汉族人髓样分化蛋白2基因启动子区多态性与严重创伤后并发症易感性的关系

目的探讨中国汉族人髓样分化蛋白2(MD-2)基因启动子单核苷酸多态性及其与严重创伤患者多器官功能衰竭和脓毒症易感性之间的关系。方法应用限制性片段长度多态性-聚合酶链式反应技术,检测105例严重创伤患者(其中42例并发脓毒症)MD-2基因启动子-1625C/G单核苷酸多态性位点基因型。并对所有患者进行多器官功能障碍综合征(MODS)评分。结果-1625G等位基因携带者MODS评分显著高于C等位基因携带者(显性遗传模式P<0.001,隐性遗传模式P>0.05)。携带G等位基因型的创伤患者比C等位基因携带者并发脓毒症的可能性高(OR值为0.477,95%可信区间为0.266-0.855,P<0.05)。携带G等位基因型的创伤患者死亡率显著高于C等位基因携带者(显性遗传模式P<0.05,隐性遗传模式P>0.05)。结论汉族人严重创伤后多器官功能衰竭、脓毒症的易感性与MD-2基因启动子-1625C/G单核苷酸多态性相关。-1625G可能是严重创伤后并发症发生的危险因素。     

严重交通伤与坠落伤救治结局比较和创伤急救模式探讨

目的 进一步提高严重交通伤（ＲＴＴ）与坠落伤（ＦＩ）的救治水平。方法 为重庆急救中心１９９６年８月～１９９７年７月救治的严重ＲＴＴ和ＦＩ（ＩＳＳ≥１６或ＡＩＳ≥３）结局进行比较分析。结果 ＲＴＴ２１９例,ＦＩ１１７例。严重多发伤组的致死率及其死亡及其死亡组ＩＳＳ值ＦＩ显著高于ＲＴＴ（Ｐ〈０．０５）,其腹部和（或）盆腔脏器伤、上肢伤、下肢和（或）骨盆伤、脊柱的发生率ＦＩ显著高于ＲＴＴ（Ｐ〈０．０１或     

Analysis on care outcome of patients with polytrauma and coma

Objective ： To make further improvement of outcome of patients with polytrauma and coma. Methods： The data of 3 361 patients （2 378 males and 983 females, aged from 5-95 years, 38. 2 years on average） with severe polytrauma and coma admitted to Chongqing Emergency Medical Center （Level I Trauma Center ）, Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. Results： The overall survival rate and mortality were 93.2%（3 133/3 361 ）and 6.8%（228/3 361 ）, respectively. The mortalities in patients with coma duration 〈 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were signifieantly higher than that of those with coma duration 〈 1 hour but without neural dysfunction [39.5%（136/344）vs 3.0%（92/3 017）, P 〈0.01]. There existed significant differences in GCS, ISS, and revised trauma score （RTS） between the death group and the survival group （P 〈 0. 01 ）. RTS was in good correspondence with patient＇ s pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure （SBP）. The mortality in patients with SBP 〈90 nun Hg was significantiy higher than that of those with SBP ≥ 90 mm Hg [ 33. 3 % （68/204） vs5.1%（160/3 157）, P 〈0.01]. The mortality in polytranma patients combined with serious head injury （AIS≥3） was8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury （23.9%, 61.1% vs 27.3 %, 50.0 % ）. The mortality reached up to 61.9 % in patients complicated with severe head, chest and abdomen injuries simultaneously. Conclusions： It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe palytrauma and coma.     

应用ISS和NISS评估伴严重胸部损伤的多发伤患者并发症与救治结局

目的 探讨新的损伤严重度评分(new injury severity score,NISS)和ISS在评估伴严重胸部损伤的多发伤患者的并发症与救治结局中的应用价值.方法 采用简明损伤评分-2005(AIS-2005)对重庆市急救医疗中心2005年1月-2011年1月救治的1377例伴严重胸部损伤的多发伤患者资料(胸部AIS≥3分)进行回顾性分析.计算NISS和ISS,并分析其与死亡的相关性.结果 治愈率为93.2％,死亡率为6.8％,并发症发生率为28.5％.NISS值(r=0.569,P＜0.01)、ISS值(r=0.442,P＜0.01)分别与并发症发生率呈正相关,NISS值(r=0.693,P＜0.01)、ISS值分别与死亡率呈正相关(r=0.774,P＜0.01),其中NISS值与并发症发生率、ISS值与死亡率有更强的相关性.在并发症发生预测方面,NISS敏感性优于ISS,特异性不及ISS(P＜0.01),在死亡预测方面,ISS与NISS相当(P＞0.05).结论 NISS和ISS均能较好评价伴严重胸部损伤的多发伤患者的并发症与救治结局.利用NISS值预测并发症的发生,ISS值预测救治结局以尽可能提高预测的准确性.     

院前创伤急救进展：新研究带来的机遇与挑战

院前创伤急救是整个创伤救治体系的重要组成部分。大多数院前急救医疗服务（EMS）体系源自于军事医学经验和改进,对于创伤患者的确定性急救自现场就应尽快开始。院前创伤急救成功的关键在＂创伤急救ABC＂：即气道、呼吸、循环,核心是建立并保证气道、通气、液体复苏和快速转运至就近的恰当医院。传统的院前处理面临着新的研究成果的挑战,同时新技术、新方法、新工具的应用也使院前创伤急救变得更加容易,创伤患者的救治结局也得以改善。     

连枷胸的诊治进展

本文回顾了连枷胸伤员的临床特点及诊治进展,指出胸廓不稳定所致的浮动胸壁和肺挫伤是产生低氧血症及连枷胸伤员呼吸功能障碍的两个重要原因.由此应加强对胸廓稳定、肺挫伤、有关并发症及合并多发伤的处理.在控制浮动胸壁时,选择镍钛记忆合金肋骨接骨板等材料进行手术内固定,是目前最有效的方法之一.     

颅脑损伤合并多发伤急诊救治规范化治疗

颅脑损伤合并多发伤是医院急诊较难处理的问题之一，常影响患者的预后。本文就颅脑损伤合并多发伤急诊救治模式进行初步探讨，对其院前急诊和院内抢救的模式、人员配备模式以及相关的抢救原则进行了阐述，以期进一步规范创伤外科医师对颅脑损伤合并全身多发伤急诊救治策略，提高救治水平。     

美国小儿创伤中心概况

２８年前，小儿创伤尚未引起人们足够的重视，那时仅有少数成人创伤中心，而无专业化小儿创伤中心（ＰＴＣ）。７０年代以来，在Ｋｏｔｔｍｅｉｅｒ、Ｈａｌｅｒ、Ｍｏｒｓｅ、Ｉｚａｎｔ等先驱者的努力下，开办了美国第一批ＰＴＣ，并取得了明显成绩。现在美国许多地区都...     

533例汶川地震伤员感染流行病学分析与思考

目的 探讨综合性医院在地震等自然灾害中的应急反应能力和对伤员感染的救治水平.方法 选择2008年5月12日汶川大地震后转送至重庆6所三级甲等医院的533例地震伤员,结合创伤ISS和AIS评分,根据伤情及其与院内外感染的关系和抗生素敏感性等指标进行全面的回顾性分析.结果 533例后送伤员中,ISS<16分456例(85.6%);ISS 16-25分65例(12.2%),ISS>25分12例(2.3%).骨折433例(81.9%).头、颈部损伤42例,面部损伤7例,胸部损伤114例,腹部、盆腔损伤81例,四肢、骨盆损伤314例,体表损伤205例.仅有1处骨折180例,2处骨折139例,3处及以上骨折114例,截肢32例,挤压综合征21例,院内手术处理281例.感染79例,院外感染占87.3%.合并感染伤员抗生素敏感性实验结果显示,病原菌以大肠埃希氏菌、金黄色葡萄球菌、溶血葡萄球菌、肺炎克雷伯氏菌、鲍曼复合不动杆菌、阴沟肠杆菌、铜绿假单胞菌、C群链球菌为主,少数发生产气荚膜杆菌感染.敏感及耐药抗生素谱系各不相同且有部分重叠.抗生素选择应以头孢类和大环内酯类抗生素等为主.结论 在自然灾害紧急条件下,对伴有不同程度感染的骨折伤员,科学使用抗生素并采取综合有效的防护性救治措施对于加强伤员早期救治,预防严重创伤并发症,促进伤员康复具有重要意义.     

严重老年胸伤患者临床流行病学特征与救治结局分析

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.