急性重度胸腹联合伤56例的救治

目的探讨急性重度胸腹联合损伤(combined thoracoabdominal injury,CTI)的特点和急救经验。方法总结1999年2月至2009年12月经手术证实的急性重度CTI56例,其中开放性损伤42例,闭合性损伤14例。56例均有不同程度血胸或血气胸伴有休克。分析不同原因的损伤及不同症状与抢救方式。结果经胸手术39例,剖腹手术15例,胸腹联合手术2例。首次手术探查发现膈肌破裂52例,4例漏诊,均行二次手术修复。治愈42例,死亡14例。结论重度CTI病死率高,伤情复杂,一般原则应先处理胸部损伤,后处理腹部损伤,但应防止漏诊膈肌损伤。在抗休克的同时及早诊断、及时手术是抢救成功的关键。     

胸腹联合伤的早期诊断与治疗

目的总结胸腹联合伤的早期诊断与治疗体会。方法对我院1993～2004年收治的经手术证实的15例胸腹联合伤病例进行回顾性分析。结果开胸手术4例．开腹手术11例,其中先后或同时行开胸开腹探查2例。治愈13例,死亡2例(13．3％)。死亡原因为严重失血性休克1例,严重颅脑外伤1例。结论胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高,早期诊断、及时手术是减少死亡率．提高救治效果的关键;治疗原则为先处理胸部损伤,后处理腹内脏器损伤,根据每一例患者的具体情况决定手术方式。     

胸腹联合伤的早期诊断与治疗

胸腹联合伤是一种特殊类型的损伤.由于伤及胸腹腔脏器并伴有膈肌破裂,伤情复杂,生理紊乱,症状相互影响,因此给临床上及时诊断、救治的顺序和手术入路选择带来一定困难.笔者总结我院1996年5月～2006年5月收治的11例患者,分析并总结经验教训,以期提高救治胸腹联合伤的水平.     

胸腹联合伤26例救治体会

目的探讨胸腹联合伤（CTI）的临床特点和救治经验。方法回顾本院1995年1月至2007年12月经手术证实的胸腹联合伤26例，对其损伤类型、临床特点和诊断、治疗情况进行了分析。结果治愈24例，治愈率92.3％；死亡2例，死亡率7．7％。结论及早诊断和及时正确的手术处理是胸腹联合伤救治成功的关键。     

胸腹联合伤的临床诊断与手术治疗

目的 分析胸腹联合伤的临床表现特征,总结胸腹联合伤的早期诊断与手术治疗的特点,以降低病死率.方法 对我院30例胸腹联合伤患者采取回顾性分析的方法 ,分析不同原因的损伤类别及不同临床症状与手术方式.结果 治愈28例,治愈率93.3%;死亡2例,死亡率6.7%.主要并发症有:肺部感染、创口感染、连性肠梗阻.结论 对胸腹联合伤的早期确诊和早期手术治疗是救治成功关键     

胸腹联合伤20例诊疗分析

我院2003—08～2006—05收治胸腹联合伤20例，现将其救冶总结如下。     

胸腹联合伤52例诊治分析

现将1990-03～2005—01我们收治的胸腹联合伤52例分析如下。 1临床资料 1．1一般资料本组男38例，女14例，年龄21～54岁。钝性伤36例，包括交通伤21例，坠落伤13例，重物砸伤2例；穿透伤16例，包括锐器刺伤15例，火气伤1例。受伤至入院时间20min～72h。入院时BP〈90／60mmHg35例（83．3％）；血氧饱和度低于90％者为34例（65．4％）。     

3例开放性胸腹联合伤延误诊治分析

开放性胸腹联合伤多以刃器刺伤常见 ,多为盲管伤。通过本文分析 3例开放性胸腹联合伤延误诊治的原因。1　病历简介例 1:男 ,2 6岁。左上腹刀刺伤 8小时。查 :休克表现 ,伤口位于左肋缘下。连续硬膜外麻醉下剖腹探查发现胃体前壁、胃底部贯通伤 ,食物残渣外溢。行单纯胃裂口修补术 ,术中未探查膈肌。术后胃肠功能恢复 ,72小时进食 ,但体温持续中、高热不退 ,左下肺呼吸音消失 ,摄全胸 X线片示胸腔中等量积液并气胸。追问病史 ,伤后曾咯血痰数口并感胸闷气促 ,术前因腹部体征典型 ,而忽略胸部检查。诊断开放性胸腹联合伤 :1胃贯通伤 ;2左膈穿…     

胸腹联合伤51例分析

我院1989-2000年共收治胸腹联合伤51例，现分析如下。     

胸腹联合伤44例治疗分析

目的：探讨胸腹联合伤的特征、诊断与治疗方法。方法：对我院2002/2007年所收治的44例胸腹联合伤患者的诊断和手术治疗情况进行回顾性分析。结果：本组44例患者经手术救治,治愈37例,治愈率为84.1%。结论：胸腹联合伤多属严重多发伤,早期正确的诊断是提高抢救成功率的关键。手术时,首先解决威胁生命最大的创伤,手术方式应根据患者的具体情况而定。     

Multiple thoracoabdominal impalement injuries

A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm (0.59 in) diameter rods, each 2 m (6.56 ft) in length. The first rod entered below his right nipple, the second through the right hypochondrium, and the third through the right upper thigh. He was transported to the hospital with the rods in situ. This paper provides insight as to how these unusual injuries were managed in a limited-resource environment. Even in a developing country, the challenges posed by multiple impalement injuries can be managed successfully by rapid prehospital transfer, along with an adequate and coordinated hospital team effort.     

锐器致急性胸腹联合伤的外科治疗

目的 探讨锐器致急性穿透性胸腹联合伤的诊断方法 与手术治疗技巧,快速止血、修复损伤的脏器,降低死残率.方法 回顾性分析我院2000年1月至2008年12月收治的17例锐器致急性穿透性胸腹联合伤患者的临床资料,其中刀刺伤12例,钢筋刺伤2例,尖锐木棒刺伤1例,玻璃刺伤1例,火器伤1例,17例患者均有膈肌破裂.结果 治愈16例,死亡1例,死亡原因是严重失血性休克.1例切口感染,未发生其它并发症.13例患者随访1～5年,无损伤或缺失的器官所致的生理功能障碍.结论 锐器致急性胸腹联合伤痛情危急、复杂、进展快,常为多部位、多器官损伤,早期确诊和抢救是治疗成功的关键,经胸探查是简捷、实用的手术路径.     

高原急性上消化道出血362例急诊内镜诊治结果分析

急诊内镜作为上消化道大出血早期诊断和治疗的有效手段和方法，已经得到内镜医师的普遍重视和广泛应用，本文对我院内镜室1997年6月～2005年4月362例上消化道大出血患者行急诊内镜检查和简单镜下止血的资料进行回顾性分析，旨在评价急诊内镜的诊治价值。现报告如下：     

Surgical treatment for muscle injuries

Muscle injury causes functional impairment. The healing process takes time and fibrotic tissue can result. Recurrence and delayed recovery remain as unsolved problems. Surgical intervention can be a feasible alternative to avoid early and late complications associated with complete muscle tear in attempt to improve functional results. This article hopes to provide an update about surgical treatments for muscle tears in different scenarios.     

坐骨神经损伤的显微外科手术及康复治疗

目的观察显微外科手术及康复治疗坐骨神经损伤的效果.方法本组22例,在伤后2h～8个月后分别行神经吻合术和神经松解术,术后予以康复治疗.结果随访3个月～5年,优10例(45.45%);良5例(22.72%);可6例(27.27%);差1例(4.54%).结论坐骨神经损伤后尽早行显微外科手术及康复治疗,疗效满意.     

多发伤救治的组织建设与救治目标

现代社会的发展，人类疾病谱已经发生了明显的改变，创伤已成为仅次于肿瘤和心脑血管疾病之后的主要疾病之一。在创伤患者中，多发伤发生率几乎占有一半的比例。多发伤通常是指一个致伤因素所致的两个以上解剖部位的损伤，而且每一部位的损伤都是严重的。由于其损伤重，损伤部位多，出血量多，各部位损伤的协同作用，病理生理复杂，治疗决策复杂而且常常存在矛盾，这给临床医师在治疗决策上带来困难。因此，多发伤的救治需要专业的创伤医师或有创伤救治经验的医师来组织与实施，以达到综合、全面、一体化救治，从而挽救生命，提高生存质量，尤其在医学学科愈分愈细的今天，重视多发伤救治的组织，提高救治的目标愈显重要。     

Assessing thoracoabdominal asynchrony

The traditional method of derivation of phase difference between ribcage and abdomen breathing movements from a Lissajous plot is shown to be unsatisfactory for assessing the degree of asynchrony. The signal processing technique of cross‐correlation is introduced as a better, statistically based approach. Even so, examination of the latent structure of a Lissajous figure leads to the concept of movement sum and difference components along its principal axes. This more general form of analysis is used for indicating relative changes in tidal volume during postoperative monitoring of Cheyne–Stokes breathing with obstructive apnoea, as well as tracking the degree of asynchrony. The theoretical and practical limitations of inductive plethysmography calibrations are such that the proposed methods of uncalibrated non‐invasive respiratory monitoring are also preferable as research tools.     

Evidence-based treatment for ankle injuries: a clinical perspective

The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-term effects. Electro-physical agents do not appear to enhance outcomes and are not recommended. Exercise may reduce the occurrence of recurrent ankle sprains and may be effective in managing chronic ankle instability. After surgical fixation for ankle fracture, an early introduction of activity, administered via early weight-bearing or exercise during the immobilization period, may lead to better outcomes. However, the use of a brace or orthosis to enable exercise during the immobilization period may also lead to a higher rate of adverse events, suggesting that this treatment regimen needs to be applied judiciously. After the immobilization period, the focus of treatment for ankle fracture should be on a progressive exercise program.