共查询到20条相似文献,搜索用时 62 毫秒
1.
目的探讨各类严重闭合性胸部创伤患者的早期凝血功能变化,以提高该类患者的早期识别及干预。方法回顾性研究2013年1月—2016年6月伤后24h内成都大学附属医院急诊收入ICU及胸外科的胸部创伤患者的临床资料,根据简明损伤分级90版(AIS-90),纳入AIS≥3分的严重闭合性胸部创伤患者,以是否输血、是否为单纯性严重闭合性胸部创伤、是否ISS25分以及是否GCS9分分组,比较入院24h内凝血功能变化差异。结果共纳入228例患者,死亡15例,死亡组ISS评分均高于存活组(t=14.49,P0.01),GCS评分均低于存活组(t=14.44,P0.01)。在严重闭合性胸部创伤患者中,D-二聚体(D-D)和纤维蛋白原降解产物(FDP)在多发伤组、ISS评分25分组及GCS9分组均高于相应的单纯胸部创伤组、ISS﹤25分组及GCS9分组(P﹤0.01);凝血酶原时间(PT)ISS25分组中,高于ISS≤25分组(P0.01)。结论合并多发伤的严重闭合性胸部创伤患者在受伤早期,D-D和FDP明显升高,且该类患者多具有GCS和ISS高评分特点,是临床筛选高危创伤患者并指导进行早期干预的重要指标。 相似文献
2.
目的 探讨严重创伤患者早期凝血功能变化及与血浆血栓调节蛋白(thrombomodu1in,TM)、蛋白C水平的关系及其临床意义. 方法 选择早期多发伤患者64例,按严重创伤程度评分( ISS)分为重伤组(ISS≥16分)和轻伤组(ISS< 16分),比较分析各组凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)变化,同时检测血浆TM和蛋白C水平,分析与凝血功能变化的相关性.另选择30例健康人为正常对照组.比较分析死亡和生存患者血浆TM和蛋白C水平的变化. 结果 重伤组PT和APTT较轻伤组及正常对照组明显延长(P<0.05),与血浆TM和蛋白C的水平变化均有明显的相关性(P<0.05).死亡患者血浆TM水平明显高于生存患者,蛋白C明显低于生存患者. 结论 严重创伤患者早期出现凝血功能异常,与血浆TM和蛋白C的活化相关,血浆TM和蛋白C水平对预后有重要的预测价值. 相似文献
3.
目的探讨不同复苏液经骨髓腔通路复苏失血性休克犬对凝血功能的影响。方法建立犬失血性休克模型,从胫骨骨髓腔输注小剂量7.5%氯化钠羟乙基淀粉40溶液(HSH)、生理盐水(NS)两种复苏液,测定复苏各时间点凝血酶原时间(PT),活化部分凝血活酶时间(APTT)。结果失血性休克后,实验组PT、APTT延长,与对照(sham)组比较差异有统计学意义(P<0.05),实验组间比较差异无统计学意义(P>0.05);复苏后2 h,HSH组PT、APTT明显延长,与NS组比较差异有统计学意义(P<0.05);复苏后48 h实验组PT、APTT降至正常,与sham组比较差异无统计学意义(P>0.05),实验组间比较差异无统计学意义(P>0.05)。结论经骨髓腔通路输注小剂量HSH复苏失血性休克,对凝血功能影响轻微,未出现严重的出血倾向,是一种安全、有效的复苏方案。 相似文献
4.
目的探讨血小板及冷沉淀输注对创伤大出血患者凝血功能的影响。方法以保定市第一中心医院西院2011年8月~2014年8月收治的131例行大量输血治疗的创伤大出血患者作为研究对象,在大量输血早期预防性输注血小板和(或)冷沉淀预防性输注。将仅输注血小板的患者设为血小板组;将仅输注冷沉淀的患者设为冷沉淀组;将联合输注血小板与冷沉淀者设为联合组。观察不同输注方法对3组患者输血前后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板(PLT)等的影响。结果联合组患者输注后PT、APTT、TT较输注前明显缩短(P0.05),FIB、PLT较输注前明显增加(P0.05);联合组与血小板组比较,PT、APTT、TT明显缩短,FIB明显增加,差异均有统计学意义(P0.05),联合组与冷沉淀组比较,PT、APTT、TT明显缩短,PLT明显增加,差异均有统计学意义(P0.05);3组在住院时间上无统计学差异;联合组生存率高于血小板组和冷沉淀组,但无统计学意义(χ2=1.09,P0.05和χ2=0.64,P0.05);3组入院后24h红细胞输注量无统计学差异;联合组血小板输注量少于血小板组(t=6.30,P0.05),冷沉淀输注量少于冷沉淀组(t=7.17,P0.05)。结论创伤大出血患者大量输血早期联合输注血小板与冷沉淀可明显提高患者凝血物质的含量,缩短凝血时间,比单独输注血小板或冷沉淀更有利于避免凝血功能紊乱,具有更显著的止血效果。 相似文献
5.
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 总被引:1,自引:1,他引:0
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。 相似文献
6.
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 总被引:3,自引:0,他引:3
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. 相似文献
7.
目的 研究多发创伤患者早期血清促卵泡生成素(FSH)、促黄体生成素(LH)变化与创伤严重度和格拉斯哥昏迷评分的关系.方法 随机选取2003年3月~2004年2月急诊就诊的多发创伤患者93例,就诊时间均在伤后24h内,即时采集血样,采用放射免疫双抗体沉淀法测定血清FSH、LH水平,并另选20名健康体检者作为对照组.93例患者按照ISS评分予以分组(ISS<16分47例,25≥ISS≥16分24例,ISS>25分22例),其中合并颅脑损伤者按GCS评分分组ISS<16分14例,25≥ISS≥16分14例,ISS>25分12例,并比较各分组间FSH、LH水平.结果 严重创伤组(ISS>25分)与合并颅脑损伤组患者早期FSH、LH明显升高(P<0.01).ISS>25分组、25≥ISS≥16分组、ISS<16分组血清FSH、LH水平依次降低(P<0.05或0.01),且前2组明显高于对照组(P<0.01).合并颅脑损伤者中,GCS>8分组、8≥GCS>5分组、5≥GCS≥3分组血清FSH、LH水平依次降低,组间比较差异有显著性(P<0.05或0.01),且均显著高于对照组(P<0.05或0.01).结论 血清垂体前叶激素FSH、LH水平的改变与严重创伤、颅脑损伤的严重程度相关,可作为判断伤情、观察预后的参考指标. 相似文献
8.
目的比较重度腹部枪伤伴失血性休克行损伤控制手术与传统一期手术对全身炎症反应的影响。方法雌性本地杂种猪腹部枪伤及放血后建立肠袢多处伤及失血性休克模型后,32只动物随机分为2组(n=16):传统手术组(CS组)和损伤控制组(DCS组)。经适量晶体液复苏后行剖腹探查。CS组行损伤肠管切除端端吻合、腹腔冲洗、确定性关腹;DCS组行肠管残端血管钳夹闭、结扎、腹腔冲洗、临时关腹。记录手术时间、输液量、失血量、小时尿量,检测血流动力学参数、动脉血气、凝血指标等。术后6h,每组处死6只动物,取心肌、肺、小肠和肝组织行病理学检查。每组剩余10只动物用于观察创伤后24h生存率。结果两组间失血量、平均动脉压(MAP)无明显差异(P=0.05);与CS组比较,DCS组的手术时间(1.1±0.2hvs2.4±0.3h,P<0.01)短、输液量(3204±254mlvs3756±313ml)少(P<0.05)、小时尿量多、心率慢,酸中毒和凝血障碍较轻。DCS组的组织损伤及中性粒细胞浸润程度较CS组更低。尽管DCS组创伤后24h生存率(80%)的数值高于CS组(50%),但两组无统计学差异(P=0.175)。结论损伤控制手术较传统手术的手术时间短、输液量少,能更快纠正酸中毒、凝血障碍和低体温,避免进一步加重休克复苏后的再灌注损伤和炎症反应、维护多脏器功能。 相似文献
9.
目的观察严重创伤患者院前允许性低压复苏的效果。方法采用前瞻性研究,对在重庆市急救医疗中心和陆军军医大学大坪医院急救部收治的63例严重创伤患者(ISS 16~25),根据随机数字表法分为常压复苏组(MAP 80mm Hg,38例)和低压复苏组(MAP 60mm Hg,25例)。其中男性46例,女性17例;道路交通伤52例,刀刺伤7例,坠落伤4例。观察止血前分别采用常压复苏或低压复苏处理对患者输血输液量、血流动力学、血气、凝血功能以及器官功能的影响。结果与常压复苏组相比,手术止血前低压复苏可降低患者运输和手术过程中的输血、输液量,增加血球压积,稳定血流动力学参数和改善氧饱和度,常压复苏组的输液量、术中输液量和术中输血量分别为1 643、3 526和361m L,低压组分别为543、1 801和201m L(P0.01);低压组血球压积为32.3%,显著高于常压组(24.1%,P0.01);同时低压复苏组患者的器官功能(肝、肾)和凝血功能明显优于常压复苏组。结论适度低压复苏可保护严重创伤患者的器官功能,MAP60mm Hg是较理想的目标复苏压力。 相似文献
10.
目的探讨多发伤合并颅脑损伤患者颅内血肿进展相关因素。方法笔者回顾性分析2007年1月~2014年1月收治的134例多发伤合并颅脑损伤患者的临床资料,其中男性91例,女性43例;年龄16~60岁,平均(35.6±10.7)岁。其中30例血肿进展患者为进展组,104例为未进展组,利用统计学方法对两组患者性别、年龄、伤情、格拉斯哥昏迷评分(GCS)、创伤严重度评分(ISS)、创伤严重指数(IISI)、休克指数、手术、凝血状况、液体复苏及血压调控等因素进行单因素及多因素分析。结果两组在年龄、性别、GCS、ISS评分、IISI、6h内的平均动脉压、休克指数、开颅手术情况对比无统计学意义。两组患者治疗前后休克指数均明显改善,比较无统计学意义。颅内血肿进展与48h平均动脉压(OR=1.994,P0.001)、平均24h补液量(OR=0.342,P=0.038)、凝血功能异常情况(48h,OR=3.173,P=0.039)、多发脑挫裂伤情况(OR=2.921,P=0.041)相关。两组预后组间比较采用Ridit分析(R值_(进展)=0.590,R值_(未进展)=0.474,t=2.007,P=0.047),未进展组好于进展组。结论多发伤合并颅脑损伤患者颅内出血是影响预后的重要因素,多发脑挫裂伤患者更易出现,应予重视,通过限制性液体复苏和早期血压目标管理有利于减少血压波动和凝血功能异常发生,对改善患者预后有一定益处。 相似文献
11.
Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version 总被引:5,自引:0,他引:5
E. M. Roos H. P. Roos C. Ekdahl L. S. Lohmander 《Scandinavian journal of medicine & science in sports》1998,8(6):439-448
The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living. 相似文献
12.
13.
14.
Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered. 相似文献
15.
Introduction Ankle sprains are the most common musculoskeletal injury that occurs inathletes particularly in sports that require jumping landing on one foot such assoccer and basketball 《中国运动医学杂志》2008,27(3):378-381
Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8). 相似文献
16.
Martin J.Gibala 《中国运动医学杂志》2008,27(3)
KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief,intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.,≥90%of VO2 peak). 相似文献
17.
Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents. 相似文献
18.
Tucker VC Hopwood AJ Sprecher CJ McLaren RS Rabbach DR Ensenberger MG Thompson JM Storts DR 《Forensic science international. Genetics》2011,5(5):436-448
In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex® ESI 16 (European Standard Investigator 16) and the PowerPlex® ESI 17 Systems. The PowerPlex® ESI 16 System combines the 11 loci compatible with the UK National DNA Database®, contained within the AmpFlSTR® SGM Plus® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR® SGM Plus® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex® ESI 17 System amplifies the same loci as the PowerPlex® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR® SGM Plus® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors. 相似文献
19.
Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players
下载免费PDF全文
![点击此处可从《Scandinavian journal of medicine & science in sports》网站下载免费的PDF全文](/ch/ext_images/free.gif)
K. Thorborg M. S. Rathleff P. Petersen S. Branci P. Hölmich 《Scandinavian journal of medicine & science in sports》2017,27(1):107-114
The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season. 相似文献
20.
LI Yong-dong HAN Xin-wei WU Gang LI Ming-hua 《介入放射学杂志》2007,16(4):253-257
Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 (87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257) 相似文献