美国急诊外科的内涵和发展趋势及对我国创伤救治医师培养的启示

美国急诊外科是其创伤学界为应对创伤医师短缺而创建的外科急症救治模式和培训模式,对提高美国的创伤救治水平和效率具有重要的积极意义。其课程设置包括选择性普通外科、急症普通外科、创伤外科和外科重症监护,同时还选择性加入部分神经外科、骨科和介入性放射学技能的培训。美国急诊外科的成功经验值得我国创伤学界借鉴。     

我国儿科介入放射学现状及展望

儿科介入放射学是介入放射学与儿科放射学的重要分支,因疗效显著和创伤较小而深受临床医师与患儿家长的欢迎。但该学科在我国尚未得到广泛开展。本文评述我国儿科介入放射学的发展现状,临床诊治过程中的特殊性,以及未来发展中存在的问题。     

创伤救治中电离辐射损伤的研究进展

创伤是当今世界普遍面临的健康问题,特别是严重创伤病情危重、复杂,具有很高的死亡率和致残率,能否进行及时有效的救治成为影响预后的关键因素[1],在创伤救治中对患者进行快速准确的评估尤为重要.根据国际创伤救治的规范程序和大量的实践证明,X线片、CT和数字减影血管造影(DSA)等放射学检查在伤情评估、指导治疗及疗效评价方面发挥着重要作用[2,3].但检查中患者接受的电离辐射会增加肿瘤的发生率[4],有报道约2%的肿瘤患者是影像学检查所致[5].笔者就创伤救治中电离辐射损伤及控制措施的研究现状进行综述.     

人工智能技术在创伤救治中的应用及研究进展

创伤引起的多发伤致残率和致死率高,救治难度大但目前创伤救治的医疗模式仍然存在不足,创伤患者的救治面临巨大挑战。人工智能(AI)是基于机器学习、强化学习和深度学习等基础算法的智能技术,现已应用于创伤患者的救治工作中,其高效精准的计算机视觉、规划决策以及大数据统计分析等技术方向既提高了创伤患者救治的安全性和效率,同时也降低了临床医师的工作负荷,弥补了传统创伤救治模式的不足。笔者对AI在创伤急诊分诊、诊断、治疗及战创伤预防等方面的应用及研究进展进行综述,为AI的临床应用提供参考。     

《创伤与急危重病医学》征稿启事

<正>《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。     

《创伤与急危重病医学》征稿启事

《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。本刊为ASPT     

《创伤与急危重病医学》征稿启事

<正>《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。本刊为ASPT     

《创伤与急危重病医学》征稿启事

<正>《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。本刊为ASPT     

《创伤与急危重病医学》征稿启事

<正>《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。本刊为ASPT     

《创伤与急危重病医学》征稿启事

<正>《创伤与急危重病医学》杂志(国际标准连续出版物号ISSN 2095-5561,中国标准连续出版物号CN 21-1588/R)是由国家新闻出版总署批准的公开出版物。本刊由沈阳军区总医院主管、主办,以国内外从事创伤与急危重病等相关学科的广大临床医师为主要读者和作者对象;以面向临床,突出实用,注重传播创伤与急危重病医学最新研究进展及临床救治中难点、热点的争鸣讨论为重点;以促进和提高广大临床医师救治水平为办刊宗旨。本刊为ASPT     

Computed tomography of the injured larynx.

Computed tomography (CT) permitted a much more detailed appraisal of laryngeal dysfunction in patients with blunt laryngeal trauma (8 cases) and iatrogenic injury caused by radiation therapy (7 cases), surgery (2 cases), or intubation (1 case). In thyroid cartilage fractures, the fragments may be widely displaced. The cricoid ring breaks in two places, frequently involving the signet. CT facilitates diagnosis of the mechanism of injury based on the site and extent of fractures. The patterns of distortion and fibrosis of the laryngeal cartilage following radiation therapy may be manifested as encroachment on the airway, easily mistaken for recurrent tumor or localized edema. Minor distortion probably escapes detection on clinical examination. The authors consider CT the examination of choice in laryngeal injury.     

103例重型颅脑损伤患者医院感染临床分析

目的探讨重型颅脑损伤并发医院感染的临床规律。方法对我科2009年1月～2011年1月收治的重型颅脑损伤并发医院感染103例作回顾性总结,对格拉斯哥昏迷评分（GCS）与感染的关系、感染部位和易感因素及病原学检查等行统计学分析。结果院内感染发病率为23.78%。感染部位依次是肺部49.51%、泌尿道20.38%、消化道14.56%、颅内感染8.74%、血液系统感染4.85%;医院感染中革兰氏阴性菌占69.78%,革兰氏阳性菌占30.22%。危险因素为病情严重程度、侵袭性医疗操作（如机械通气、中心静脉置管、保留导尿等）和药物治疗。结论尽量减少或避免医源性危险因素的产生和损伤,能有效地预防和控制重型颅脑损伤院内感染。     

Milchige Flüssigkeit in der Brusthöhle

A chylothorax can occur as a rare complication of intensive care treatment and can lead to infection and thrombosis as well as to metabolic acidosis, electrolyte derangement and finally to respiratory insufficiency with potentially fatal outcome. In the following article the case of a 9-month-old female infant is described who died as a consequence of hypoxic brain damage after a 27-day period of intensive care treatment. The postmortem examination additionally showed a bilateral chylothorax mainly as a consequence of a traumatic iatrogenic injury in the context of bilateral positioning of central venous catheters (CVC).     

创伤感染控制的临床认识

感染是严重创伤的常见并发症,是导致创伤患者后期死亡的主要原因。控制创伤感染目前仍是临床创伤救治的重要课题。本文通过文献复习,就如何控制创伤外源性感染、防治创伤后内源性感染和医源性问题以及抗内毒素治疗4个方面进行综述。     

Imaging evaluation of traumatic hematuria in children

The 3 major causes of traumatic hematuria in children are accidents, iatrogenic damage, and child abuse. While computerized tomography plays a major role in the evaluation of accidental trauma, ultrasound and routine radiography are important in the work-up of iatrogenic hematuria and injuries caused by child abuse. This paper reviews the role of these imaging modalities in diagnosing traumatic hematuria in children.     

Imaging evaluation of traumatic hematuria in children

The 3 major causes of traumatic hematuria in children are accidents, iatrogenic damage, and child abuse. While computerized tomography plays a major role in the evaluation of accidental trauma, ultrasound and routine radiography are important in the work-up of iatrogenic hematuria and injuries caused by child abuse. This paper reviews the role of these imaging modalities in diagnosing traumatic hematuria in children.     

做好严重创伤早期救治的几个关键环节

做好严重创伤早期救治的各个环节对提高创伤救治的整体水平具有非常重要的意义。应尽量缩短院前时间,做好院前急救的各项措施;充分发挥绿色通道的作用;处理好检诊和早期手术的关系;掌握多发伤的伤情特点和救治程序,做好多专业的合作;救治过程中优先处理危及生命的损伤;合理应用损害控制技术。     

Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients transferred for minor trauma

Many clinicians order focused computed tomography (CT) examinations for trauma patients based on history and physical examinations. Trauma patients transferred to our level I trauma center undergo an extensive, nonfocused standard trauma CT protocol. We hypothesize that the use of the standard trauma CT protocol does not contribute significant clinical information for patient care when compared with CT examinations based on history and physical examination. We aim to quantify the utility of the additional CT examinations required by our institution’s trauma protocol compared with emergent CT examinations dictated by the patient's history and physical examination findings. In this IRB-approved study, we retrospectively evaluated 132 trauma patients transferred to our center who underwent additional CT examinations as determined by fulfillment of our institution’s standard trauma CT protocol. The emergency radiologist evaluated the CT examinations acquired after the patient's transfer to determine if there were any additional acute findings that were identified on these additional examinations compared with the initial assessment undertaken at the outside institution. A total of 101 patients transferred to our trauma center met inclusion criteria. The majority of these patients sustained minor trauma. The standard trauma protocol generated 474 negative CT examinations in 101 patients. In seven patients, there were unexpected acute findings. However, these unexpected acute findings did not change clinical management in any of the patients. After initial evaluation, the acquisition of additional nonfocused CT examinations based on the standard trauma CT protocol provides little useful clinical information in patients who are transferred for minor trauma. Rather, CT utilization should be based on clinical findings. Replacement of standard trauma CT protocol with focused CT examinations in trauma patients is a way to curtail overutilization, thereby decreasing health care cost and the amount of patient radiation exposure.     

极重度骨髓型急性放射病病人MODS的临床特征及成因分析

目的 分析山东"10·21"60Co辐射事故极重度骨髓型急性放射病患者后期并发多器官功能障碍综合征(MODS)的临床特征,找出MODS的形成原因,积累治疗经验.方法 总结该病例诊治过程中的临床表现、辅助检查结果,结合尸解病理,提出MODS诊断.治疗上予以重症监护、呼吸机辅助通气、抗感染、营养支持及保护重要脏器功能等治疗.结果 患者经异基因外周血造血干细胞移植成功后出现反复发热、肺部感染、呼吸衰竭、心律失常、循环衰竭、肝功能损伤、少尿、胃肠道麻痹等表现的MODS,最终于照射后75天死于多器官衰竭(MOF).辅助检查结果提示患者全心扩大、心律失常,生化检查提示超敏C反应蛋白持续增高.尸解结果为全身广泛性的真菌感染、放射性小肠及大肠炎、肺间质纤维化、心肌细胞变性坏死、肝脏淤血、肾脏出血、脑实质出血.结论 极重度骨髓型急性放射病病人MODS原因主要与重要脏器的放射性损伤、机体免疫能力低下及全身感染有关,其表现的临床特征有一定的特殊性.需积极防治感染和多脏器维护.改善放射性损伤后的组织修复和提高机体免疫力是预防MODS发生的重点和难点.     

Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging

Effective radiation risk communication is a core competency for radiology care providers and can prevent and resolve potential conflicts while helping achieve effective public health safeguards. The authors present a synopsis of the challenges to holding such dialogue and review published methods for strengthening and maintaining this discourse. Twelve strategies are discussed in this article that can help alleviate concerns about the iatrogenic risk associated with medical imaging using radiation exposure.