手背部深度烧伤切削痂延期植皮的临床观察

分析19例手部深度烧伤患者行削痂自体皮移植,术后近期自体皮移植成活优良率达96%,远期手功能恢复Ⅳ～Ⅴ级达90.5%。     

损伤控制外科理论在不稳定骨盆骨折中的应用

不稳定骨盆骨折可以认为是致命性的骨折,随着诊治技术不断提高,治疗方法呈现多样化,但疗效还不尽理想。本文引入了损伤控制外科的概念,对不稳定骨盆骨折伴有多发伤的救治程序进行综述。     

聚丙烯延胡索酸酯/β-磷酸三钙合成和对骨髓基质细胞生物学行为的影响

目的制备聚丙烯延胡索酸酯／β-磷酸三钙（PPF／β-TCP）复合材料。在体外检测PPF／β-TCP材料对骨髓基质细胞（BMSC）的黏附、增殖、成骨能力的影响，对PPF／β-TCP生物材料的性能进行评价。方法二步反应法合成PPF单体，加入β-TCP后进行交联。骨髓基质细胞在PPF／β-TCP材料上培养2、4、6、8、10、12h后胰蛋白酶消化，检测黏附细胞数。BMSC和PPF／β-TCP材料复合培养，用MTT法检测BMSC的增殖，绘制生长曲线，检测碱性磷酸酶的含量。结果BMSC在PPF／β-TCP材料上黏附，2～8h细胞数增加，到10h黏附数达最高，约为68％。BMSC在PPF／β-TCP材料上生长，第4、5天为对数生长期，第7、8天进入平台期。BMSC种植在PPF／β-TCP后上表达ALP并不断增加。结论PPF／β-TCP生物降解材料对BMSC的黏附、增殖、成骨功能无不良影响，是一种有前途的生物降解材料。     

以腹部损伤为主的多发伤全程一体化救治经验

目的 总结以腹部损伤为主的多发伤全程一体化救治经验,提高救治水平.方法 对2002年7月～2007年7月收治的675例腹部创伤合并多发伤患者资料进行回顾性分析.结果 急诊室滞留时间平均为(1.7±0.2)小时.其中实施手术者平均为(1.3±0.1)小时.确定性手术前时间平均为(2.2±0.3)小时,排除先送入病房观察再送入手术室患者,平均为(1.5±0.2)小时.救治成功率91.2%,死亡率7.3%.平均住院时间(20.5±1.3)天.结论 专业化救治模式、尽快明确诊断和确定手术指征、把握多部位损伤的处理顺序、合理运用损伤控制策略、积极防治早期致死性并发症对提高救治水平有重要意义.     

4 519例多发伤院内救治分析

目的研究多发伤患者的临床特点、治疗情况、并发症与预后的关系。方法回顾性分析我院4519例多发伤患者的致伤原因、治疗情况、并发症、死亡原因及与病死率的相关性。结果多发伤后致伤主要原因为道路交通伤(2410例,53.33%)、暴力伤(747例,16.53%)、坠落伤(575例,12.72%);主要受伤部位颅脑(2247例,18.71%)、腹部和骨盆损伤(2118例,17.64%)、胸部损伤(1853例,15.43%);主要并发症为休克(1497例,33.13%);后期主要致死原因为脓毒症合并多器官功能不全/衰竭(28例,82.35%),显著高于同时段其他致死原因(P<0.01)。结论多发伤致病因素复杂,临床病情、急救与诊断有其特点,并发症多,病死率高,一体化救治模式值得进一步探讨。     

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.     

人骨肉瘤外周血T淋巴细胞亚群和自然杀伤细胞免疫变化的研究

目的研究人骨肉瘤患者外周血T淋巴细胞亚群和自然杀伤细胞(NK细胞)的变化。方法采用流式细胞术对42例骨肉瘤、41例骨髓炎、34例健康者的外周血CD4 、CD8 、CD4 、CD4 /CD8 、CD3 、CD16 56均显著性低于骨髓炎患者和健康对照组(P<0.01),而CD8 则升高(P<0.05)。骨髓炎患者外周血CD4 、CD4 /CD8 、CD3 较健康人降低,CD8 则升高,但差异均无统计学意义(P>0.05),而CD16 56与健康对照组相比降低(P<0.05)。结论骨肉瘤患者细胞免疫功能明显降低;骨肉瘤患者的免疫抑制远较骨髓炎的强;骨肉瘤患者NK细胞的降低较骨髓炎患者明显多。流式细胞术可作为检测骨肉瘤患者免疫功能的有效方法。     

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.     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.