连枷胸的机械通气治疗

目的探讨机械通气治疗连枷胸的指征、呼吸机的管理,以及连枷胸、肺挫伤与呼吸功能障碍的关系。方法回顾分析1996年1月-2004年10月我院收治的66例连枷胸患者,将其分为机械通气组和非机械通气组,并对两组的损伤特点和治疗情况进行比较。结果非机械通气治疗38例;机械通气治疗28例,采用同步间歇指令通气(SIMV)+呼吸末正压通气(PEEP)模式,机械通气后PaO2、PaCO2及pH值明显改善,与通气前比较,差异有统计学意义(P<0.01)。全组死亡9例,总体死亡率为14%,其中机械通气组死亡4例(14%),非机械通气组死亡5例(13%),两组死亡率比较,差异无统计学意义(P>0.05)。结论(1)机械通气治疗连枷胸效果可靠,但要有一定的应用指征;(2)机械通气的指征为:低氧血症和(或0高碳酸血症,合并颅脑外伤、严重休克,双侧连枷胸,有气道阻塞或反复肺不张;(3)缩短机械通气时间,防治肺部感染是减少住院时间的关键。     

连枷胸救治的进展与争议

连枷胸大多合并肺挫伤,综合治疗应包括浮动胸壁的固定和肺挫伤的处理.手术内固定治疗连枷胸越来越多地被接受,但应掌握手术指征和注意手术方法.机械通气应当不是对浮动胸的"气体正压内固定",而是用于因严重肺挫伤导致的急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS).     

连枷胸伴肺挫伤的手术固定与非手术固定的临床研究

目的比较伴有肺挫伤的创伤性连枷胸加压包扎、肋骨牵引和手术内固定的治疗效果。方法本文回顾性分析浙江省立同德医院2000年～2009年收治的46例连枷胸伴肺挫伤的临床资料。治疗分组:A组(牵引治疗组)12例、B组(包扎治疗组)13例、C组(手术固定组)21例。C组治疗方法包括在胸腔镜指引下行止血、肺修补及采用记忆合金肋骨环抱接骨器内固定。比较3种治疗方法的呼吸机通气支持率、机械通气时间、ICU时间、肺炎发生率、伤后第3天疼痛指数、死亡率等指标,以P0.05为差异具有统计学意义。结果与A组比较,B组需呼吸机支持率增高(P0.05),肺部感染的发生率增加(P0.05),机械通气时间、ICU住院时间、死亡率、疼痛指数均无统计学差异(P0.05);C组需呼吸机支持率及死亡率无统计学差异(P0.05),机械通气时间缩短(P0.01),ICU住院时间缩短(P0.01),肺部感染的发生率减低(P0.05),疼痛指数下降(P0.05)。结论连枷胸肋骨骨折内固定可以迅速稳定胸壁,改善连枷胸对呼吸功能的影响,减少机械通气时间、ICU住院时间和肺部感染率,减轻疼痛程度,从而缩短病程,但是对死亡率无影响。总体上,手术内固定优于牵引治疗和包扎治疗,而包扎治疗效果最差。     

机械通气治疗创伤性连枷胸（附10例报告）

目的：探讨机械通气治疗连枷胸的指证、呼吸机的管理，以及连枷胸与肺挫伤的关系．方法：总结我院自１９８８年１月～１９９５年８月１０例用机械通气治疗的连枷胸病例．结果：死亡３例，治愈７例．治愈者机械通气时间４～２０天，住院时间１８～７４天．结论：（１）肺挫伤是造成连枷胸呼吸功能障碍的重要因素之一；（２）机械通气的指证：呼吸窘迫，低氧血症，合并严重休克、颅脑外伤等，因手术全麻气管插管，气道梗阻；（３）缩短机械通气时间，防、治肺部感染是减少住院时间的关键     

创伤性连枷胸合并肺挫伤诊治进展

连枷胸是一种常见的胸部钝性伤,多合并肺实质的损伤,易引起急性呼吸窘迫综合征（ARDS）及呼吸衰竭。多层螺旋CT、床旁超声、经食道超声心动图（TEE）及电视胸腔镜是诊断连枷胸和肺挫伤的良好方法。连枷胸合并肺挫伤的治疗较复杂,良好的镇痛、可靠的软化胸壁固定及呼吸机辅助治疗是提高连伽胸合并肺挫伤疗效的关键。本文就连枷胸合并肺挫伤的诊治进展进行了综述。     

不同时期的连枷胸临床救治分析

目的 比较不同时期连枷胸临床治疗方式和疗效,探讨连枷胸治疗经验.方法 回顾性分析我院所收治的91例连枷胸患者的临床资料,按年代不同分为组I(1995年1月-2000年12月)和组Ⅱ(2001年1月-2007年3月),按治疗方式不同分为保守治疗组和有创治疗组. 结果 组Ⅱ总例数63例,(9.00±3.16)例/年,明显高于组I的28例和(4.67±1.21)例/年(P<0.01);治疗方法上组11采取有创治疗措施增多;不同时期伤情严重度比较差异无统计学意义,但组I的死亡率(25.0%)明显高于组Ⅱ(6.3%)(P<0.05);有创治疗组伤情较保守治疗组重,而死亡率(6.7%)却低于保守治疗组(17.4%)(P<0.01),且有创治疗组中残留胸廓畸形例数、肺不张发生率明显低于保守治疗组(P<0.05). 结论 近6年来连枷胸患者死亡率明显降低,主要救治措施是早期稳定胸壁与治疗肺挫伤并重,保持呼吸道通畅,有效止痛,适时给予机械通气,预防和治疗呼吸功能不全和肺部感染.     

机械通气联合内固定治疗创伤性连枷胸合并肺挫伤的临床研究

目的研究机械通气联合内固定治疗创伤性连枷胸合并肺挫伤的临床疗效。方法选择2013年1月—2017年1月于成都医学院第一附属医院行手术治疗的创伤性连枷胸合并肺挫伤患者62例,随机分为试验组(n=31)与对照组(n=31),对照组行胸廓外固定+机械通气治疗,试验组行机械通气+内固定治疗。观察两组入住ICU时间、机械通气时间、住院时间,治疗后90d肺功能指标,治疗前及治疗后3d动脉血气指标,术前、术后7d血清炎性因子等指标以及并发症。结果试验组入住ICU时间、机械通气时间、住院时间均小于对照组,差异有统计学意义(P0.05)。试验组治疗后90d肺活量(VC)、肺总量(TLC)及最大自主通气量(MVV)均高于对照组,残气量(RV)低于对照组,差异有统计学意义(P0.05)。治疗后3d,两组动脉血氧分压(PaO_2)、氧合指数均较治疗前增大,PaCO_2较治疗前减小,试验组PaO_2、氧合指数均大于对照组,动脉血二氧化碳分压(PaCO_2)小于对照组,差异有统计学意义(P0.05)。治疗前及治疗后3d,两组动脉血pH值差异无统计学意义(P0.05)。治疗后7d,两组白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)均较治疗前减小,试验组IL-6、TNF-α、CRP均小于对照组,差异有统计学意义(P0.05)。试验组并发症发生率(19.35%)低于对照组(51.61%),差异有统计学意义(P0.05)。结论机械通气联合内固定治疗创伤性连枷胸合并肺挫伤可提高患者肺功能,改善动脉血气指标,减少机体炎性反应,且恢复快、并发症发生率低,值得临床推荐。     

机械通气治疗外伤性连枷胸

探讨机械通气用于治疗外伤性连枷胸,连枷胸病人应用呼吸机进行间歇正压通气的“呼吸内固定法”的治疗方法,疗效肯定,值得推广.     

创伤性连枷胸伴肺挫伤的外科治疗

目的:比较连枷胸的治疗方式和疗效,提高救治成功率。方法:回顾性分析1998-01~2010-10我院收治的56例连枷胸病例,分为牵引治疗组14例、包扎治疗组12例、手术内固定组30例,比较三组的治疗效果。结果:手术内固定组机械通气时间、ICU时间、留置胸管时间缩短,肺挫伤评分、需呼吸机支持率、胸部并发症的发生率及病死率降低(P<0.01),PaO2、SaO2显著升高(P<0.01)。结论:手术内固定优于牵引治疗和包扎治疗,而包扎治疗效果最差。     

创伤性连枷胸合并肺挫伤的几个问题

连枷胸主要通过胸内压与胸骨旁肌力的失衡产生矛盾运动,浮动胸壁出现的呼吸窘迫与低氧血症主要是因肺挫裂伤所致的肺实质损害,并非来自反常呼吸。连枷胸是一种多见的胸部钝性伤,常合并肺实质的损伤,易引起急性呼吸窘迫综合征（ARDS）及呼吸衰竭。本文深入地分析连枷胸的病理生理最新进展,结合当前的研究现状重点对连枷胸和肺挫伤的内固定和机械通气的适应证及硬膜外麻醉镇痛等进行综述。良好的镇痛、软化胸壁良好的固定、呼吸机辅助是治疗连枷胸和肺挫伤的关键。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.