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解答:损害控制性复苏(darmage control resuscitation,DCR)于2006年由美军提出,迅速得到国际创伤界认同的重要理念。DCR包括以下主要内容:(1)允许性低血压复苏;(2)识别和预防低体温;(3)纠正酸中毒;(4)早期纠正创伤后消耗性凝血病。 相似文献
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骨科损害控制的研究进展 总被引:3,自引:0,他引:3
损害控制是针对严重多发伤患者,为了避免进入"死亡三角"即低体温、凝血病、酸中毒而采取的分步骤救治策略,主要有初期简单有效的救命手术,然后ICU复苏及后期的确定性手术.随着损害控制理论的不断发展,逐渐被引入到创伤骨科领域.本文针对该理论在创伤骨科的发展及应用进行综述. 相似文献
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严重创伤性凝血病防治新进展 总被引:1,自引:0,他引:1
失血作为严重创伤患者早期死亡的首要原因,一方面与无法控制的创伤出血有关,另一方面则与失血后凝血病有关。新近关于创伤性凝血功能障碍及凝血病急救医学得到发展,主要表现在基础研究的深入和临床医学救治措施的改进。本文阐述了严重创伤凝血病新观点及认识,旨在加深临床对该病症发生、发展的整体认识,以提高救治效率。 相似文献
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正急性重症创伤是急诊常见疾病类型,如不能及时诊断与救治,致残率、病死率极高,急性重症创伤患者多并发创伤性凝血病(TIC),以凝血功能障碍为主要特征,是导致患者病死率增加的主要原因之一,早期诊断与治疗是成功救治的关键~([1-2])。因此分析凝血功能相关指标与急性重症创伤患者疾病严重程度及预后的关系,对于早期准确诊断与治疗、预后评估就显得尤为重要。目前,相关文献报道并不多见。鉴于此本研究针对笔者医院收治的重症创性患者,监测凝血功 相似文献
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目的探讨严重肝脏损伤并发凝血病的救治方法。方法回顾性分析重庆市急救医疗中心2010年2月—2016年4月收治的32例严重肝脏损伤并发凝血病患者的临床资料。其中男性23例,女性9例;年龄15~84岁,平均37.4岁。致伤原因:道路交通伤17例(56.3%),坠落/跌倒10例(28.1%),压砸/掩埋伤3例,其他2例。分析其救治方法及治疗结果。结果 32例均为多发伤。入院后按"CRASH PLAN"原则,快速做出伤情评估,同时建立静脉通道及抽血做凝血功能、配血等检测,按照损害控制复苏(DCR)原则进行复苏。术前有凝血功能障碍19例。大量输血按新鲜冰冻血浆、悬浮红细胞各6~10U和10U冷沉淀配送22例。肝脏损伤Ⅳ级20例、Ⅴ级12例。手术包括清创性肝切除22例,改良肝周填塞13例;手术时间30~90min。本组共存活24例,死亡8例(25%),因肝脏损伤及其并发症死亡6例(18.8%,6/32)。结论Ⅳ、Ⅴ级肝脏损伤容易并发创伤性凝血病;DCR是严重肝脏损伤并发凝血病的救治策略;"改良肝周填塞法"和清创性肝切除是抢救严重肝脏损伤并发凝血病时的主要损害控制性手术措施。 相似文献
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骨盆骨折合并脏器损伤时,死亡率和并发症明显增加.治疗骨盆骨折合并脏器损伤时,应遵循"损害控制外科"原则.早期首先采用髂内动脉断血术加骨盆外固定支架控制骨盆大出血,全面探查和处理脏器合并伤;重症监护病室(ICU)治疗改善血流动力学状况和通气障碍,纠正消耗性凝血病、低体温和酸中毒(致死三联征);病情稳定后再行确定性手术做骨... 相似文献
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Jaemin Cho Taebeom Shin Kyeongneo Jun Jaeuk Ryoo Hocheol Choi Bongryeong Choi Jinyong Hwang 《Cardiovascular and interventional radiology》2010,33(1):169-172
It has been reported that anastomoses between the bronchial and the coronary arteries can become dilated and functional in
certain diseases, provoking angina pectoris through coronary steal syndrome. The condition can be treated with endovascular
or surgical management. It is possible that this abnormality may be associated with hemoptysis in patients with parenchymal
or vascular disease of the lung but this condition is very rare. We present the coronary CT angiographic findings of bronchial
arteries arising from the left coronary artery and their treatment with transcatheter embolization for the control of massive
hemoptysis. 相似文献
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Daley AJ 《Sports medicine (Auckland, N.Z.)》2008,38(8):659-670
Primary dysmenorrhoea (PD) is chronic, cyclic, pelvic, spasmodic pain associated with menstruation in the absence of identifiable pathology and is typically known as menstrual cramps or period pain. PD is the most common gynaecological disorder in menstruating women. Despite treatments being available for PD, relatively few women consult a clinician about their symptoms, preferring not to use treatment, or to self-treat using non-pharmacological or over-the-counter interventions. The notion that exercise is effective in preventing and treating symptoms has prevailed for many years and led to the promotion of anecdotal belief that exercise is beneficial. Behavioural interventions such as exercise may not only reduce dysmenorrhoea, but also eliminate or reduce the need for medication to control menstrual cramps and other associated symptoms.With emphasis on data from experimental studies, this report seeks to review the available evidence regarding the role of exercise in the management of PD and menstruation-related symptomatology. Using key search terms, online bibliographical databases were searched from the beginning of each database to 1 April 2007. Despite the widespread belief that exercise can reduce PD, empirical support is limited. Evidence from observational studies was mixed. Several observational studies reported that physical activity/exercise was associated with reduced prevalence of dysmenorrhoea, although numerous other studies found no significant association between outcomes. Evidence from controlled trials suggests that exercise can reduce PD and associated symptoms, but these have been small and of low methodological quality. There are, however, several plausible mechanisms by which exercise might be effective in the management of PD. A large randomized controlled trial is required before women and clinicians are advised that exercise is likely to be effective in reducing PD and related menstrual symptoms. 相似文献
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左莉莉 《中国航天工业医药》2013,(9):18-20
目的探讨规范化吸入激素治疗儿童哮喘的疗效。方法收集我院儿科哮喘门诊登记就诊的哮喘患儿128例,分为管理组和非管理组(对照组).随访3年,两组首次就诊时即由我科医师建立门诊档案,对管理组患儿家长进行哮喘规范化教育.根据病情吸入不同剂量的布地奈德或二丙酸倍氯米松,坚持长期维持治疗,而对照组仅于发作期治疗。结果管理组患儿3年内哮喘急性发作次数、旷课天数、住院次数及治疗费用均少于对照组;管理组息儿身高年增长速率及体重年增长速率均高于对照组:两组患儿随访期间不良反应无明显差异。结论通过对哮喘患儿进行规范化吸入激素维持治疗,患儿临床症状可有效控制,哮喘急性发作次数、旷课天数、住院次数及医疗费用降低,规范化治疗的患儿身高及体重年增长率高于未规范化治疗的患儿。规范化吸入激素治疗是一种安全有效的儿童哮喘治疗方法,值得临床推广应用。 相似文献
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Therapeutic embolization for acute haemorrhage is increasingly being utilized. An audit of 34 patients undergoing therapeutic embolization for acute abdominal or pelvic haemorrhage was undertaken, in an attempt to assess the importance of the following variables in determining a successful outcome: coagulation status, transfusion status, time to procedure after onset of circulatory instability, duration of procedure, and the effect of the embolization technique employed. Overall success was 79%, with definitive control of haemorrhage achieved by embolization; 21% required surgical management for rebleeding 4-24 h post embolization. The duration of the procedure and transfusion status of the patient were the most important factors associated with a successful outcome. 相似文献
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A vascular access team (VAT) can provide a full scope of PICC services, including pre-placement evaluation, placement of the PICC, educational resources to bedside nursing staff, management and monitoring of the insertion sites, discontinuation of the line, and documentation for quality control purposes. Two hospitals that have developed VAT programs outline key factors in forming a successful team, which include identifying the resources and associated costs,developing policies and procedures, establishing quality assurance, and enabling employee satisfaction. Facilities will need to consider the cost associated with the implementation of the team; however, benefits the team provides to the facility far outweigh the financial commitment required. 相似文献
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Although uncommonly encountered, knee dislocation is frequently associated with major vascular injury. Serious injuries resulting in ischemia demand prompt recognition and efficient management to prevent devastating long-term sequelae. In this review, we detail mechanisms of knee dislocation and associated popliteal vascular injuries. Diagnostic modalities used to evaluate the extent of vascular injury are individually discussed. Appropriate initial management of vascular injuries is crucial and an algorithm for diagnosis and management will be reviewed. We elaborate on the salient points of vascular reconstruction in the context of the dislocated knee: surgical approach, conduct of the procedure, and adjunctive maneuvers are described. 相似文献
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Tyler M. Miklovic Omar A. Protzuk Matthew S. Kang Mark A. Feger 《The Physician and sportsmedicine》2018,46(1):116-122
Lateral ankle sprains (LAS) have been reported as one of the most common musculoskeletal injuries observed in sports and in individuals who are recreationally active. Approximately 40% of individuals who sustain a LAS develop a condition known as chronic ankle instability (CAI). Years of research has identified numerous impairments associated with CAI such as decreases in range of motion (ROM), strength, postural control, and altered movement patterns during functional activities when compared to individuals with no LAS history. As a result, an impairment-based rehabilitation model was developed to treat the common impairments associated with CAI. The impairment-based rehabilitation model has been shown to be an effective rehabilitation strategy at improving both clinical and patient-oriented outcomes in patients with CAI. To date, the efficacy of an impairment-based rehabilitation model has not been evaluated in patients with an acute LAS. Prior to implementing an impairment-based model for the treatment of an acute LAS, similarities between impairments associated with acute LAS and CAI across the spectrum of the healing process is warranted. Therefore, the purpose of this review paper is to compare and contrast impairments and treatment techniques in individuals with an acute LAS, sub-acute LAS, and CAI. A secondary purpose of this review is to provide clinical commentary on the management of acute LAS and speculate how the implementation of an impairment-based rehabilitation strategy for the treatment of acute LAS could minimize the development of CAI. The main findings of this review were that similar impairments (decreased ROM, strength, postural control, and functional activities) are observed in patients with acute LAS, sub-acute LAS, and CAI, suggesting that the impairments associated with CAI are a continuation from the original impairments developed during the initial LAS. Therefore, the use of an impairment-based model may be advantageous when treating patients with an acute LAS. 相似文献