多发伤120例的救治体会

随着社会的发展,创伤在逐年增多,多发伤随之增多,多发伤伤情严重而复杂,已成为创伤救治的难点。1990年1月—1996年8月我们救治创伤2104例,其中多发伤120例,占5.7％,现将我们对多发伤的救治体会总结如下:1 临床资料1.1 一般情况 本组120例,男107例,女     

论多发伤急救的时效性

多发伤是一种"时间依赖性疾病",急救时存在"时间窗",一旦时间延误或超过救治的"时间窗",患者可能会失去最佳的救治机会,伤死率、并发症发生率将会增加。多发伤急救的时效性,体现在救治的"时间窗"内,通过采取正确、有效的救治措施,达到最佳救治效果;要求在最短的时间内进行伤情评估、快速急救、术前准备等。多发伤急救的时间理念,已由越快越好的定性过程发展到精确的定量过程;分清个体伤员救治的时效性及批量伤员救治的群体时效性,对决定多发伤急救的优先顺序意义重大;要保证多发伤急救的时效性,必须建立一个与之相适应的制度和流程,在救治各个环节上遵循损害控制外科策略。     

合并骨与关节损伤多发伤患者的评估及救治

随着全球城市化进程的高速发展,特别是交通、工业以及高层建筑事业的飞速发展,多发伤发生率日益增多,严重威胁人类生命安全和健康。若处置不规范,常可增加伤残率和病死率。重视多发伤患者的院前急救和入院后的规范处理,能明显降低患者的病死率、致残率。强化培训,建好各级医疗体系、各阶段的急诊救治工作,可以提高多发伤诊断的准确率,降低误诊率及漏诊率,提高救治成功率,降低病死率等。规范地处理多发伤患者的骨与关节损伤,可以明显提高多发伤患者救治满意度,最大程度恢复其机体功能。充分认识和正确处理多发伤患者的骨与关节损伤,为进一步提高多发伤的救治水平提供有效的支撑。     

基层园地·问答

问题 1 :基层医院救治多发伤应注意哪些问题 ?(王德才　重庆市大足县第二人民医院外科　 4 0 2 36 0 )解答 :首先要区别多发伤与多部位伤 ,多发伤指 2个解剖部位以上损伤 ,并且其中一个部位的损伤危及伤员的生命 ,如果不具备后一个条件 ,则为多部位伤。按此标准 ,多发伤均为严重创伤 ,创伤评分均≥ 1 6分。严重创伤及多发伤伤员最好及时送条件较好的创伤中心及大中型综合性医院救治 ,以保证救治质量和效果。但有时受通讯及交通等多种因素限制 ,部分伤员需就地在基层医院进行早期救治。多发伤救治强调快速、准确、高效。快速即尽量缩短院前急…     

在急救中心开展多发伤一体化救治分析

目的 探讨提高多发伤救治成功率的措施。方法 回顾性总结2002年6月～2003年6月间中山市急救中心开展多发伤救治的效果，分析多发伤一体化救治的模式和关键点。结果 共收治135例，抢救成功107例，成功率79．3％；死亡28例，死亡率20．7％。结论 (1)住急救中心实施多发伤一体化救治是提高其成功率的有效途径，也是多发伤救治的发展趋势，(2)在急救中心实施多发伤一体化救治的模式：急救中心设立创伤中心、建立成套的创伤急救体系，培养高素质专业人员．多发伤的诊治由急救中心医师实施或组织实施。(3)严重多发伤救治的关键点：抓好院前、院内急救——抢救生命；开展急诊手术——尽早修复损伤器官，消除致死致残因素；重视重症监护及治疗——进一步治疗原发损伤，保护各脏器功能，促进机体恢复，防止并发症。     

基层医院多发伤早期救治体会

对68例基层医院多发伤救治资料进行回顾性分析,救治成功52例,死亡16例.基层医院是多发伤第一救治场所,阶梯救治网络、技术能力保证、合理程序、安全转送是提高其救治成功率的保证.     

严重多发伤在急诊室抢救的重要性

目的总结严重多发伤早期救治的经验教训。方法对113例严重多发伤的救治过程进行回顾分析。结果急诊室抢救中死亡16例,另97例收入病房,入院后死亡5例,抢救成功率为81·5%。结论在院前急救体系不完善的条件下,严重多发伤在急诊室进行及时而有效的救治,是目前提高抢救成功率的重要措施。     

骨关节多发伤的战时救护

为适应现代高技术战争的需要,现代野战条件下的战伤救治工作必须遵循简单、安全、快速、有效的救治原则,要求伤员受伤后黄金抢救时间内应得到最有效的救治,为降低骨关节多发伤的致残率,为此我们探讨骨关节多发伤的特点及其救治程序.     

颅脑损伤合并多发伤急诊救治规范化治疗

颅脑损伤合并多发伤是医院急诊较难处理的问题之一，常影响患者的预后。本文就颅脑损伤合并多发伤急诊救治模式进行初步探讨，对其院前急诊和院内抢救的模式、人员配备模式以及相关的抢救原则进行了阐述，以期进一步规范创伤外科医师对颅脑损伤合并全身多发伤急诊救治策略，提高救治水平。     

严重多发伤一体化急诊救治的效果

在我国,创伤已成为40岁以下成人的第一位死亡原因,其中严重多发伤及其伴发的创伤性休克是导致患者死亡最为重要的原因[1].因此,如何最大限度提高严重多发伤患者的生存率仍是创伤急救领域的研究热点和重点.与传统的专科专治急救模式相比,一体化创伤急救模式下的严重多发伤急诊规范救治因其强调生存链与创伤救治连续体理念,正逐渐被广大医师所重视和接受.我院2007年1月创建急诊危重病中心,采取创伤一体化救治新模式,对严重多发伤实行急诊规范化救治.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.