胸部创伤MODS临床分析

多脏器功能不全综合征(MODS)发病机制错综复杂，临床表现多种多样，治疗难度大，预后差。胸部创伤发生MODS有其特点，如何早期识别、预防及治疗，对预后有着重要的意义。为此，笔者对25例胸部创伤后MODS患者综合分析如下。     

创伤后多脏器功能障碍综合征患者血清白介素-2及其受体的动态变化与意义

本研究前瞻性观察了26例创伤后多脏器功能障碍综合征(MODS)和38例无MODS的严重创伤病人血清白介素-2(IL-2)与可溶性IL-2受体(sIL-2R)水平动态变化及其与创伤后MODS发生、发展的关系,结果报告如下.     

腹腔感染和多器官功能不全综合征

多器官衰竭一词现已用多器官功能不全（MODS）代替，因为后者较为确切。30年前已提出此综合征，其特点是序贯性、进行性多个（＞2个）生命器官或系统功能不全；譬喻为多米诺骨牌，当一块骨牌倒下，随之序贯性骨牌相继倒下。临床外科初期认识MODS，总是和腹腔内重症感染相关联。当时已有重症腹膜炎、呼吸衰竭和肾功能衰竭相继出现而称之“死亡三联征”。此后才知道无感染、其它脏器重症感染、严重复合创伤同样可以发生MODS。重症创伤经复苏和手术后2～5天内即出现MODS者称为原发性MODS或早期模式MODS。若重症创伤或感染术后5～7天…     

重型颅脑损伤并发多器官功能不全综合征的预防与治疗

多器官功能不全综合征(Multuole organs dysfunction syndrome,MODS)是严重创伤、休克、感染及手术后最严重的并发症,常提示预后不良.重型颅脑损伤后由于脑挫裂伤、脑出血、脑肿胀引起颅内压升高,下丘脑及脑干损伤,更易引起多器官功能紊乱、衰竭.本文对本院神经外科收治的208例重度颅脑损伤患者(入院GCS≤8)进行研究,探讨重度颅脑损伤后多器官功能不全综合征的预防与治疗方法,提高对MODS的治疗水平.……     

早期抗炎治疗对多发伤患者器官功能保护作用的研究

近年来,随着交通事业的飞速发展以及车辆的普及,交通事故及其它原因引起的创伤患者日渐增多,对患者生命威胁最大的是严重多发伤所致器官功能不全(MODS).     

肠道屏障功能临床评估方法

1 概述 研究已证实肠道是体内最大的"细菌库",当在创伤、手术、严重感染等条件下,肠道的微生物、内毒素通过肠黏膜侵入肠外组织,肠道菌群易位,导致全身炎症反应综合征(SIRS)甚至多脏器功能不全综合征(MODS).     

间充质干细胞移植治疗多器官功能不全综合征的研究

目的 观察骨髓间充质干细胞(mesenchymal stem cells,MSC)移植对多器官功能不全综合征(multiple organ dysfunction syndrome,MODS)的影响,探讨骨髓间充质干细胞用于多器官功能不全综合征治疗的应用前景.方法 建立性休克合并内毒素休克引起的官功能不全综合征模型.兔骨髓间充质干细胞体外扩增、鉴定、分化、慢病毒转基因标记GFP、静脉移植,通过PCR和病理切片观察MSCs对MODS兔的作用.结果 与对照组相比,模型移植组病理切片发现肝、肾、肺等脏器有慢病毒转基因标记有GFP的MSCs.结论 骨髓间充质干细胞具有良好的生物学活性,移植后通过整合能替代凋亡坏死细胞并对多器官功能不全综合征起到治疗作用.     

连续性血液净化治疗多脏器功能障碍综合征

多脏器功能障碍综合征(MODS)是严重创伤、严重感染、外科大手术、病理产科等原发病发生后,同时或序贯出现两个或两个以上系统器官的功能不全或衰竭的临床综合征,病死率较高.我院近年来采用连续性血液净化(CBP)抢救此类患者11例,现报告如下.     

腹部创伤后并发症的防治

严重腹部创伤的特点是伤情严重、并发症多及病死率高,常见为严重多发伤。腹部创伤后并发症则多发生于严重的单个或多脏器损伤,以及血管和软组织的广泛损伤后。腹部创伤后并发症可分为早期和远期并发症。早期并发症包括创伤失血性休克、腹腔间隙综合征、腹部创伤后感染、肠梗阻等;远期并发症包括各种消化道瘘、腹壁缺损、腹壁疝、短肠综合征等。由于腹部创伤后并发症涉及的内容很多,笔者选择性介绍创伤后腹腔间隙综合征     

近年火车创伤中关节损伤变化的特点

目的 探讨与分析快速列车所致火车创伤中关节损伤的变化特点。方法 集1997～2000年火车提速后10214例火车创伤中1279例关节损伤病例，分析在特定条件下的致伤因素、损伤严重程度、损伤类型特点，经AIS-ISS评分证实与预后的关系。结果 提速后关节损伤发生率由提速前33.54％上升到34.12％，死亡率由28.88％上升到30.33％，多关节离断伤由19.84％上升到34.13％，开放性关节损伤由31.71％上升到63.65％，关节离断伤的死亡率由21.19％上升到49.07％。结论 火车创伤无疑是十分严重的损伤，多发伤率远高于其他损伤，治疗棘手，多器官功能不全综合征(MODS)是致死的主要因素。     

多手指多节段离断再植

目的探讨多手指、多节段断指再植的方法及功能恢复。方法对12例43指113节段予以再植,采用分组协作、“流水式”清创、“逆行法”再植的方法,按先远端、后近端顺序依次再植示、中、环、小指。结果再植指成活率93.0%,平均随访3.5年,手功能评定:优2例,良5例,差4例,劣1例,优良率58.3%。结论多手指、多节段断指再植采用非常规方法,仍能获得较高成活率;手功能恢复较差原因可能有适应证选择、贯穿关节固定、忽视术后康复等有关。     

Using multiple response true-false multiple choice questions.

The Royal Australasian College of Surgeons (RACS) Board of Examiners, having agreed to replace Type K with Type X multiple choice questions (MCQ), undertook a study to determine the most appropriate method of scoring the latter. Retrospective scoring of candidates' responses in a previous examination, using six reported scoring techniques for Type X items, showed that the Middlesex technique yielded a mean score closest to the mean score of the Type K items which were being replaced. However, as candidates' responses are affected by instructions, and the latter could not be controlled, a prospective study was carried out on three examinations, in each of which the nature of Part C varied among the three papers, while Parts A and B were similar. Paper 1 contained Type K items in Part C, Paper 2 contained Type X items with instructions appropriate for the Middlesex technique, and Paper 3 contained Type X items scored +1 if correct, -1 if incorrect and 0 if omitted. Items sampling the same content areas were randomly distributed among the three papers. The results indicated that the two Type X systems yielded significantly lower mean scores than Type K, probably due to combinations characteristic of the latter, enabling candidates with partial knowledge to obtain a maximum score. The difference in mean scores between the two Type X systems was not significant. A significantly higher mean percentage score in reused Type X (Middlesex system) items over that of the same items when they were previously used as Type K items was attributed to the combined effects of credit for partial knowledge, practice on reused items and differences in mean candidate ability across years. Pearson product-moment correlation coefficients between pairs of Part C mean percentage scores at each examination were positive and significant. The Board decided to replace Type K with Type X items, and the +1, 0, -1 system of scoring was adopted as it was considered more efficient than the Middlesex system, which did not give credit for identifying false statements as false.     

Pediatric multiple sclerosis

Opinion statement  The diagnosis of multiple sclerosis (MS) in a child remains challenging, given the limited diagnostic criteria and the somewhat poorly defined overlap with acute disseminated encephalomyelitis. Although there are many similarities between pediatric-onset and adult-onset MS, an earlier age at disease presentation seems to be associated with specific features such as more frequent encephalopathy, seizures, and brainstem and cerebellar symptoms during the first event. In addition, the initial brain MRI scan of younger patients shows more frequent involvement of the posterior fossa and higher numbers of ovoid, ill-defined T2-bright foci that often partially resolve on the follow-up scan, thereby challenging early diagnosis. Finally, the spinal fluid in younger patients may fail to reveal oligoclonal bands or elevated IgG index at disease onset. No therapy for MS in children has been approved by the US Food and Drug Administration. As a result, physicians have started to use off-label drugs approved for adults. Recent data suggest that some children experience a disease breakthrough on first-line therapies approved for adult MS, and thus second-line therapies must be considered.     

Harvesting multiple organs

The development of organ transplants is limited by the shortage of organs. The improvement of this situation depends on two factors: increased awareness by the general public that refraining from refusing the removal of organs from the body of a patient with brain death is the most modern form of solidarity; and increased awareness by the medical profession that removal of organs should be proposed for every patient with brain death and that adequate resuscitative techniques should be used to preserve the organs in these patients. When the decision to harvest organs is taken, the transplant specialists must decide whether an organ should be used or not. Advances have been made in preservation techniques but are still insufficient to allow a reduction in immunosuppression. The UW solution is a major advance for liver, kidney and pancreas transplants. During harvesting, the separation of the vascular pedicles requires a good knowledge of surgical anatomy. Furthermore, the needs of the other surgical groups should be taken into account and concessions made to allow the harvesting of the greatest possible number of organs and consequently the treatment of the largest number of patients awaiting organs.