经静脉超声造影在钝性腹部创伤患者中的应用进展

创伤是全球面临的一个重大公共卫生问题,为及时救治创伤患者、降低其死亡率,早期诊断至关重要。然而,在腹部创伤,尤其是钝性腹部创伤患者中普遍存在早期诊断困难。基于微泡造影剂无肾毒性、无辐射、可重复使用等优点,超声造影（contrast-enhanced ultrasound, CEUS）技术在国内外已广泛应用于钝性腹部创伤患者的早期诊断。在血流动力学稳定的患者中,非手术治疗（non-operation management, NOM）是安全有效的,具有减少手术并发症、降低死亡率等优点,已成为目前腹部钝性创伤患者的标准治疗方法,而CEUS在NOM患者病情监测中具有很高的应用价值。本文就近年来CEUS在钝性腹部创伤患者的早期诊断以及在该类接受NOM患者中的监测价值进行综述。     

腹部创伤定点超声在腹部闭合性创伤中的诊断价值

目的:探讨腹部创伤定点超声检查在闭合性腹部创伤的患者中的应用.方法:选取2019年1月—2020年7月间山东省阳谷县人民医院急诊科113例闭合性腹部创伤患者纳入研究,所有患者均实施CT诊断和腹部创伤定点超声检查,比较两种方法的诊断价值.结果:两组患者脾破裂、肝破裂、肾损伤、腹膜后血肿、空腔脏器破裂发生率,不具有统计学意...     

腹部创伤主要并发症及其处理

1　腹壁切口裂开　腹部创伤术后发生切口裂开者约13％。切口裂开可分为腹壁各层全部裂开及部分裂开、腹壁切口裂开的原因：①年老体弱，营养不良；②缝合技术欠佳，伤口对合不好，缝合时腹膜撕裂等；③术后发生肺部并发症，咳嗽频繁使腹内压增加；④术后发生腹胀或腹腔有感染发生肠麻痹；⑤腹壁切口感染；⑥营养不良，影响愈合而裂开。[第一段]     

腹部创伤387例诊治分析

随着交通及建筑业的高速发展，流动人员增多，创伤病例近几年在基层医院总病人数中所占比例激增。本文就1991～1996年7月收治的腹部创伤387例进行诊治分析如下。1临床资料1．1一般资料：男295例，女92例，年龄最小6岁，最大70岁。18～55岁352例，闭合伤282例，开放伤105例。1．2创伤病因与病情：车祸伤186例占48％，斗殴伤123例占32％，坠落伤68例占17％，余3％为挤压伤等。共损伤脏器586个，其中肝占27％、脾23％、大小肠占21％、胃10％、肾9％、腹内血管4．8％、胰2．2％、膈1．5％、胆十二指肠1．5％。脏器损伤多达6个涉及系统5个。颅脑…     

56例腹部创伤的治疗体会

目的 探讨腹部创伤的诊断、治疗及临床效果。方法 大部分手术探查、引流。结果治愈以上，死亡率7%，效果较满意。结论 仔细诊断，掌握求治原则，及时手术探查、引流为患者生存，康复提供有力保障。     

腹部创伤的救治经验

目的 探讨腹部创伤的治疗与预后.方法 回顾性分析该院2006~2010年收治的215例腹部创伤患者治疗情况.结果 215例腹部创伤患者中,治愈203例,治愈率94.4%,死亡12例,死亡率5.6%.结论 腹部创伤的预后与受伤程度,受累脏器的数目、种类,休克程度及时间长短,是否合并其他部位损伤等因素有关.及时正确的诊断与治疗是成功抢救患者的关键.     

腹部创伤急诊抢救手术的配合

腹部创伤急诊抢救手术的配合７１００３２第四军医大学西京医院王西玲，金淑凤腹部创伤平时和战时都较为常见。平时多为闭合性损伤，战时则以开放性损伤多见。腹部创伤因实质性脏器或空腔脏器的破裂，大血管损伤，引起大出血、休克，导致机体短时间内代谢发生急剧变化。正...     

Selective nonoperative management of blunt abdominal trauma

The management of patients with blunt abdominal trauma has evolved over the past two decades with increasing reliance on a non-operative approach. An in-depth understanding of the clinical and radiographic parameters used to determine those who may be eligible for this form of treatment is an essential component of modern trauma care. This case-based review highlights critical aspects of non-operative management and provides a framework for the role of the emergency medicine provider.     

Nonoperative management of blunt abdominal trauma in pediatrics

The management of blunt abdominal trauma in children has undergone significant modification in the past decade because of advances in diagnostic imaging and an improved understanding of the natural history of injury to the spleen and liver. Mandatory laparotomy for proven or suspected hemoperitoneum has been replaced by intensive observation of most patients who are stable or who can be stabilized in the Emergency Department. The result has been a significant reduction in morbidity owing to anesthetic complications, postsplenectomy sepsis, and peritoneal adhesions. To take full advantage of these advances, emergency physicians and other primary care providers should be aware of the often subtle manifestations of abdominal trauma, the available diagnostic modalities and their limitations, and the requirements for volume resuscitation in pediatric patients.     

Current value of peritoneal tap in blunt abdominal trauma.

This study aimed to establish the diagnostic value of paracentesis (peritoneal tap) in the assessment of patients with blunt abdominal trauma. Paracentesis, using a four-quadrant puncture technique, was performed in blunt abdominal trauma victims presenting to the emergency department of a tertiary-care university medical centre. Pregnant patients, those under 18 or those having an abdominal scar were excluded from the study. All patients then underwent one of the following procedures as indicated: emergency ultrasound, abdominal computed tomography scan, diagnostic peritoneal lavage or laparotomy. Paracentesis results were compared with the results of other tests and surgery in diagnosing haemoperitoneum. Haemoperitoneum was confirmed surgically in six of the seven patients with a positive paracentesis. Nine out of 65 patients with positive clinical findings but negative taps underwent surgical intervention, and abdominal bleeding was confirmed in eight. Three seriously injured patients died before diagnostic studies or laparotomy could be performed. In conclusion, a positive paracentesis result may be used to guide decision-making in the setting of blunt abdominal trauma if other diagnostic methods are unavailable. Its high false-negative rate limits its overall usefulness.     

超声造影在腹部应用现状及问题

<正>超声造影成像技术已被广泛应用于肝脏等腹部脏器,在疾病诊断、介入治疗等方面发挥着巨大作用,成为影像医学中重要组成部分。本文仅就超声造影在肝脏、胰腺、胆囊胆管、脾脏、肾脏、腹部创伤的应用现状及目前存在的问题做一简要概述。一、肝脏超声造影肝脏超声造影是超声造影应用最早和最多的领域之一。肝脏接受肝动脉及门     

慢性病管理现状

我国是人口大国,随着社会经济的飞速发展,居民生活水平和生活方式发生了巨大的变化,与此同时,慢性病的发生、发展亦呈现明显的上升趋势,严重威胁我国人民的健康,对家庭和社会经济造成沉重的负担。与发达国家相比,我国的医疗体系尚不完善,尤其在慢性病管理方面起步较晚,尚存在许多不足,需要不断改进。本文收集国内外慢性病管理研究的最新文献,对国内目前慢性病管理的现状和问题进行综述。     

常规超声及超声造影在肝脾创伤非手术治疗期间的监测作用

目的探讨常规超声及超声造影在肝脾创伤非手术治疗期间的监测作用。方法腹部肝脾创伤后非手术治疗患者66例,其中行单纯保守治疗20例(保守治疗组),超声造影引导下经皮穿刺注射止血剂治疗46例(局部注射治疗组),治疗期间对两组患者行常规超声和超声造影定时监测2周,动态观察治疗效果。结果常规超声显示,治疗前非手术治疗患者肝脾创伤灶呈偏高回声,边界不清,2周内回声逐渐减低,但仍稍高于周围实质,其中保守治疗组和局部注射治疗组各有9例和27例创伤灶内可见不规则低回声液化区。局部注射治疗组患者注射α-氰基丙烯酸酯处可见强回声灶,后伴声影,超声造影观察创伤灶呈不规则低至无增强区,边界清楚,3d内创伤灶变化不明显,3d后开始逐渐缩小。常规超声观察腹腔积液量增加,提示3例再发活动性出血,超声造影依据造影剂溢出确诊其中1例活动性出血。常规超声引导穿刺抽液确诊1例肝内胆漏;常规超声和超声造影确诊1例脾动静脉瘘。结论常规超声通过腹腔积液量的变化间接提示腹腔活动性出血,超声造影能较常规超声更清楚显示创伤灶部位、范围及创伤脏器微循环变化情况,明确创伤的预后,常规超声及超声造影在肝、脾创伤非手术治疗监测中具有重要价值。