LR组,并接近正常水平。结论 CsA显示出较好的抗创伤失血性休克作用,其中以5 mg/kg和10 mg/kg的给药剂量效果明显。     

Pathophysiological basis for the use of steroids in the treatment of shock and trauma

Summary Although glucocorticosteroids have been used, for over 30 years, in almost every medical specialty, the scientific foundation for their clinical indication is, in many instances, still unclear. Corticosteroids are being advocated as a therapy for numerous forms (e.g., septic, hypovolemic, traumatic, cardiogenic, etc.) of circulatory shock. They are also used in other conditions where histamine is thought to be the putative primary mediator. In general, glucocorticoids are considered useful because they decrease the immune response associated with anaphylaxis, stabilize lysosomal and endothelial cell membranes, and inhibit the release (and formation) of mediators from endothelial and mast cells. But, are glucocorticoids and/or other steroids (e.g., mineralocorticoids, estrogens, androgens, etc.) of real therapeutic value in low-flow states. Much of this controversy seems to center around the absence of good clinical studies (with proper controls), when to give the steroid, how much should be given (and for how long), and what is the mechanism(s) of action. The data reviewed, herein, indicate that pharmacologic doses of both glucocorticoids and estrogens can be useful in the treatment of shock and trauma. The results demonstrate that steroid treatment should be instituted very early in shock in order for it to be able to exert its beneficial actions.Pharmacologic doses of glucocorticoids and estrogens, but not other steroids (i.g., mineralocorticoids, aldosterone, or androgens) exert direct pharmacologic actions on vascular smooth muscle cells, especially in the microvasculature. These pharmacologic actions result in an inhibition of the constrictor action of the many vasoactive substances (e.g., catecholamines, peptides, serotonin, prostanoids, etc.) released early into the blood stream to compensate for blood and/or fluid loss. Both types of steroids probably are useful in therapy because they prevent the uptake and utilization calcium ions which are essential for contraction of vascular smooth muscle cells. Although the steroids, in pharmacologic doses, can open up ischemic vascular beds in target organ regions in circulatory shock, they do not actively vasodilate normal blood vessels form untraumatized subjects.In addition, to their microvascular actions, these two different classes of steroid compounds also exert benficial actions on reticuloendothelial system (RES) function; RES phagocytic function is restorted to normal when pharmacologic doses of glucocorticoids or estrogens are administered early to shocked and traumatized animals.The data presented herein also clearly demonstrate that in order for one to be able to get the maximum benefit from steroid therapy in shock, steroids must be administered early and in very high dosage. Overall, the data reviewed herein provide a solid scientific basis for the therapeutic use of glucocorticoids (and possibly estrogens) in various forms of cilculatory shock and trauma.Supported by grants HLBI-18002 and HLBI-18015 from the USPHS     

膈的解剖学特点与创伤性膈破裂及膈疝的救治

目的：探讨创伤性膈疝／创伤性膈破裂的诊断及治疗特点。方法：总结经手术证实的32例创伤性膈破裂与膈疝病例，其中开放性损伤18例(56．2％)，以刀刺伤为主；闭合性损伤14例(43.8％)，以交通伤多见。膈破裂18例，膈疝14例中有2例慢性(延迟期)膈疝：分析不同致伤原因造成的损伤类别，临床症状特点及手术方式。结果：术前确诊膈破裂与膈疝的13例(40．6％)；31例(96、8％)在第一次手术中发现膈破裂与膈疝，予以修补；1例漏诊(3．2％)；死亡3例(9、6％)。结论：(1)创伤性膈破裂与膈疝是一种特殊类型的损伤，伤情危重、复杂，死亡率高；(2)可根据受伤机制及胸腹腔出血量对诊断作判断；(3)正确选择手术入路与受损器官处理先后顺序能提高抢救成功率。     

Functional state of the endogenous opioid peptide system in rats with traumatic shock

Laboratory of Pathophysiology, Research Institute of Cardiology, Tomsk Scientific Center, Academy of Medical Sciences. (Presented by Academician of the Academy of Medical Sciences R. S. Karpov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 113, No. 5, pp. 467–469, May, 1992.     

Inversion of the response to serotonin in rats with traumatic shock

Normally serotonin reduced blood pressure. It was shown that in rats with traumatic shock its hypotensive effect was transformed into hypertensive one. In vitro serotonin exhibited a slight vasoconstrictor effect on isolated rat aorta, while 24 h after injury, the strength of aortic contractions in response to serotonin increased 2.2 times. Desensitization of glucocorticoid receptors caused by injection of high doses of dexamethasone (3 mg/kg) to rats for 5 days led to similar changes in serotonin effect. We hypothesized that inversion of the response to serotonin in shock was caused by increased activity and/or expression of vasoconstrictor serotonin receptors in blood vessels. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 3, pp. 266–269, March, 2008     

An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis

Context:

Attainment of hemodynamic parameters to within a normal range may leave patients in compensatory shock. In such patients, serial blood lactate evaluation can be useful in predicting shock.

Aims:

To ascertain the role of serum lactate as a predictor of shock and its outcome in patients of trauma and sepsis.

Settings and Design:

A prospective, non-interventional study.

Materials and Methods:

The study included 50 patients (5 to 60 years old) of trauma admitted within 12 hours of injury and patients of suspected or proven sepsis. Those with chronic medical illnesses, alcohol intoxication, or poisoning were excluded. Blood lactate levels were analyzed at admission and 12, 24, and 36 hours of inclusion with records of corresponding hemodynamic variables, investigations, and interventions. The outcome was recorded as survival or non-survival.

Statistical Analysis Used:

Statistical analysis was done with a student''s t test and repeated measure ANOVA (Analysis of Variance).

Results:

An analysis revealed higher mean lactate levels in non-survivors as compared with survivors. Mean lactate levels in non-survivors did not attain normal levels, while that of survivors reached normal levels by 24 hrs in trauma patients and 36 hrs in sepsis patients. The predicted mortality rates by a lactate level >40 mg/dl at admission, 12, 24, and 36 hours were 52.6%, 61.5%, 83.3%, and 100%, respectively for both the subgroups combined. Non-survivors had a higher incidence of MODS (Multi Organ Dysfunction Syndrome).

Conclusions:

Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of trauma or sepsis. Interventions that decrease lactate values to normal early may improve chances of survival and can be considered effective therapy. Lactate values need to be followed for a longer period of time in critical patients.     

Energy metabolism in the rat brain in the course of traumatic shock

The concentration of high-energy phosphates (ATP, creatine phosphate), the total content of adenyl nucleotides, and the energy potential of the brain cells did not change significantly in experimental animals after trauma to the soft tissues of the thigh, until the terminal phase. The intensity of glycolysis was increased. In the terminal phase anaerobic processes predominated somewhat over aerobic. The absence of changes in the concentration of high-energy phosphates in the rat brain in traumatic shock is probably associated with centralization of the circulation and it is evidence that no critical exhaustion of energy takes place in the brain.I. I. Dzhanelidze Leningrad Emergency Aid Scientific-Research Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. S. Il'in.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 78, No. 11, pp. 27–29, November, 1974.     

闭合性胰腺外伤18例诊治分析

目的探讨闭合性胰腺外伤的诊断和治疗方法。方法对我院1991年6月至2006年6月收治的18例闭合性胰腺外伤的病例资料进行总结分析。结果18例中治愈17例,死亡1例。发生严重并发症6例(33.3%),其中胰瘘2例,腹腔脓肿1例,假性胰腺囊肿2例,假性胰腺囊肿伴大出血1例。结论早期腹部CT检查是诊断胰腺损伤最快捷、直观的方法,在剖腹探查术中常规探查胰腺是早期发现和避免漏诊胰腺外伤的关键。治疗时应综合考虑胰腺损伤的类型、合并伤和病人全身情况,选择合理的治疗方法。     

Disturbances in hormonal regulation of vascular tone during traumatic shock

Changes in hormonal regulation of the vascular tone in Wistar rats were studied on Cannon model of traumatic shock. The pressor response to angiotensin II decreased by 30–40% 3 h after the incidence of trauma. The reaction to vasopressin remained unchanged. However, phenylephrine in medium and high doses produced a more pronounced pressor response under these conditions. One day after trauma we revealed a decrease in vascular sensitivity not only to angiotensin II, but also to vasopressin and α₁-adrenoceptor agonist phenylephrine. The vascular response was observed only after treatment with phenylephrine in maximum doses. Traumatic shock was accompanied by inverse response to serotonin: hypertensive effect instead of blood pressure drop. Our results show that traumatic shock is accompanied by specific changes in vascular reactivity. __________ Translated from Byulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 141, No. 5, pp. 511–514, May, 2006