严重胸部创伤病死率的相关因素分析

目的分析严重胸部创伤病死率的相关因素。方法回顾性分析2006年1月至2009年4月重庆市急救医疗中心收治的777例严重胸部创伤患者资料,对影响其病死率的15项相关因素进行多因素逐步Logistic回归分析。结果对严重胸部创伤病死率有价值的相关因素分别是年龄、失血性休克、多器官功能障碍综合征(MODS)、肺部感染、腹腔脏器损伤、格拉斯哥昏迷评分(GCS)、胸简明损伤定级标准(AIS),其中影响严重胸部创伤病死率的最终独立危险因素有5个,分别为失血性休克(B=1.710,OR=1.291,P=0.001)、MODS(B=3.453,OR=1.028,P<0.001)、肺部感染(B=2.396,OR=10.941,P<0.001)、腹腔脏器损伤(B=1.542,OR=1.210,P=0.005)、胸AIS值≥4(B=0.487,OR=1.622,P<0.001);影响严重胸部创伤病死率的保护因素有2个,分别为年龄≤60岁(B=-0.035,OR=0.962,P=0.01)、GCS值≥12(B=-0.635,OR=0.320,P<0.001)。结论年龄、严重并发症、伤情准确诊断与评估是预测创伤后救治结局的相关因素,针对这些因素制定有效的治疗方案是提高严重胸部创伤患者生存率的关键。     

血清骨钙素及SIRT6在急性缺血性脑卒中的表达及预后价值分析

目的 分析急性缺血性脑卒中(AIS)患者血清骨钙素、去乙酰化酶6(SIRT6)表达及其对临床预后的评估价值。方法 收集2019年2月—2021年2月重庆市巴南区人民医院神经内科诊治AIS患者90例为AIS组,以同期诊治的高血压或糖尿病患者90例为非AIS组,以同期体检的健康人90例为健康对照组。随访3个月,根据AIS患者预后分为预后不良亚组(n=24)和预后良好亚组(n=66)。利用酶联免疫吸附试验检测血清骨钙素及SIRT6水平。分析AIS患者预后影响因素及血清骨钙素、SIRT6对AIS患者预后评估价值。结果 与健康对照组比较,AIS组血清骨钙素、SIRT6水平显著降低(t/P=25.013/<0.001、27.571/<0.001),与非AIS组比较,AIS组显著降低(t/P=31.808/<0.001、36.440/<0.001),健康对照组及非AIS组比较差异无统计学意义(t/P=2.559/0.152、3.113/0.067);重症亚组、中症亚组及轻症亚组AIS患者血清骨钙素及SIRT6依次降低(F/P=15.234/<0.001、30.388/&...     

重庆地区摩托车事故中驾乘人员伤害分析

目的 探讨重庆地区摩托车事故中人员损伤特征,为降低摩托车事故伤亡风险提供可靠信息和参考依据.方法 深度采集发生在2015年1月至2016年6月重庆地区213例摩托车道路交通事故,采集内容包括事故基本情况、驾驶员信息、人员损伤等,并对事故数据进行统计分析.结果 摩托车驾驶员死亡率高于乘员,驾乘人员死亡原因为颅脑损伤和颅脑合并胸腹腔脏器损伤的比例为58.8％和20.0％,头颈部、胸背部、下肢、上肢、腹盆部和会阴部Max简明损伤评分(MAIS)≥2分的比例分别为71％、59％、33％、25％、20％和7％,摩托车驾驶员会阴部损伤发生率高于乘员,驾乘人员中下肢骨与上肢骨发生率之比为1.8∶1.0,摩托车与货车事故中人员更容易遭受车辆碾压.结论 头部和胸部损伤是导致摩托车驾乘人员死伤的主要原因,会阴部损伤可作为鉴别部分摩托车事故中驾乘人员的重要依据.     

抑郁症患者的痛阈及其相关因素研究

目的 探讨抑郁症患者的疼痛敏感性及其相关因素.方法 对20例抑郁症无疼痛患者(抑郁症组)和30例正常人(正常对照组)用贝克抑郁量表(BDI)、贝克焦虑量表(BAI)、阿森斯失眠量表(AIS)进行测查,痛阈测试仪和视觉模拟评分法(VAS)检测被试的痛阈. 结果抑郁症组BDI、BAI、AIS得分和耐痛阈强度刺激下疼痛、难受程度[分别为(30.2±8.79)分,(38.5±12.07)分,(11.7±6.11)分,(69.03±20.17)分,(64.98±25.55)分]高于正常对照组[分别为(10.83±5.4)分,(24.87±4.81)分,(4.9±3.24)分,(50.92±21.16)分,(44.33±23.28)分],差异有显著性( t =9.668、t =5.580、t =5.123、t =3.02、t =2.95,均P ＜0.01),抑郁症组痛阈和耐痛阈[分别为(0.87±0.58)mA,3.82±1.3)mA]低于对照组[分别为(2.09±1.05)mA,(4.43±0.81)mA],差异有显著性( t = 4.697,P ＜0.01; t =2.053,P ＜0.05);痛阈与BDI 、BAI、AIS得分均呈显著负相关( r =-0.581,r =-0.245,r =-0.253; P ＜0.01或P ＜0.05).采用回归分析显示BDI、BAI得分可以预测痛阈.结论 抑郁症无疼痛症状患者痛阈降低,抑郁、焦虑水平与疼痛敏感性有关.     

基底节损伤与额叶损伤对工作记忆和学习能力的影响

目的 探讨基底节损伤与额叶损伤对工作记忆和学习能力的影响,为不同脑区损伤患者记忆康复策略的制定提供理论依据.方法 采用汉诺塔(TOH)和威斯康星卡片分类(WCST)分别对额叶损伤组( n =12)、左侧基底节损伤组( n =8),右侧基底节损伤组( n =8)和非脑部疾病的对照组( n =10)进行训练前后的测试.结果 学习前TOH和WCST各项指标在额叶损伤组和基底节损伤组较对照组差异有显著性[(0.66±0.24)分,(0.93±0.09)分,t =0.28,P <0.05;(0.74±0.17)分,(0.93±0.09)分,t =0.19, P <0.05];学习前WCST完成第一分类项目数在额叶损伤组较基底节损伤组显著增高[(22.67±15.03)分,(9.69±4.77)分,t =4.10, P <0.05].学习后基底节损伤组的TOH准确率和得分较学习前显著提高[(0.91±0.11)分,(0.74±0.17)分,t =0.07, P <0.05],且WCST错误率、保持反应率、概念性水平反应率也较学习前和额叶损伤组学习后显著改善[(0.35±0.15)分,(0.53±0.17)分,t =0.06, P <0.05].左右基底节损伤组学习后TOH得分和WCST保持反应率较学习前显著改善.结论 基底节损伤和额叶损伤有类似的工作记忆障碍,单侧基底节损伤者仍保留一定的学习能力,需要通过早期的认知康复训练予以促通.     

急性缺血性脑卒中患者住院期间 死亡的危险因素分析

目的 探讨急性缺血性脑卒中（acute ischemic stroke,AIS）患者住院期间死亡的危险因素。方法 回顾性分析2014年1月至2019年2月深圳市第二人民医院住院AIS患者的临床资料,分析患者住院期间的死亡发生率。采用单因素及多因素Logistic回归分析AIS患者住院期间死亡的危险因素。结果 451例AIS患者住院期间死亡发生率为4.65%（21/451）,影响AIS患者住院期间发生死亡的危险因素包括颈动脉中重度狭窄≥50%（OR=6.901, 95%CI :1.992~23.908）、白细胞计数升高（OR=1.186, 95%CI :1.058~1.329）、完全前循环梗死（OR=5.581, 95%CI :1.947~16.002）、后循环梗死（OR=4.235, 95%CI :1.202~14.921）、基线NIHSS评分（OR=1.225, 95%CI :1.108~1.353）、肺部感染（OR=4.719, 95%CI :1.190~18.710）等。结论 AIS患者住院期间发生死亡的危险因素较多,AIS患者入院后应及早进行干预和规范治疗,才能降低住院期间死亡发生率。     

血清ITIH4和MCL-1水平与急性缺血性脑卒中患者病情程度及预后的关系

目的 探究急性缺血性脑卒中(AIS)患者血清间α胰蛋白酶抑制因子重链4(ITIH4)、髓样细胞白血病因子-1(MCL-1)表达与病情程度及预后的关系。方法 纳入2019年7月—2022年7月河南科技大学附属黄河医院神经内科诊治AIS患者128例为AIS组。根据入院时美国国立卫生研究院卒中量表(NIHSS)评分,分为轻度亚组(NIHSS<6分,n=42)、中度亚组(NIHSS 6～<14分,n=52)和重度亚组(NIHSS≥14分,n=34)。根据出院3个月时AIS患者改良Rankins评分,分为预后不良亚组(mRS评分>2分,30例)和预后良好亚组(mRS评分≤2分,98例)。另选取同期医院体检的健康人70例为健康对照组。酶联免疫吸附试验检测血清ITIH4、MCL-1水平。Pearson相关分析血清ITIH4、MCL-1水平与病情程度及预后的相关性;多因素Logistic回归分析影响AIS患者预后的因素;受试者工作特征曲线分析血清ITIH4、MCL-1对AIS患者预后的预测价值。结果 AIS组患者血清ITIH4、MCL-1水平显著低于健康对照组(t/P=43.211/...     

学生抑郁症患者的自尊及认知倾向相关研究

目的 了解中学生抑郁症患者的自尊及认知倾向的相关状况,分析影响其自尊及认知倾向的因素.方法采用缺陷感量表、认知倾向问卷、抑郁自评量表对112例初高中抑郁症学生和108名健康中学生进行调查. 结果1)抑郁症组乐观因子分(7.62±3.20)低于对照组,悲观因子分(7.54±1.98)高于对照组,差异均具有显著性(t=-11.59,t=3.37,P＜0.01),且抑郁程度与乐观因子呈显著负相关(r=-0.75,P＜0.01);抑郁症组自尊(20.86±4.07)、社交自信(38.65±9.69)、学习能力(22.85±6.78)因子分低于对照组,差异具有显著性(t=-13.21,t=-10.64,t=-6.32,P＜0.01),且抑郁程度与自尊及社交自信呈显著负相关(r=-0.46,r=0.32,P＜0.01).2)回归和路经分析发现,乐观因子、自尊和社交自信进入抑郁症的回归方程,具有预测作用,其中乐观因子和自尊的预测作用较强,乐观因子对抑郁症产生直接影响效果.结论中学生抑郁症可能是认知倾向、自尊水平等多因素影响的结果,认知倾向是重要的影响因素.     

摩托车交通事故所致死亡的法医学损伤特征分析

目的研究摩托车交通事故所致死亡案件的特点,探讨分析伤亡人员的损伤特征.方法抽取摩托车交通事故鉴定案件资料365例,对其损伤类型、特征、部位分布、死亡原因进行统计分析.结果死亡原因以颅脑损伤居多,现场死亡占大部分,头颈部、胸部、背部、腹盆部、会阴部损伤在伤亡分组中的发生率有统计学差异(P<0.05),颅骨骨折、胸廓骨折和下肢骨折在伤亡分组中的发生率有统计学差异(P<0.05),锁骨骨折在摩托车驾驶员与摩托车乘员相比有统计学差异(P<0.05).结论摩托车交通事故所致死亡的死亡原因以颅脑损伤居多,且大部分在现场死亡;损伤部位主要分布在四肢和头颈部;摩托车驾驶员锁骨骨折的发生率明显高于摩托车乘员.     

APACHEⅢ评分系统在急性肾衰竭肾替代治疗中的应用

目的:探讨急性生理学及慢性健康状况评分系统(APACHE)在急性肾衰竭肾替代治疗中的应用.方法:收集我院2007年2月～2010年10月进行持续低效血液透析法(SLED)治疗的重症急性肾功能衰竭88例,于SLED前24h内计算APACHEⅢ,并估算患者的死亡风险系数.结果:88例患者存活60例,死亡28例,平均年龄(61.1±16.8)岁;死亡组使用SLED主要为少尿、酸碱失衡、电解质紊乱和SIRS,而存活组中以水负荷过重和肌酐升高为主;88例急性肾衰竭患者APACHEHI均值为(90.8±28.7)分,风险系数为(0.68±0.31);死亡组均值为(112.3±26.5)分和存活组均值为(75.7±15.9)分,差异有高度统计学意义(t=6.75,P＜0.001);APACHEⅢ＞50分时,死亡风险为60.2%;＞70分时病死率为90.0%;经统计学检验,影响SLED患者预后的危险因素为机械通气(P=G.001)、低血压(P=0.025)和高胆红素血症(P=0.029).结论:实行SLED的急性肾衰竭死亡者与存活者的APACHEⅢ评分存在显著差异.APACHEⅢ评分可用于评价实施SLED的ARF患者的死亡风险.     

Motor vehicle crash injury patterns and the Virginia seat belt law

Injuries to front seat occupants in tow-away crashes in the Charlottesville, Va, area were compared for 1 year before and 1 year after Virginia's seat belt use law took effect. Vehicle and occupant data were combined to examine crash and injury patterns. Reported seat belt use in crashes increased after the law, and there were substantial decreases in injuries. Front seat occupants were less likely to receive medical treatment following a crash in the postlaw period. The reduction in the number of injuries was greater for passengers in the right front seat than for drivers and for frontal crashes than for other types of crashes. The injury reduction effects occurred primarily through reductions in the number of head and face injuries, particularly those that occur from contact with windshields and instrument panels.     

A study on the use of car occupant restraint in Selangor

A survey was conducted in December 1995 to study car occupant restraint usage in Selangor. A total of 1082 car occupants were observed in 536 cars. The results of the study shows that only 57.3% of the car occupants observed were protected by any form of restraints. Most of the cars (99.8%) examined had front seat belts but only 44.2% had rear seat belts. Only 0.6% of the cars were found to have child restraints in the cars. 80.2% of drivers used restraints and only 65.4% of front seat passengers used any forms of restraints. In the case of the rear seat passengers, only 0.42% used an available restraint. More people in the urban areas (84.42%) than in the rural areas (66.51%) used seat belts. Usage of seat belts by car drivers influenced the use of seat belts by front seat passengers. Type of seat belts fitted was associated with usage rate. It is sad to note that 21.9% of the drivers used seat belts incorrectly.     

Severe abdominal injuries sustained in an adult wearing a pelvic seatbelt: a case report and review of the literature

In automobile accidents, the “seatbelt syndrome” (SBS) consists of a constellation of injuries, predominantly involving thoraco-lumbar vertebral fractures and intraabdominal organ injury. A recent amendment to Irish legislation has made the wearing of seatbelts mandatory for all rear seated passengers in an effort to protect children. Whilst rear seatbelts result in a significant reduction in morbidity and mortality following road traffic accidents (RTA), we present a case in which the rear lap seatbelt caused severe abdominal injuries. It is evident that the current rear seat lapbelt system is an inferior design associated with a significant morbidity and mortality when compared to three-point harness system and consideration should be given to replacing them in all motor vehicles.     

Effect of seat belts on injuries to front and rear seat passengers

Data on 2520 occupants of cars involved in accidents were analysed in relation to injury and the severity of the crash to investigate the effect of rear seat passengers on injury to restrained and unrestrained front seat occupants and vice versa. Unrestrained front seat occupants showed a higher incidence of serious injury when there were rear seat passengers. The presence of a rear seat passenger did not affect significantly the overall incidence of injury among restrained front seat occupants within the range of crash severity considered. Unrestrained rear seat passengers behind unrestrained front seat occupants showed a higher incidence of moderate injury and a lower incidence of no injury than those behind restrained front seat occupants. It is concluded that legislation on seat belts has not greatly increased the risk of person to person injury.     

The performance of seat belts in severe crashes.

This paper reports an intensive follow-up study of persons injured while wearing seat belts in crashes. Examinations of both vehicles and persons were carried out after the crash, and 30 out of 54 (55.5%) persons were judged to have been wearing seat belts at impact. Eight received injuries from the seat belt, only four of these injuries being severe, and none was fatal. A roadside survey showed that half of the occupants wearing seat belts had them adjusted incorrectly. This compared with nearly 90% of the crash cases having incorrectly adjusted belts. There is therefore an association between incorrectly worn seat belts and injury. The seat belt buckle seems to be a possible cause of injury in this situation, especially when worn in from of the hip, and with a loose belt. Comparison of police reports of belt wearing for the study cases suggests an underestimate of about 10% in the wearing rate if police data are used.     

An analysis of factors associated with seat belt use: prevention opportunities for the medical community

Motor vehicle collisions are a significant cause of morbidity and mortality in the Oklahoma population. The cost associated with this morbidity and mortality is exacerbated by the failure of individuals to use seat belts. Numerous organizations believe that seat belt compliance can be improved through physician counseling. This would allow medical resources to be redirected towards other health problems. Analysis was performed using the Oklahoma Department of Public Safety (ODPS) crash file and the hospital in-patient data discharge file from the Oklahoma State Department of Health (OSDH). These provide a profile of Oklahoma drivers who do not use seat belts. This analysis allows physicians to pinpoint and advise those individuals most likely to not utilize seat belts about the benefits of seat belt use. The results of the analysis show that non-seat belt-users tend to be young and male. Significant predictors of seat belt use are age, gender, alcohol use, time of day (day versus night), driver location (urban versus rural), vehicle type (pick up versus passenger car), and decreased hospital charges. These results show that increased seat belt use can lead to significant decreases in fatalities related to motor vehicle crashes and a decline in associated hospital charges for those who survive. Physicians should encourage seat belt use by their patients and inform them of the risks associated with failure to use seat belts.     

Association between exposure/non-exposure to the mandatory seat belt law with regards to compliance in vehicle accident victims--a hospital review

OBJECTIVE: Injuries sustained in motor vehicle accidents (MVAs) are a major challenge to the Jamaican healthcare system. In November 1999, Jamaica enacted legislation to make seat belt usage in motor vehicles compulsory. The effect of this policy change on seat belt usage is unclear. This study therefore sought to determine the prevalence of seat belt usage and to determine the association between exposure/non-exposure to the mandatory seat belt law and seat belt use in subjects who presented to the Accident and Emergency Department (A&E) of the University Hospital of the West Indies (UHWI) as a result of motor vehicle accidents. METHODS: Subjects were recruited from June to November 2003, post-seat belt law (POBL) period, and May to October 1999, pre-seat belt law (PRBL) period. Data collected included demographic variables, seat belt use and position of the occupants in the vehicle. RESULTS: Of the 277 patients who were eligible for inclusion, data were complete in 258 subjects, 87 in the PRBL period and 171 in the POBL period. The prevalence of seat belt use was 47% (PRBL) and 63% (POBL) respectively. There was no significant gender difference at each period. The odds of wearing seat belt in the rear of a motor vehicle were significantly lower than that of a driver (Table 3, OR 0.19, 95% CI 0.07, 0.48). Adjusting for age, gender and position in vehicle exposure, there was about 100% increase in the odds of seat belt use during the post seat belt law era (OR = 2.09, 95% CI 1.21, 3.61). CONCLUSION: It is concluded from this hospital-based study that the mandatory seat belt law legislature was associated with increased seat belt use in motor vehicle accident victims. However, current data from the Road Traffic Agency indicate that there is still an alarming number of fatalities. This clearly suggests that additional public health measures are needed to address the epidemic of motor vehicle trauma in Jamaica.     

Seat belts: personal choice or necessity?

The use of occupant restrains in motor vehicles has become an issue which has received increasing legislative attention in recent years. This has occurred due to the supposition that seat belt use would be effective in preventing automobile related fatalities and injuries. Twenty-five states and the District of Columbia now have mandatory safety belt laws in effect which have increased usage rates from 20% or less prior to enactment of the law to between 50% and 70% after implementation. Safety belts have proven effective in minimizing morbidity and mortality. In a study of four states enforcing mandatory usage and neighboring states without seat belt laws as a comparison, between 250 and 350 fatalities were prevented. This extrapolates to an estimated 12,000-15,000 lives saved nationally if restraints were mandatory. Nebraska is one of two states in which a seat belt law has been enacted and subsequently repealed. As a result of the repeal, seat belt usage dropped from 40% in 1986 to 29% in 1987 with an associated increase in injuries. The economic impact associated with this increase in accident related injuries is enormous. The Nebraska repeal campaign was based on the issue of individual rights versus mandatory safety requirements. As health care providers we need to examine the validity of personal rights in comparison to the documented impact of personal restraints on the morbidity and mortality of accident victims.     

Automobile restraints for children: a review for clinicians

MORE CANADIAN CHILDREN DIE OF ROAD TRAFFIC INJURIES than of any other cause. Nonuse and misuse of child restraints is common and leads to preventable severe injuries or deaths. This article, intended for clinicians interested in injury prevention counselling, advocacy, research, and treatment of child occupants in car crashes, reviews current knowledge about child safety seats and discusses controversies related to their use. Children should sit in the back seat of a vehicle and should be properly restrained in a current age- and size-appropriate device (rear-facing infant seat, child safety seat, booster seat, or lap and shoulder seat belt) that is properly adjusted. The centre rear seat is safer than side positions, but a lap belt alone should be avoided. The age at which children should start sitting in a forward-facing position is controversial. Children should be seated away from air bags. Resources to aid in patient counselling are described.     

The prevalence of seat belt use in Kingston, Jamaica: a follow-up observational study five years after the introduction of legislation

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0. 001) and as front seat passengers (79.9% vs 66.3%; p < 0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p < 0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized