轻型脑损伤患者血清S-100蛋白检测的临床意义

目的探讨S-100蛋白检测在轻型脑损伤患者中的临床应用价值。方法选择80例格拉斯哥昏迷（GCS）评分在13—15分间的头部外伤病人,进行头部CT扫描和使用电化学发光法检测病人血清S-100蛋白水平,并进行统计学分析。结果34例病人血清S-100蛋白呈阳性,占42％,其中4例病人CT呈阳性占5％;46例病人血清S-100蛋白呈阴性占58％,CT检查均呈阴性。以cT阳性作为脑损伤的判断标准相比较,S-100蛋白的灵敏度为100％,阴性预测值为100％。结论S-100蛋白检测能更好的预测头部外伤病人的颅内出血情况。     

多层螺旋CT对创伤性膈损伤的诊断价值

目的 探讨创伤性膈损伤的多层螺旋CT(MSCT)表现特征及诊断价值.方法 回顾性分析笔者医院创伤性膈损伤患者33例,其中男性28例,女性5例,患者年龄1～76岁,33例均行MSCT检查且行冠、矢状位多平面重建(MPR)处理,分析患者临床资料与MSCT表现特征及诊断价值,影像学表现包括膈肌连续性中断征、膈肌增厚征、项圈征、面包征及膈疝部位及内容物等.结果 33例中,2例为单纯挫伤,31例为钝性损伤(左侧26例,右侧5例),膈疝内容物分别为胃或含液气肠袢(左侧25例,右侧1例)、肝脏(仅右侧3例)及腹腔脂肪(左侧16例,右侧2例);MSCT提示膈肌异常的敏感度为100％,21例(67.7％)可见膈肌连续性中断征,10例(32.2％)可见膈肌增厚征,项圈征与面包征各5例(16.1％).与横断面相比,MPR能更好地显示膈肌连续性中断征(P＜0.05).结论 MSCT检查对诊断创伤性膈损伤有重要价值,尤其是MPR技术对诊断有很大帮助.     

七氟醚与氯胺酮在小儿麻醉维持中的荟萃分析

目的系统评价七氟醚和氯胺酮在小儿麻醉维持中的效果及其并发症,为其临床决策提供依据。方法以七氟醚或氯胺酮、小儿麻醉维持为检索词,检索Pubmed、中国知网和维普等数据库,文献起止时间均从建库至2011年12月,纳入所有采用七氟醚吸入或氯胺酮静脉维持小儿麻醉的研究文献,用RevMan 5.1.1软件进行Meta分析。结果共纳入17个随机对照试验,3 771例患儿。Meta分析结果示,①呼吸道分泌物：七氟醚麻醉口腔分泌物明显少于氯胺酮[RR=0.03,95%CI（0.01,0.09）];②术中躯体运动：氯胺酮全麻术中体动高于七氟醚全麻[RR=0.06,95%CI（0.03,0.12）];③术后睁眼或体动时间：七氟醚的苏醒时间明显短于氯胺酮[WMD=-29.84,95%CI（-36.61,-23.07）];④出手术室或PACU时间：七氟醚的出室或PACU的时间少于氯胺酮[WMD=-21.41,95%CI（-29.99,-12.84）];⑤术后躁动：七氟醚术后躁动发生率显著高于氯胺酮[RR=0.07,95%CI（0.04,0.11）];⑥术后呕吐：两者之间差异无统计学意义[RR=0.75,95%CI（0.61,0.93）]。结论小儿氯胺酮麻醉后分泌物明显多于七氟醚,术中七氟醚维持较少出现体动,七氟醚麻醉苏醒更快,但七氟醚麻醉术后躁动明显高于氯胺酮。     

How to become Pediatric Orthopedic surgeon inEurope:a long journey offering a unique career,full of satisfactions

In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthopedic and Trauma surgery program,the future PO surgeon must complete an additional subspecialty training (one to two years,depending on the country) in PO surgery.The possibility to become a certified PO surgeon through the specialization in Pediatric Surgery (option Orthopedics) or through a dedicated PO surgery training program only exists in France and in Romania,respectively.Credit as active and fully responsible PO surgeon can only be claimed when the trainee has actively participated in all phases of treatment,from diagnosis to treatment,without forgetting the management of complications and the setting up of an adequate follow-up of children and adolescents with musculoskeletal disorders.     

急性创伤性凝血病的研究进展

急性创伤性凝血病是创伤后发生率较高且后果较为严重的并发症之一,其死亡率高,较易发展为多器官功能衰竭。早期诊断和积极处理急性创伤性凝血病是急诊创伤外科治疗的重要内容,也是降低创伤死亡率的关键。本文就近期急性创伤性凝血病的流行病学资料、影响因素、病理生理机制和临床治疗等方面的研究新进展作一综述,希望为临床工作提供参考。     

Radiation exposure from head computed tomography scans in pediatric trauma

Background

We have previously reported that children receive significantly less radiation exposure after abdominal and/or pelvis computed tomography (CT) scanning for acute appendicitis when performed at our children's hospital (CH) rather than at outside hospitals (OH). In this study, we compare the amount of radiation children receive from head CTs for trauma done at OH versus those at our CH.

Methods

A retrospective chart review was performed on all children transferred to our hospital after receiving a head CT for trauma at an OH between July 2012 and December 2012. These children were then blindly case matched based on date, age, and gender to children at our CH.

Results

There were 50 children who underwent head CT scans for trauma at 28 OH. There were 21 females and 29 males in each group. Average age was 7.01 ± 0.5 y at the OH and 7.14 ± 6.07 at our CH (P = 0.92). Average weight was 30.81 ± 4.69 kg at the OH and 32.69 ± 27.21 kg at our CH (P = 0.81). Radiation measures included dose length product (671.21 ± 22.6 mGycm at OH versus 786.28 ± 246.3 mGycm at CH, P = 0.11) and CT dose index (53.4 ± 2.26 mGy at OH versus 49.2 ± 12.94 mGy at CH, P = 0.56).

Conclusions

There is no significant difference between radiation exposure secondary to head CTs for traumatic injuries performed at OH and those at a dedicated CH.     

严重创伤患者早期外周血淋巴细胞变化与预后之间的关系

目的: 探讨严重创伤早期外周血淋巴细胞变化趋势与预后间的关系。方法: 选取2017年6月至2020年6月北京大学人民医院创伤救治中心收治的严重多发伤患者作为研究对象进行回顾性研究, 观察入院后连续5 d血常规中淋巴细胞变化趋势并进行分组, 第1组: 淋巴细胞减少后在5 d内恢复正常; 第2组: 淋巴细胞减少后未恢复正常; 第3组: 淋巴细胞一直处于正常水平, 并记录各组患者在住院28 d后的转归情况。对收集的临床资料进行统计学分析, 了解创伤早期淋巴细胞变化趋势与预后间的关系。同时, 为排除年龄的影响, 依据年龄是否≥65岁进行分层, 并根据住院时间是否≥28 d分为住院时间延长组和住院时间非延长组, 在不同年龄组中分别探讨淋巴细胞变化与住院时间的关系。结果: 共纳入患者83例, 其中男性66例, 女性17例, 主要受伤机制为车祸伤和高处坠落伤, 创伤严重程度评分(injury severe score, ISS)为(30±11)分。根据连续5 d淋巴细胞变化趋势分组, 第1组32例, 第2组33例, 第3组18例。第2组33例患者中, 在住院28 d内死亡5例, 死亡率为15.2%(5/33), 未出院9例, 均高于其他两组(P < 0.05)。进一步按年龄进行分层后, 发现在高年龄患者中淋巴细胞处于低水平是住院时间≥28 d的危险因素, 但在低年龄患者中, 发现中性粒细胞持续偏高与预后不良相关。结论: 严重创伤后外周血淋巴细胞一直处于低水平与预后不佳密切相关, 尤其在高年龄患者中明显, 淋巴细胞可作为一项可靠指标用于预后评估。     

手术室护理干预在颌面外伤清创缝合术中的效果观察

目的 分析手术室护理干预在颌面外伤清创缝合术中的效果。方法 选取2023年1月-12月湖南中南 大学湘雅口腔医院行颌面外伤清创缝合术患者88例,随机分为对照组和观察组,每组44例。对照组接受常规 护理,观察组接受手术室护理干预,比较两组伤口Ⅰ期愈合情况、术中依从性、抑郁和焦虑程度、护理满 意度、并发症发生情况。结果 观察组伤口Ⅰ期愈合率为95.45%,高于对照组的72.73%（P＜0.05）; 观察组术中总依从率为97.73%,高于对照组的81.82%（P ＜0.05）;两组干预后SAS和SDS评分均低于干预 前,且观察组干预后SAS和SDS评分低于对照组（P ＜0.05）;观察组护理满意度各维度评分和总分均高于 对照组（P＜0.05）;观察组并发症发生率低于对照组（P ＜0.05）。结论 手术室护理干预能够促进颌面外 伤患者伤口愈合,缓解负性情绪,提高术中依从性,降低并发症发生率,且患者满意度较高。     

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.     

不同液体复苏方法对重症胸部创伤合并休克患者ARDS发生率及预后的改善作用

目的：：探讨急诊手术对重症胸部创伤合并休克患者ARDS发生率及预后的改善作用。方法：随机选取我院2014年5月至2016年5月收治的112例重症胸部创伤合并休克患者,依据急诊手术方法将这些患者分为常规液体复苏组( n＝56)和限制液体复苏组( n＝56)两组,对两组患者的临床疗效、ARDS等并发症发生情况及死亡情况进行统计分析。结果：限制液体复苏组患者治疗的总有效率显著高于常规液体复苏组( P<0.05),ARDS、脓胸、肺部感染发生率及死亡率均显著低于常规液体复苏组( P<0.05)。结论：急诊手术中限制液体复苏法较常规液体复苏法更能有效降低重症胸部创伤合并休克患者ARDS发生率,改善其预后。