心脏穿透性损伤的急诊救治

目的 总结心脏穿透性损伤的急诊救治经验.方法 对47例心脏穿透性损伤患者的临床资料作回顾性分析.结果 急诊手术42例,均抢救成功.3例入院时已死亡,2例在急诊科抢救无效死亡.结论 早期诊断、及时手术是心脏穿透性损伤抢救成功的关键.对本病的诊断,胸部CT比其他检查更具优越性.简化院内抢救流程,缩短就诊至手术的时间,将能提高抢救成功率.     

心脏贯穿性损伤7例治疗分析

目的　探讨心脏贯穿性损伤急救治疗经验。方法　回顾性分析 1994年 6月— 2 0 0 3年 5月收治的 7例心脏贯穿性损伤患者的诊断和救治手术方法。结果　 6例存活 ,1例死亡。结论　心脏贯穿性损伤的救治重点在于及时诊断 ,解除心脏压塞 ,修复心脏破口 ,纠正失血性休克 ,改善心功能。     

心脏外伤诊治14例分析

目的探讨心脏外伤的诊治要点。方法回顾性分析14例心脏外伤病人救治的临床资料。结果心脏破裂急诊手术14例,抢救成功12例,手术效果满意,无明显后遗症,死亡2例。结论早期正确诊断和迅速开胸行心脏修补、止血是成功抢救心脏外伤的关键。对于极度危重,尤其是濒死或心脏已停跳的病人,主张行急诊室剖胸术。     

基层医院重型颅脑损伤病人规范化救治分析

目的探讨基层医院重型颅脑损伤病人规范化治疗的有效策略,以降低病人病死率。方法 2003年9月—2008年10月运用我院现有的医疗技术和设备,对102例重型颅脑损伤病人进行了院前急救,急诊室复苏,早期手术及专科监护室加强治疗等规范化治疗。结果全组102例病人中82例手术治疗,全组死亡27例,病死率为26.5%。结论提高对颅脑损伤急救意识,建立高效急救体制,重视院前急救,加强急诊室抢救,及时CT检查,早期手术及术后专科监护室加强治疗可提高重型颅脑损伤病人救治成功率。     

介入诊治所致心脏创伤18例临床分析

目的　探讨医源性心脏创伤的损伤机理和救治原则。方法　对近 2 0年来作者处理的18例心脏创伤病人进行回顾性分析研究。结果　全组男性 6例 ,女性 12例 ,年龄 11～ 6 0岁 ;致伤原因主要有心脏介入性诊断或治疗过程中的损伤、心包穿刺损伤。死亡率为 11%。结论　心脏创伤的临床表现和凶险程度因其接受的损伤方式及机理形成等因素不同而表现各异 ,必须根据病情及轻重缓急决定抢救方式 ,才能有效地降低死亡率。     

骨盆骨折合并腹盆脏器损伤的救治体会

目的总结骨盆骨折合并腹盆脏器损伤的救治体会。方法对2000～2012年该院收治的25例严重骨盆骨折合并腹盆脏器损伤患者的临床资料进行回顾性分析。结果 25例患者中,早期手术治疗23例,其中22例获得随访。治疗效果优12例,良10例,死亡3例,优良率为88%。结论早期正确诊断和处理合并伤可提高骨盆骨折合并腹盆脏器损伤患者的生存率。     

心脏介入治疗患者并发心脏压塞的早期识别抢救及护理

目的探讨心脏介入治疗患者并发心脏压塞的早期识别抢救与护理。方法我院收治的心脏介入治疗并发心脏压塞患者20例,对其临床资料进行回顾性分析。结果经过早期识别与抢救护理,救治成功17例,死亡3例。结论对心脏介入治疗并发心脏压塞的患者,进行早期有效识别和实施积极抢救是非常重要的。完善的术前指导和术中、术后对病情的密切观察为挽救生命赢得了宝贵时间。     

心脏外伤的诊断与治疗

目的:探讨心脏外伤的诊断及治疗方法,提高心脏外伤的抢救成功率。方法:我科于1999年3月至2010年10月共收治10例心脏外伤患者,男性7例,女性3例,年龄18～51岁,平均(29.5±8.5)岁。其中刀刺伤5例,车祸伤3例,高处坠落伤2例。表现为出血性休克者3例,急性心包填塞者7例。损伤部位有:左心室4例,左心房2例,右心室3例,右心耳1例。结果:所有患者手术均取得成功,没有死亡病例。结论:早期快速诊断、紧急开胸手术治疗,及时有效补充血容量,采取自体血液回输,是成功抢救心脏外伤的关键。     

心脏穿透伤8例救治体会

目的总结8例心脏穿透伤救治经验教训。方法回顾性分析8例心脏穿透伤临床资料。结果本组8例心脏穿透伤患者中，成功救治5例，死亡3例。结论早期诊断，及时手术开胸缝合心脏伤口是心脏穿透伤患者救治成功的关键。     

心脏外伤的诊治

目的探讨心脏外伤的诊断及治疗方法。方法分析2000年7月至2006年9月收治的7例心脏外伤患者资料,男性6例,女性1例,年龄18-37岁,其中刀刺伤5例、胸部挤压伤2例、急性心包填塞6例。损伤部位：右心室3例、左心室2例、室间隔破裂1例、单纯急性心包填塞1例。结果急诊手术6例,保守治疗1例,没有死亡病例。结论早期快速诊断、积极抗休克治疗、紧急开胸手术是成功抢救心脏外伤的关键。     

昏迷患者急诊救治368例临床分析

目的探讨昏迷患者急诊的早期诊断及急救处理方法,以期提高抢救成功率。方法对急诊科2008～2010年接诊的368例昏迷患者的诊断和抢救资料进行回顾性分析。结果 368例昏迷患者中,脑血管意外疾病最多,颅脑损伤次之,随其后依次是休克、中毒、心血管疾病、内分泌和代谢性疾病;368例昏迷患者中死亡11例,病死率为2.99%。结论昏迷患者中脑血管意外占大多数,尽快明确病因诊断、加强急救治疗,有助于提高昏迷患者的抢救成功率,降低病死率。     

严重多发伤致急性呼吸窘迫综合征救治体会

目的总结严重多发伤致成人急性呼吸窘迫征的救治经验。方法分析2006年6月～2012年4月收治的交通事故致急性呼吸窘迫征病例144例的临床资料。结果本组伤员144例。其中死亡病人28例,死亡率19.44%,死于原发性损伤10例,主要死于失血性休克、广泛的心脏挫伤和肺挫伤。死于继发性损伤18例,主要死于多脏器功能不全和重症感染。结论对于严重多发伤致急性呼吸窘迫征患者,快速有效的院前急救,经验丰富的创伤救治团队是提高救治率的前提。快速诊断,及早进行损伤控制性手术,正确使用呼吸机,积极改善胃肠功能,积极控制原发病是提高治愈率,降低死亡率的关键。     

Tricuspid Valve Avulsion after Blunt Chest Trauma

Blunt cardiac trauma causing tricuspid regurgitation is rare and is most often associated with traffic accidents. Falling from a height can also cause such injuries, resulting in hemodynamic compromise and arrhythmias. The signs of traumatic tricuspid regurgitation can appear early or be delayed, depending upon the severity of injury. We present the case of a 68-year-old woman who fell from a height onto rocks during a hike. She sustained blunt cardiac injury with complete tricuspid valve avulsion, and underwent successful repair. In addition, we review the relevant medical literature.Key words: Cardiovascular system/injuries, echocardiography, transesophageal, heart injuries/complications/diagnosis/physiopathology/surgery, time factors, treatment outcome, tricuspid valve/injuries/surgery, wounds, nonpenetrating/diagnosis/physiopathologyTricuspid valve injury can occur secondary to various events, including blunt cardiac trauma. The manifestation of this condition after blunt cardiac trauma can vary, depending upon the structural damage to the tricuspid apparatus. We present the case of a patient who had severe tricuspid regurgitation due to tricuspid valve avulsion after blunt cardiac trauma, and we review the relevant medical literature.     

肠系膜急性闭合性损伤的CT影像学特征及临床分析

目的通过对腹部闭合性外伤肠及肠系膜损伤的术前CT检查影像学表现与临床手术进行对比,探讨CT检查在腹部外伤肠及肠系膜损伤影像学表现及诊断优势,从而提高CT影像在肠及肠系膜损伤中的诊断符合率。 方法选取2008至2020年40例中山市东升医院收治疑似腹部闭合性损伤患者,均实施CT检查,将患者的CT检查结果与确诊结果进行对比,总结CT影像检查的诊断符合率,不同肠系膜损伤患者的CT影像学特征。 结果CT诊断符合率、漏诊率分别为97.5%、2.5%,与确诊结果比较,差异无统计学意义(P>0.05);CT检查的影像学特征有腹腔游离气体、腹腔以及肠间隙积血与积液、肠壁增厚水肿及肠壁血肿及肠系膜水肿。 结论CT检查在肠系膜急性闭合性损伤患者诊断中效果理想,其影像学特征显著,可鉴别不同类型肠系膜损伤,且诊断符合率高。     

急性心肌梗死住院患者应用临床路径的效果评价

目的:评价在急性心肌梗死(AMI)住院患者诊治中应用临床路径的效果。方法:根据ACC/AHA及中国急性冠脉综合征诊治指南制定我院AMI临床路径,并将临床路径附在病例中,每6个月对关键环节执行情况进行一次评估,并对数据进行分析,提出改进措施。以我院心内科住院AMI患者为研究对象,临床路径应用前收集2006年10月~2008年3月住院AMI患者76(男54,女22)例,年龄(63±12)岁,作为应用前对照组(应用前组);应用临床路径后连续收集2008年4月~2009年9月住院AMI患者98(男74,女24)例,年龄(62±12)岁,作为临床路径应用组(应用组)。结果:临床路径应用组AMI患者住院时间较应用前明显缩短,其中急性ST抬高心肌梗死患者住院天数[(13±8)d vs.(9±7)d,P<0.05],急性非ST抬高心肌梗死患者住院时间[(13±7)d vs.(7±9)d,P<0.05];应用后高危患者接受冠脉造影率为78%,较应用前(48%)显著提高(P<0.01);应用后急性ST抬高心肌梗死患者入院到球囊扩张时间(D-B时间)较应用前显著下降(P<0.01);12 h内到达医院的ST抬高心肌梗死患者中早期再灌注治疗率临床路径应用前后分别为67%和87%(P<0.05);AMI药物规范治疗方面,应用后联合用药明显提高;干预后AMI患者住院期间病死率较应用前显著下降(12%vs.2%,P<0.05)。结论:在AMI住院患者中应用临床路径进行诊疗可显著改善医疗质量,提高临床疗效,缩短住院时间。     

Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center

BACKGROUND: Laparoscopic cholecystectomy has a higher incidence of bile-duct injuries than open cholecystectomy. Although a learning curve phenomenon was attributed to biliary injuries early after its introduction, we were interested in trends in biliary injury rates over time as laparoscopic cholecystectomy has become a mature technology. OBJECTIVE: To analyze the frequency and anatomic distribution of bile-duct injuries referred after laparoscopic cholecystectomy over a 10-year period. DESIGN: Retrospective, case-series. SETTING: Tertiary, referral hepatobiliary unit. PATIENTS: Referrals to ERCP unit for diagnosis and treatment of biliary injuries after laparoscopic cholecystectomy. INTERVENTION: ERCP to diagnose level and severity of bile duct injury. MAIN OUTCOME MEASUREMENTS: Type and anatomy of bile-duct injury, reason for cholecystectomy, mean time between injury and diagnosis, presenting symptoms, ratio of bile-duct injuries diagnosed over total ERCPs done per year. RESULTS: There were 87 bile-duct leaks, 28 leaks with stones, 51 strictures, and 17 complete duct transactions. The bile-duct injury rate calculated per 100 ERCPs per year was 0.84 (1994), 0.99 (1995), 1.36 (1996), 1.41 (1997), 1.03 (1998), 1.31 (1999), 0.84 (2000), 0.75 (2001), 1.15 (2002), and 0.94 (2003). LIMITATIONS: Single institution, retrospective analysis, unknown denominator of cholecystectomies done in referral area per year to calculate true bile-duct injury rate. CONCLUSIONS: Static incidence in frequency, anatomic distribution, and rate per 100 ERCPs per year of postcholecystectomy bile-duct injuries at a tertiary referral hepatobiliary unit over a 10-year period of observation.     

Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

Background/purpose

Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high.

Methods

The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed.

Results

In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team.

Conclusions

Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.     

335例壶腹周围癌手术分析

目的 我院近十年来开展的335例壶腹周围癌的手术情况，以期能为逐步提高其外科手术治疗的安全性和疗效提供有益帮助。方法 分析1990年1月至1999年12月间在我院普外科施行手术的335例壶腹周围癌患的临床资料，其中胰头癌237例，壶腹部癌98例。结果 胰头癌与壶腹部癌手术切除率分别为13．5％与66．3％，总手术切除率为29％，根治性手术死亡率为7．69％与5．45％，手术并发症发生率分别为26．9％与32．7％。本组手术并发症主要是：胰瘘、胆瘘、出血、腹腔感染、吻合口梗阻。结论 要最大眼度地提高壶腹周围癌的手术切除率和长期生存率，降低手术死亡率、并发症发生率，除了提高早期诊断率以外，更重要的是一支专业手术组医师梯队的建立。