严重多发伤48例临床分析

多发伤是指在同一伤因打击下 ,人体同时或相继有 2个以上的解剖部位或脏器受到损伤。其中严重多发伤救治困难 ,死亡率高。为提高救治水平 ,我们对收治的 4 8例多发伤患者分析如下。1　临床资料1 .1　一般资料　本组男 3 2例 ,女 1 6例 ,年龄最小 5岁 ,最大 87岁 ,平均 3 6岁。致伤原因 :交通事故伤 3 0例 ( 62 .5% ) ,高处坠落伤 1 6例 ( 3 4 .3 % ) ,刀刺伤 2例 ( 4.2 % )。创伤后来院时间 :最短 1 0ｍｉｎ,最长 90ｍｉｎ ,平均 55ｍｉｎ;创伤性休克 4 0例 ( 83 .3 % )。创伤部位 97个 ,其中骨盆、四肢骨折 3 6例 ( 3 7.1 % ) ;颅脑损伤 :…     

严重多发创伤救治的临床研究

目的探讨提高严重多发创伤的救治成功率。方法 2003年6月~2008年6月收治严重多发创伤69例。外伤原因为交通伤、高处坠落伤、斗殴刀刺伤等。按AIS90版与ISS标准评定均>16,最高89。损伤组织器官依次为颅脑、左心室、右上肺、左右胸腔、肝及血管、脾脏、左肾、膈肌、胰腺、小肠,脊柱及骨盆等。同时伤及2~3个部位54例,4~5个部位15例。急诊抗休克65例,急诊手术69例,抢救手术11例。结果存活66例(95.65%),入院时血压为零及心脏刀刺伤11例均抢救成功。死亡3例(4.35%),死于重度脑外伤。无一例并发症及MOF。结论严重多发创伤救治严禁按诊断程序救治,采取争分夺秒地边抗休克复苏边进行急诊手术。及时手术止血是抗休克的根本措施,开胸剖腹探查是急救患者的诊断与救治的首选方法。手术治疗应选择最佳时机与恰当术式,同时注意早期保护重要器官。处理器官伤仍坚持"保全生命第一,保全器官第二"的手术救治原则。     

高速公路事故创伤急救与战创伤救治的比较研究

目的：探讨高速公路交通事故创伤急救与现代战创伤救治的相关性。方法：对2006年1月—2012年9月我院救治的高速公路事故严重创伤8669例伤情特点、救治方法和效果进行汇总分析,重点对创伤评分、受伤部位、损伤类型、严重并发症、主要死亡原因等数据与以往战创伤资料进行比较,探讨现场救治的通用技术和方法。结果：两组数据在损伤部位、损伤严重程度评分（ISS）、失血性休克等并发症、主要死亡原因等方面均具有可比性,且现场急救方案及技术基本相似。结论：部分高速公路严重创伤院前急救方案及技术适用于现代战创伤救治。     

颅脑减速伤的损伤特点研究

目的研究颅脑减速伤的损伤特点,探讨其在颅脑创伤的伤情判断和影像诊断中的应用价值。方法分析361例临床典型颅脑减速伤患者的颅脑CT影像资料,结合致伤病史及临床资料,总结归纳颅脑减速伤的损伤特点。结果颅脑减速伤损伤的主要特点为:撞击部位头皮损伤、颅盖骨折、硬膜外血肿、硬膜下血肿和脑挫裂伤,对冲部位硬膜下血肿、颅底骨折和脑挫裂伤;颅骨骨折以撞击部位多见,硬膜下血肿以对冲部位多见,蛛网膜下腔出血主要位于脑底部及脑挫裂伤区;额、颞叶严重对冲伤是常见颅脑减速伤的重要特征。结论根据颅脑减速伤的损伤特点,结合致伤病史或颅脑CT表现,可为临床颅脑减速伤伤情的快速判断与救治、CT扫描及诊断、创伤事故原因的评判提供理论依据。     

339例严重创伤的流行病学分析

目的 探讨现阶段严重创伤流行病学特点.方法 采用描述性流行病学方法,分析2005年8月～2006年7月收治严重创伤患者的临床资料.结果 严重创伤病人339例,前3位的伤因依次是: 道路交通伤、坠落伤、斗殴致伤.20～49岁是严重创伤的高危人群.平均院前时间(38.19±15.92)分钟,不同转运方式的院前急救率有显著性差异(P＜0.01),实施院前急救与否患者病死率差异有显著性(P＜0.05).头、胸、骨盆、四肢是创伤的高发部位,其中以颅脑为首发损伤部位,亦是首位死亡原因.结论 应加强对严重创伤的预防和急救医疗服务体系(EMSS)建设,提高公众现场急救意识和能力.强调严重创伤救治的连续性、整体性、时效性,重视严重创伤临床救治的研究和培训是减少创伤造成的病死率和伤残率的关键.     

352例颅脑伤为主的多发伤的临床分析

我科自1991年4月～1998年5月共收治颅脑伤主为的多发伤病人352例,占同期收治病人总数的22.9%。现分析如下。临　床　资　料1.一般资料:男253例,女99例;年龄3～80岁,其中16～55岁282例,占80.1%。2.致伤原因:交通伤252例(71.6%),高处坠落伤80例(22.7%),挤压伤20例(5.7%)。3.颅脑损伤类型:开放性颅脑损伤25例(7.1%),闭合性颅脑伤327例(92.8%)。4.休克程度:本组220例(62.5%)伴有不同程度休克,轻度休克68例(30.9%),中度休克105例(47.7%),重度休克47例(21.4%)。5.合并伤:(1)严重胸部创伤伴肢体骨折93例(26.4%);(2)腹部脏器损伤并胸部创伤103例(29.…     

严重多发性创伤的救治研究

目的 探讨严重多发性创伤有效可靠的救治方法。方法 对急诊处于休克状态,主诉不清,伤因不明的病人。边检查,边治疗,保持通气正常的情况下控制出血、抗休克、扩容,并按胸、头、腹、四肢的顺序抢救,除外心脏损伤、气胸、大出血,应先抢救颅脑损伤并脑疝的病人。结果 本组277例,其中合并颅脑损伤215例,4例因早期休克、脑疝死亡;56例重型颅脑损伤行急诊手术,其中45例术前休克已基本纠正;5例手术止血及抗休克同时进行,8例经抗休克等抢救治疗待病情稳定后再行手术;46例开放性骨折均行早期清创缝合,酌情采用内外固定。结论 迅速查明伤情,本着先救命后治伤的抢救原则,综合分析伤情,合理有效的治疗,避免误诊,是成功救治的关键。     

严重交通事故多发伤324例救治分析

对324例交通事故多发伤伤情资料及救治情况进行回顾性分析,认为：交通事故引起的严重多发伤发生年龄多在16－40岁的青壮年,受伤部位多见腹部、头部、胸部、四肢和骨盆;伤员主要死亡原因依次为颅脑损伤、胸腹部外伤引起的休克、MOF、呼吸衰竭。强调此类伤员的急救应重视现场急救和伤员转运,综合复苏、及时手术能有效地提高伤员的生存率。     

颅脑损伤合并多发伤257例的急诊处理

目的：总结交通伤致颅脑损伤合并多发伤的救治经验。方法：回顾性分析2007-09-2009-12收治的257例因交通伤致颅脑损伤并发多发伤患者的临床资料。结果：257例病人中,死亡53例,死亡率20.6%。主要以颅脑创伤合并其他部位损伤居多,且致伤因素复杂,伤情严重,救治困难。结论：积极正确的院前急救,入院后的早期诊断,规范的抢救程序,早期发现和处理危及生命的损伤及多学科的协调是颅脑损伤并发多发伤救治的关键。     

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…     

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.