闭合性腹部创伤的诊断与治疗

目的：总结腹部闭合伤的诊治体会。方法：１９９１年４月～１９９８年４月,对闭合性腹部创伤伴多脏器损伤１４８例进行回顾分析。男１２０例,女２８例;共损伤腹部脏器共１６６个,均经手术探查。结果：治愈１３７例,死亡１１例。结论：Ｂ超、Ｘ线检查、腹腔穿刺对诊断腹部闭合伤的准确率高,简单易行;在复苏及多发伤处理同时,应积极剖腹探查,正确掌握手术指征,认真全面地探查,合理使用抗生素,这是救治成功的关键。     

冠心病合并2型糖尿病患者冠状动脉造影特点分析

目的分析冠心病合并2型糖尿病患者的冠状动脉造影特点。方法选择2010—2011年经冠状动脉造影确诊为冠心病的患者486例,其中合并2型糖尿病215例(观察组),未合并2型糖尿病271例(对照组),比较两组患者的冠状动脉病变程度及特点。结果两组冠状动脉病变支数、冠状动脉弥漫性病变发生率比较,差异均有统计学意义(P<0.05)。结论冠心病合并2型糖尿病患者冠状动脉病变弥漫且更加严重。     

60例汶川地震经历者创伤后应激障碍分析

目的 回顾性研究汶川地震创伤患者及亲属创伤后应激障碍的发生情况及影响因素.方法 随访60例汶川地震经历者,其中创伤患者40例(创伤组)及亲属20例(对照组),进行相关问卷调查和临床检查评定,了解创伤后应激障碍的发生情况并对结果进行分析.结果 创伤组创伤后应激障碍发生率、SCL-90总分和各项分值均显著性高于对照组(P＜0.01),且转归情况差;损伤程度、受困时间、治疗效果和生活正常化程度是创伤后应激障碍发生和迁延的影响因素.结论 创伤后应激障碍的发生率和迁延率较高,严重影响患者的治疗效果.     

严重多发伤患者气管切开术后痰培养病原菌的分布及耐药性分析

目的 分析严重多发伤患者气管切开术后痰培养病原菌的分布、变迁及耐药.方法 对该院创伤外科ICU病房2005年1月～2007年12月收治的210例多发伤气管切开术后的患者进行痰培养,分析病原菌的分布、变迁以及细菌耐药状况.结果 93例患者痰培养阳性,病原菌分离率达44_3%;培养出病原菌122株,其中细菌114株,真菌8株;混合感染17例,混合感染率达18.3%.病原菌以鲍曼氏不动杆菌(33.6%)、金黄色葡萄球菌(22.1%)和铜绿假单胞菌(18.3%)为主.鲍曼氏不动杆菌和金黄色葡萄球菌检出率在逐年上升.革兰氏阴性杆菌主要对头孢哌酮/舒巴坦、亚胺培南、美洛培南敏感,革兰氏阳性球菌以金黄色葡萄球菌为主,对万古霉素和替考拉宁敏感.结论 严重多发伤患者气管切开术后易发生肺部感染,痰培养的病原菌主要为革兰氏阴性杆菌,但革兰氏阳性球菌的检出率在逐年上升.检出病原菌对临床常用抗生素耐药率上升,且部分呈多重耐药.     

嗅鞘细胞移植与脊髓损伤再生修复

嗅鞘细胞(olfactory ensheathing cells，OECs)是存在于嗅觉系统的一种特殊类型的大胶质细胞，分布于嗅神经、嗅球的第一、二层和嗅上皮。OECs能伴随嗅束进入中枢神经系统。OECs兼有星形胶质细胞和雪旺细胞的特点，并迁徙于周围神经系统和中枢神经系统。在受损的脊髓组织移植OECs后，OECs不仅能引导、支持损伤神经轴突再生、延伸和髓鞘化作用，     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.     

干预移位髋臼骨折预后相关因素的研究

目的 探讨干预移位髋臼骨折(DAF)预后的相关因素.方法 根据可能干预DAF预后的各种因素及临床疗效对2002年5月～2006年7月收治的115例DAF患者资料进行回顾性分析.结果 临床治疗效果优良率分别为: (1) 致伤原因;(2) AO分型;(3) 复位质量;(4) 治疗方式;(5) 年龄;(6) 手术时机;(7) 手术入路各因素分组比较,其中(2)、(3)、(4)、(7)组间差异无显著意义(P＞0.05);(1)、(5)、(6)组间差异有显著意义(P＜0.05).结论 医师技能、DAF原因、患者身体状况和手术时机对临床治疗效果优良率产生显著影响.因此严格控制手术适应证,降低DAF负面因素的影响将有助于提高其优良率.     

Correlation between Blood cAMP, cGMP Levels and Traumatic Severityin the Patients with Acute Trauma and Its Clinical Significance

Atpresent,therearemanymethodsusedtoas sesstheseverityoftrauma ,suchasAIS ISS ,TS ,RTS ,ASCOT ,PHIandsoon ,intermsoftheinjuryofanatomicregions ,changesin phathophysiology ,agesetc .,butnotinvolvingthechangesofstressre sponsesofwholebodyatcellularandmolecul…     

肌腱移植材料与组织工程化肌腱移植技术

目的:就近年来国内外肌腱移植材料的研究进展,对组织工程化肌腱移植技术取得的成果进行总结。资料来源:应用计算机检索Medline1980-01/2005-01相关肌腱移植材料与组织工程化肌腱移植技术的文献,检索词“tendon transplant,tissue engineer,progress”,并限定文献语言种类为English。同时计算机检索CBM1990-01/2005-01相关肌腱移植材料与组织工程化肌腱移植技术方面的文献,检索词为“肌腱移植,组织工程,综述文献”,并限定语言种类为中文。资料选择:对资料进行初审,选取包括肌腱移植材料与组织工程化肌腱移植技术的文献,开始查找全文。纳入标准:①肌腱移植材料。②组织工程化肌腱移植技术。排除标准:综述文献,重复研究,Meta分析类文章。资料提炼:共收集到45篇关于肌腱移植材料与组织工程化肌腱移植技术的文献,纳入30篇符合标准的文献。资料综合:用于肌腱移植的材料主要有以下几类:自体肌腱、同种异体肌腱、人工肌腱和组织工程化肌腱。近年来在异体肌腱移植方面取得了较成熟的经验。20世纪80年代后期组织工程技术的建立和发展,为肌腱组织缺损的修复又提供了一条新的思路和途径。组织工程化肌腱的研究目的是将体外预制的肌腱回植入体内的肌腱缺损处以恢复关节的功能。目前,研究者正致力于研究同时集两类生物材料优点的细胞支架,与肌腱细胞联合体外培养,使之可以成为一种永久性的有生命活性的组织工程化肌腱。结论:肌腱移植的材料主要有自体肌腱、同种异体肌腱、人工肌腱和组织工程化肌腱等。种子细胞、细胞外基质材料应用的深入研究必将推动组织工程化肌腱移植技术的进一步发展。     

严多发伤并发症的早期控制

Objective To analyze the efficacy of early management of eomplications in patients with multi-ple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to resuscitate from shock, lethal triad of death (LTD), complications and treatment outcomes after operation. Results The length of operation time was (67.43±19.52) min, resuscitation time from shock was (6.77±3.16) h and LTD was (11.54±4.10) h in the damage control group, and (163.95±55.41) min, (22.51±11.65) h and (34.55±5.63) h, respectively, in the conventional group, with significant differences between the two groups (P< 0.01). The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the dam-age control group and 363.93 % and 9.84%, respectively, in the conventional group (P <0.05). Couclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by apply-ing the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of comphcations and the mortality rate of patients with severe multiple traumas.