严重多发伤中膈肌损伤六例早期诊断与治疗体会

目的　探讨严重多发伤中膈肌损伤的早期诊断和治疗效果。方法　回顾性分析我院1996年 1月～ 2 0 0 3年 5月期间诊治的 6例严重多发伤中膈肌损伤、膈疝形成的早期诊断及治疗的临床资料。结果　 6例均得到早期诊断和及时、有效的治疗 ,无死亡病例及并发症的发生。结论　严重多发伤中膈肌损伤治疗的关键在于早期、明确的诊断及选用恰当的麻醉和手术方法。     

胸腹联合伤36例临床分析

目的总结胸腹联合伤的诊断与手术治疗经验。方法对1993-2003年收治的36例胸腹联合伤病例进行回顾性分析。结果开胸手术15例，胸腔闭式引流加开腹手术21例。治愈34例，死亡2例(6％)，死亡病例均因心血管损伤严重失血性休克。结论胸腹联合伤病情重，临床表现复杂，早期正确诊断、及时和合理的手术治疗是减少死亡率、提高救治水平的关键。积极抗休克，重症监护和防治并发症等非常重要。     

胸腹联合伤的诊治体会

目的　总结胸腹联合伤的早期诊断与治疗体会。方法　对我院 1 992年～ 2 0 0 2年收治的 78例胸腹联合伤病例进行回顾性分析。结果　开胸手术 2 7例 ,胸腔闭式引流 +开腹手术 4 0例 ,非手术 1 1例。治愈 72例 ,死亡 6例 (8% )。死亡原因均为心血管损伤伴严重失血性休克。结论　胸腹联合伤病情重 ,表现复杂 ,早期诊断、及时合理治疗是减少死亡率 ,提高救治效果的关键。     

腹部闭合性损伤伴严重多发伤42例的诊治体会

目的 对42例腹部闭合性损伤伴严重多发伤的患者的临床资料进行系统回顾性分析，总结腹部闭合性损伤伴严重多发伤的诊断和治疗经验。方法 42例中均行剖腹探查术，以及相应多发伤的处理。其中行胸腔闭式引流术10例，经胸腹手术2例，颅内血肿清除术2例，四肢骨折手术内固定2例。结果 经治疗治愈出院38例，切口脂肪液化2例，胆汁瘘1例，因多器官功能衰竭而死亡1例。结论 腹部闭合性损伤伴严重多发伤的病人病情复杂、危重，必须迅速及时正确地早期诊断严重危及生命的损伤，力争早期建立静脉通道，边抗休克边手术治疗，手术探查全面细致，分清轻重缓急，以及腹外伤的处理。     

胸腹联合伤63例诊治体会

胸腹联合伤属严重多发伤,患不仅有胸腔脏器损伤同时还有腹腔脏器损伤,伤情重,早期容易误诊,死亡率高。我院自1996年5月～2004年5月共收治胸腹联合伤63例,其中开放型胸腹联合伤44例,闭合型胸腹联合伤19例,全组病人死亡3例,死亡率4．76％。本着重讨论了胸腹联合伤的特点、诊断与治疗。     

65例胸腹联合伤的诊断与手术治疗

目的：总结胸腹联合伤的早期诊断与手术治疗经验。方法：对1990－1998年收治的65例胸腹联合伤病例进行回顾性分析。结果：开胸手术15例,胸腔闭式引流加开腹手术50例。治愈62例,死亡3例（5％）,死亡病例均因心血损伤严重失血性休克,结论：胸腹联合伤病情重,临床表现复杂,早期正确诊断,及时和合理的手术治疗是减少死亡率提高救治水平的关键。积极抗体克,实行重症监护的防治并发症等非常重要。     

胸腹联合伤的早期诊断与治疗

目的　总结胸腹联合伤早期诊断与治疗的经验。方法　对42例胸腹联合伤患者的临床资料进行回顾性分析。结果　伤后24h内入院者40例,48～72h入院2例。胸腹部开放性损伤8例,胸腹部闭合性损伤34例(包括膈肌破裂并腹部脏器损伤)。术前确诊38例(90%)。42例均在入院后24h内手术。治愈40例;死亡2例(48%)。结论　胸腹联合伤一般都有合并伤和伤后出现并发症,病情凶险,因此对胸腹联合伤必须迅速正确地诊断和处理,尤其合并严重胸外伤、出现呼吸功能不全者。     

颈椎脊髓损伤早期死亡原因分析

目的探讨颈椎脊髓损伤早期死亡原因。方法回顾性分析1993年1月～2005年12月63例颈椎脊髓损伤早期死亡病例的一般状况、受伤原因、受伤至入院时间、脊柱损伤节段、脊髓损伤严重程度、合并伤、颈椎脊髓损伤影像学表现、治疗方法、过程及结果,总结其早期死亡的原因。结果本组49例因呼吸衰竭死亡,8例因多脏器功能衰竭死亡,2例因癫痫发作导致急性呼吸、循环衰竭死亡,2例因多发伤导致肺部感染及感染性休克死亡,2例因上消化道大出血导致出血性休克死亡。结论呼吸衰竭为颈椎脊髓损伤早期死亡的首要原因,其与脊髓损伤节段及损伤程度密切相关。     

交通事故致多发伤536例临床救治分析

目的:回顾性分析交通事故致多发伤的临床特点及救治效果。方法:对本院近10年所收治的多发伤536例,按简明损伤定级和损伤严重评分,即AIS-ISS和颅脑损伤(GCS进行评分分析。结果:本组536例,死亡146例(27.2％),致残48例(8.9％),痊愈342例(63.9％),ISS≥31分126例,死亡108例;GCS3～8分47例,死亡44例。结论:多发伤多见颅脑、胸腹伤合并骨折,伤情伤重,休克率高,急救科应与相关科室协同抢救,早期准确判断多发伤情,制定确切治疗方案,合理安排手术顺序,快速进行正确处理,对降低死亡、致残率至关重要。     

胸腹联合伤诊疗体会

目的探讨胸腹联合伤的诊断和治疗体会。方法对86例胸腹联合伤患者的诊断、治疗进行分析与总结。结果治愈79例（91.9%）,死亡7例（8.1%）。结论早期明确诊断、保持呼吸道通畅、快速有效处理休克多发伤等综合治疗措施,可提高治愈率,降低病死率。     

Mortality rate in multiple trauma and prospects of its reduction

In all the 1746 patients, who died from trauma, the multiple and associated injuries were revealed. Multiple wounds of a head and thoracicoabdominal trauma, shock, blood loss, combination of two and more severe injuries were the leading cause of death. The aid to the patients with polytrauma at all the stages of treatment should be given with maximal promptitude, admission to the multiprofile hospitals is expedient.     

损伤控制性手术在严重胰腺损伤治疗中的应用

目的探讨损伤控制外科在严重胰腺损伤患者治疗中的临床应用效果。方法采集本院2005年3月至2009年12月期间符合DCS纳入标准的28例严重胰腺损伤患者的临床资料。结果 24例（85.7%）痊愈出院,2例（7.1%）患者死于多器官功能衰竭,l例死于术后合并严重颅脑损伤,l例死于术后拒绝治疗。结论在复苏同时应尽快采用简单省时的手术挽救生命,控制出血和污染、充分引流、保存胰腺功能,病情稳定后再做相应的手术和治疗,可提高严重胰腺外伤的抢救成功率,减少术后并发症的发生。     

Thoraco-abdominal wound in peaceful time

The results of treatment of 63 injured persons with thoracicoabdominal trauma were analyzed. Injured persons with severe trauma and pronounced infringements of hemodynamic (41.25%); with severe injury of inferior organs and stable hemodynamical indexes (47.62%), light injury (11.12%) were detailed. Algorithm of curative-diagnostical measures for every group was elaborated. Among the injured persons 11 (17.46%) died.     

Treatment of 336 cases of chest trauma

Objective: To summarize the clinical features,diagnosis and treatment of chest trauma.Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from Janua...     

严重多发脏器损伤的临床特点及诊治

目的探讨严重多发脏器损伤的临床特点和诊治方法.方法对1988～1998年间收治的合并有闭合性腹内脏器损伤的严重多发伤、ISS大于16的165例患者进行回顾性分析.结果3个或3个以上部位多发伤占28.5%.63例有腹内多脏器损伤.腹腔穿刺是确诊的主要检查手段,部分病例选用了腹部B超和CT,3项诊断检查阳性率均在90%以上.全组漏诊腹内伤21例(12.7%),死亡29例(17.6%).死亡病例平均ISS41.6,明显高于非死亡病例24.8(t=15.21,P<0.01).结论严重多发伤病例应常规行诊断性腹腔穿刺,酌情选择腹部B超和CT等检查,以排除腹内脏器损伤.对全身多发伤并存腹内伤的病例,要根据伤情确定急救处理顺序.剖腹手术中要注意多脏器损伤.ISS大于40提示预后不良.     

Multiple organ failure and severe bone marrow dysfunction in two 18 year-old Caucasian patients: Epstein-Barr virus and the haemophagocytic syndrome

Haemophagocytic lymphohistiocytosis secondary to viral infection is an unusual but well recognised cause of bone marrow dysfunction and multiple organ failure in young patients. Two 18 year-old patients were admitted to a tertiary liver unit with features of acute liver failure, cardio-respiratory collapse and pancytopenia. Serological tests and bone marrow examination with in-situ hybridisation revealed severe acquired haemophagocytic lymphohistiocytosis secondary to acute Epstein-Barr virus infection. Both patients died despite full supportive therapy; the first due to pulmonary haemorrhage, the second due to acute respiratory distress syndrome refractory to high frequency oscillatory ventilation. The clinical spectrum, diagnostic features and current evidence based recommendations for treatment of this condition are explored. The diagnosis of haemophagocytic lymphohistiocytosis should be considered in young patients with marked bone marrow dysfunction and multiple organ failure. Further research into appropriate therapy for patients with acute severe forms of the disease who require intensive organ support is required.     

妊娠期急性胰腺炎并发肾功能损害的诊治体会

目的 探讨妊娠期急性胰腺灸并发肾功能损害的临床特点及诊治方法.方法 回顾性分析我院2002年1月～2010年4月收治的妊娠期急性胰腺炎患者并发肾功能损害的患者13例的临床资料.结果 7例轻型患者中6例治愈,1例进展成为重症后并发急性肾衰竭死亡;6例重症患者中4例并发急性肾衰竭,经连续性静脉-静脉血液滤过(CVVH)治疗...     

Surgical treatment for traumatic tracheobronchial injuries

Tracheobronchial injury is a relatively rare but often fatal condition due to the injury from the neck to the chest. Different clinical features depend on the site of injury. We experienced 5 cases of tracheobronchial injury; cervical trachea in 2, thoracic trachea in 1, tracheal carina in 1, left main bronchus in 1. Three cases were caused by blunt trauma by traffic accident and 2 cases were due to penetrating injury (stab wound and gunshot wound). Thoracotomy with primary repair for 3 (simple repair, bronchoplasty, pneumonectomy) and cervicotomy for 2 (end-to-end anastomosis) were performed. One patient with severe associated injury died of multiple organ failure after surgery. Accurate diagnosis and the appropriate treatment in the early stage is essential in the treatment of tracheobronchial injury.     

Clinical analysis of 28 children suffering from intracranial hematoma and multiple injuries following traffic accidents

Objective: To evaluate the result of diagnosis and treatment of intracranial hematoma and multiple injuries caused by road traffic accidents. Methods: Twenty-eight patients, aged from 1 to 14 years, receiving craniotomy and other surgical treatments were retrospectively reviewed. Results: Among the 28 cases, 23 cured with the recovery rate of 82.3%, 2 had a sequel of moderate disability, and 3 died from severe brain injury, hemorrhagic shock, and other visceral complications. The clinical sympotoms and signs were severe and perplexing. The major characters included: severe head injury, usually combined by multiple injuries, and easy of access to missed diagnosis and misdiagnosis. Conclusions: The occurrence of infection is high after traffic accidents as a result of depression of humoral and cellular immunity, long-term bed rest, and fractures of limbs. Hence, on the basis of maintaining vital signs, the management of primary wound is essential to reduce infection and underlying death. In addition to the management of brain injury, concurrent injuries should also be highlighted so as to reach a good result for their patients.     

多层螺旋CT诊断胸食管异物损伤的临床价值

目的探讨MSCT诊断胸食管异物损伤的临床价值。方法 22例胸食管异物损伤患者均接受MSCT平扫,其中13例接受增强薄层扫描及后处理成像。依据MSCT特征、结合临床表现决定诊断及治疗方案。结果 MSCT平扫及后处理影像诊断与临床诊断的总符合率分别为68.18%（15/22）和76.92%（10/13）,结合临床特征均确诊。22例中,痊愈20例,死亡2例。结论 MSCT是诊断胸食管异物损伤的最具临床价值的影像学方法,结合临床特征可确诊,对制定科学、合理的治疗方案具有指导意义。