急救措施最佳实施时间范围探讨

目的 探讨战时伤员得到急救的最佳实施时间段。方法 采用计算机模拟及统计学方法分析急救措施实施时间与伤员阵亡率之间的量化关系。结果 急救措施实施时间与阵亡率之间存在明显正相关，不同时间段阵亡率增长幅度不同。结论 伤后10分钟是伤员急救措施的最佳实施时间段。     

大批量地震伤员的早期救治

目的 探讨大批量地震伤员的早期救治方法.方法 对1 123例地震伤员实施早期救治.受伤部位:四肢伤925例,脊柱伤65例,头部伤46例,胸部伤53例,腹部伤72例.单部位伤809例,多发伤314例.紧急手术67例,其中肝破裂修补13例,脾破裂行脾切除14例,肠系膜血管损伤修补3例,腹部多脏器损伤修补6例,胸腹联合伤行胸腹脏器损伤修补及膈肌破裂修补4例,颅内血肿清除术12例,肺破裂修补4例,肺及支气管部分切除5例,心脏压塞行心包切开1例,连枷胸行肋骨内固定5例.早期手术166例,其中早期单纯清创105例,清创加骨折外固定支架固定36例,截肢25例.结果 406例治愈出院,673例经初期治疗后转院治疗,死亡3例.结论 分级救治方法适用于大批量地震伤员的早期救治.危重伤员及伴有严重心肺等基础疾病的地震伤员早期应采用损害控制技术.反复检诊是防止延误诊治的有效方法.     

创伤性膈肌破裂13例临床漏诊原因分析

创伤性隔肌破裂（简称TDR）虽非属常见，但其对创伤伤员危害十分严重，而且常不易早期诊断，以致漏诊和延误治疗。我院自1984年1月至1994年8月共收治13例TDR伤员，现报告如下。1临床资料与结果1．1一般情况本组男10例，女3例。年龄7～69岁，平均31岁。锐器贯通伤7例，钝挫伤6例。受伤至来诊时间：12例在伤后30min至4h，平均1h时13min；1例伤员在外地医院诊断不明确，久治不愈于伤后74d来诊。13例中多发伤12例，非多发伤1例。12例多发伤伤员中10例发生创伤失血性休克。13例伤员术前诊断TDR2例，但手术探查证实13例均有膈肌破裂，其中6例…     

地震伤严重伤员的早期救治

目的 探讨地震伤严重伤员的早期救治方法.方法 对286例严重地震伤员实施早期救治,单部位伤189例(66.1%),AIS评分平均3.8分;多发伤97例(33.9%),ISS评分平均27.7分.紧急手术65例:其中肝破裂修补12例,脾破裂行脾切除13例,肠系膜血管损伤修补3例,腹部多脏器损伤修补6例,膈肌破裂修补4例,颅内血肿清除术12例,大量血气胸行开胸手术9例(肺破裂修补4例,肺及支气管部分切除5例),心脏压塞行心包切开1例,连枷胸行肋骨内固定5例.早期手术72例:清创加骨折外固定支架固定57例,截肢术15例.结果 59例治愈出院,196例经初期治疗后转院,28例接受后期康复治疗,死亡3例.结论 分级救治可保证严重伤员得到及时有效救治;危重伤员及伴有严重心肺等基础疾病的伤员应实施损害控制;做好反复检诊是防止延误诊治的有效方法;加强多专业合作对提高危重病人救治成功率具有非常重要的作用.     

绵竹地区5．12地震伤早期急诊救治情况分析与问题探讨

目的分析绵竹地区5．12地震伤早期急救中存在的问题,探讨处理重大灾难发生后急诊急救的新模式。方法回顾性分析我科在5．12～5．13地震发生后24小时的极早期伤病员的救治情况,并与我院震前同类疾病死亡率作比较。结果5．12地震极早期同类型伤员死亡率明显增高。结论建立有效的灾难急救体系,合理分配医疗资源可能是早期急救中降低死亡率的有效方法。     

汶川地震灾难救援与信息控制

目的探讨早期信息控制对灾难救援的作用及对救治秩序的影响。方法通过登记本、伤员信息卡、麻醉记录单及病历资料,收集德阳市某医院在“5．12”汶川地震1420例伤员基本信息,分析伤情、伤员流、信息流特点。结果1420例伤员中,受伤机制以房屋垮塌后砸伤为主,共有1821个损伤部位,四肢损伤多于其它部位伤（P〈0．01）;轻伤多于中、重度伤（P〈0．01）;震后前2天收治伤员占收治总人数的68．80％,明显多于其它时间段伤员收治数（P〈0．01）;随救治时间延长,伤员信息趋于完整。结论汶川地震后早期信息控制与救援不相适应,值得重视。国家要重视灾难医学救援信息体系建立和完善,以最快速度在震后形成陆海空救治一体的救治和信息控制网络。稳定伤员流的流序和流态,保证信息流的畅通和准确,才能科学、有序救援。     

合理人员调配对批量伤员救治效果的影响

目的 探讨医务人员的合理调配对批量伤员救治效果的影响.方法 在我院救治的地震伤员共400例,将医务人员合理调配前(5月12日)救治的208例作为对照组;医务人员合理调配后(5月13日)救治的192例作为研究组,分析比较医务人员调配前后地震伤员的救治效果.结果 两组间伤员的年龄、性别、受伤部位、伤情比较无统计学意义(P>0.05).人员凋配后,地震伤员的早期死亡率、接受救治的时间、检查的时间,危重伤员从来院到接受救治的时间等,研究组显著低于对照组,具有统汁学意义(P<0.05).结论 合理的人员调配能提高批量伤员的救治成功率,降低早期死亡率.     

汶川大地震颅脑损伤的时空特点及救治策略

目的 分析汶川大地震颅脑外伤的时空特点、临床特点,探讨救治时机、治疗方式选择. 方法 对我科在2008年5月12日四川汶川8级特大地震中92例颅脑外伤伤员诊治进行总结分析. 结果 收治地震颅脑伤伤员92例,全部来源于成都西北部平原地区.其中震后早期12 h内收治76例.开展手术10例,死亡3例. 结论 在汶川大批地震伤员早期颅脑外伤所占比例大,病情变化快.就诊伤员均来源于交通便利的平原地区.入院后早期开展急救手术治疗对提高地震颅脑伤的救治成功率有显著的效果.     

隐匿性肋骨骨折多层螺旋CT最佳检查时间段的研究

目的 探寻隐匿性肋骨骨折(ORF)多层螺旋CT的最佳检查时间段,为法医鉴定伤情及临床诊治肋骨骨折提供准确依据.方法 分析50例胸部外伤患者的影像资料,于伤后10天内行首次胸部多层螺旋CT检查,经薄层重建VR及MPR显示为ORF,并于伤后20 ～ 50天内复查多层螺旋CT,比较伤后不同检查时间诊断的隐匿性肋骨骨折数与首次检查诊断肋骨骨折数的差异.结果 同一患者在不同的时间进行检查,被诊断ORF的数目往往不同,受伤后21 ～40天复查的结果与首次检查结果显示的ORF的数目差异具有统计学意义.结论 伤后21～ 40天复查多层螺旋CT,根据骨痂的病理生理变化,能够比较准确、客观地显示ORF,21 ～ 40天为诊断ORF的最佳时间段.     

汶川地震伤员伤情特点及救治分析

目的 探讨汶川地震伤员伤情特点及早期救治. 方法 收集四川省德阳市第一人民医院在2008年5月12-30日收治的1 420例地震伤员资料,分析伤情特点和早期救治.结果 1 420例伤员中,共有1 821处损伤.其中单个部位伤1 089例,占76.69%,多部位伤331例,占23.31%;四肢损伤、体表和软组织损伤多于其他部位损伤;单个部位伤明显多于多部位伤(P＜0.01);伤员流在震后2 d最多,占68.80%,明显多于其他时间(P＜0.01);19～45岁年龄组伤员多于其他年龄组(P＜0.01);伤后12 h以上才得到救治的伤员最多(P＜0.01). 结论 在灾难救援中,救治速度是关键,救治的黄金时间和救治重点应在震后2 d;在救治中应遵循损害控制原则,平时加强自救瓦救训练和急救知识培训可能挽救更多伤员的生命.     

Early onset pneumonia following pulmonary contusion: the case of Stonewall Jackson

Confederate Lieutenant General Thomas J. "Stonewall" Jackson was wounded by his own men at the Battle of Chancellorsville during the American Civil War. While being removed from the field, Jackson fell from the litter and struck the right side of his chest on a large stone or stump. Four days following the amputation of his left arm, Jackson developed pneumonia in his right lung. His treating physicians believed the infection developed secondary to a pulmonary contusion that occurred when he fell from the litter. Pulmonary contusions are an independent risk factor in the development of post-traumatic pneumonia and an infection that occurs within 72 to 96 hours of injury is termed an early onset pneumonia. The nature and timing of Stonewall Jackson's illness following his wounding is consistent with the modem diagnosis of early onset pneumonia following chest trauma.     

A procedure for the rapid detection of depleted uranium in metal shrapnel fragments

Depleted uranium is now widely used in the armor of military vehicles as well as in kinetic-energy penetrators designed to defeat enemy armor. As a result, the potential that personnel will be wounded by depleted uranium fragments has increased. Because toxicities associated with depleted uranium fragments may ultimately require different treatment protocols than those used for traditional metal fragment injuries, a method to rapidly detect the presence of depleted uranium in surgically excised shrapnel fragments is required. By treating the shrapnel fragment with an extracting agent, such as nitric acid, for 5 minutes in an ultrasonic cleaner, sufficient metal is solubilized to allow for colorimetric detection using a pyridylazo dye. Although several metals are capable of being detected under these conditions, the reaction can be made specific for depleted uranium through the use of masking agents such as sodium citrate and ethylenediaminetetraacetic acid. This procedure allows for the rapid (< 15 minutes) extraction and detection of depleted uranium in metal shrapnel fragments.     

三甲医院应对突发大规模群体性创伤的策略和方法:附南京7.28丙烷爆炸案急救报告

目的 探讨大型综合性医院应对突发性大规模群体性创伤的策略和方法.方法 回顾南京7.28爆炸案大规模群体性创伤伤员救治过程,总结大规模创伤救治的经验.结果 急诊科2小时45分钟共救治124人,其中严重多发伤及复合伤(ISS≥16)34人(27.4%).行清创手术118人次,损害控制性手术10例(8.1%).死亡1例(0....     

多发伤中的腹部伤

本文报导以腹内伤为主的多发伤46例，对其早期复苏、诊断、处理和处理顺序进行了分析探讨。     

突发事故致批量伤员的应急救治探讨

目的探讨批量伤员救治的接诊流程,以提高批量伤员的应急救治水平。方法 2009年7月～2012年3月我院急救中心接诊批量伤员共156人,通过启动绿色通道应急预案,快速分拣合安排至不同的救治区域,施行应对突发批量伤员处理预案,完善批量伤员的急救流程并运用于实践,共治愈149人,因病情危重,抢救无效死亡7人;抢救及时率达到100%。结果 156例中4例重型颅脑损伤患者到院后1～3h内死亡,3例多发伤致失血性休克到院30～60min内死亡,149例通过医院各科室的通力合作、全力抢救,均安然度过危险期治愈出院。结论绿色通道应急预案可以为救治重症伤员争取宝贵时间;在批量伤员的救治处理中起着至关重要的作用。因此,熟悉绿色通道流程,在实践中不断完善抢救流程可以显著提高批量伤员的急救效果。     

战伤的体液免疫变化

体液免疫功能变化与伤情、感染和转归均有关系。重伤员的免疫功能差，主要为IgG和C3的变化。重伤早期和明显贫血伤员免疫功能下降尤著。多种抗生素与激素对免疫功能有抑制作用。对机体免疫机能已降低的重伤员，应尽量少用或不用抑制免疫功能的药物，使用免度促进剂或调节剂有助于增强机体抵抗力，促进康复。     

War‐wounded refugees: The types of injury and influence of disability on well‐being and social integration

The aim of this study is to describe the war injuries and investigate the influence of physical disability on well‐being and social integration in a group of war‐wounded refugees after two years in Sweden. A culturally heterogenous sample of 54 war‐wounded refugees was investigated during hospitalization shortly after arrival, and after two years. Quantitative data were covered by physical examinations, interviews and questionnaires. In addition, qualitative data were collected within semi‐structured interviews on both occasions. The major types of war injuries were: fractures (22%), traumatic amputations (17%), spinal cord injuries (17%), nerve injuries (11%), combinations of fractures and nerve injuries (9%), bilateral eye injuries (9%), brain injuries (7%), other injuries (7%). Regarding the type of injuries and medical complications, the group studied was representative of small unit operations of war with low access to early medical care. The degree of physical disability was not a salient factor for well‐being and social integration after two years in Sweden. The losses and desires to be repatriated were apparent from the qualitative findings, as exemplified by three case reports. The findings of this study are in accordance with previous research on refugees and war‐injured ex‐combatants, but further multidisciplinary research is needed. The results also imply that resettlement countries should pay continuous attention to the broad needs of their war‐wounded refugees.     

严重创伤急救最佳医疗效果的探讨

1520例车祸所致严重创伤,其部位以骨折(39.1％)、复合伤(22.3％)、腹部伤(16.8％)最多,伴有休克者806例(53％),需紧急手术者1473例(96.9％)。死亡46例(3％),其中伤后1小时内死亡31例(67.4％)。我们采用CRASH—PLAN检诊计划检诊,最大限度避免漏诊,提高了抢救成功率。提出医护人员在抢救严重创伤时应有高度的紧迫感和责任感,最大限度地争取抢救时机,提高严重创伤的急救医疗效果。     

The impact of dedicated physician staffing on patient flow and quality assurance parameters in an Air Force emergency department

A retrospective audit of 17,028 emergency charts at USAF Medical Center, Scott was performed over two time periods to compare patient waiting times and selected quality assurance parameters with two methods of physician staffing. Phase 1 consisted of 4 months when the Emergency Department (ED) was manned with five physicians assigned only to that department. Non-departmental physicians supplemented the full-time staff. Phase 2 was the corresponding 4 months the following year when the ED was staffed with six emergency physicians, and non-emergency physician coverage was minimal. The difference in daily census between the two periods of time was not statistically significant. The time required to be seen by a physician decreased from an average of 25.6 minutes per patient in phase 1 to 13.7 minutes per patient in phase 2. Time to disposition also decreased from 71.9 minutes per patient in phase 1 to 59.5 minutes per patient in phase 2. In the second phase the number of "positive" x-ray findings increased, while the number of incomplete charts and patients who left without being seen by a physician diminished.     

海水浸泡多发伤动物模型的建立

目的　建立犬海水浸泡多发伤动物模型 ,探讨其早期伤情变化特点。方法　成年杂种犬 2 0只 ,制作多发伤动物模型 (腹部开放伤 空肠破裂伤 右下肢软组织爆炸伤 )。致伤后随机分为二组 ,即多发伤海水浸泡组和对照组 (非海水浸泡组 ) ,每组 10只。实验中全程监测体温、血浆渗透压、血气分析和血电解质变化。结果　多发伤海水浸泡组伤情明显重于对照组 ,表现为低温、血浆渗透压升高、高钠、高氯血症、代谢性酸中毒 ,死亡率极高。结论　该动物模型对探讨海水浸泡多发伤早期伤情变化特点是可行的、合理的 ,适用于海战多发伤的早期病理生理研究 ,并为该类创伤的早期救治提供实验依据。