Predicting Factors for Mortality in the Penetrating Abdominal Trauma

Purpose: penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT.

Methods: the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups: “Healthy Group” (HG) (n = 942) and “Deathly Group” (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multi-variate analyses.

Results: a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01 ± 63.9 (14–74) years and 30 ± 12.5(15–71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09 ±1.3 (0.5–3) and 6.9 ±11.4 (1–6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98 ±1.08 (1–7) and 4.67 ±1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78 ± 9.44 (158) and 46.24 ± 22.18 (15-119) in the HG and DG respectively (p = 0.000).

In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03–38.12, P = 0.000], the long IBIO (OR = 1.82, CI = 1.39–2.40, P = 0.000), PSDA (OR = 94.45, CI = 28.32–314.95, P = 0.000), presence of cranial injury (OR = 0.03, CI = 0.002–0.363, P = 0.006) and high PATI (OR = 1.14, CI = 1.09–1.19, P = 0.000), were found significantly important for mortality.

Conclusion: we determined that conditions such as, female gender, long interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.     

Clinical Profile of Commotio Cordis: An Under Appreciated Cause of Sudden Death in the Young During Sports and Other Activities

Blunt Chest Impact Leading to Cardiac Arrest. Not particularly well recognized are athletic Held catastrophes in which virtually instantaneous cardiac arrest is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart (commotio cordis). To better characterize the clinical profile of this syndrome, we have assembled 70 cases, including 34 occurring during organized competitive athletics and 36 others that occurred during informal recreational sports at home, school or the playground, or during nonsporting activities. Ages were 2 to 38 (mean age: 12) with 70% < 16 years old. Most common sports involved were youth baseball (n = 40), softball (n = 7), and ice hockey (n = 7). Seven (10%) of the 70 commotio cordis victims, including six with documented ventricular fibrillation, have survived the consequences of their chest blow. Eleven of the events (16%) occurred despite the presence of chest padding believed to be potentially protective. Four victims experienced modest chest blows while in circumstances completely unrelated to sports activities; three of the four individuals who delivered these blows were ultimately convicted of criminal acts within the justice system. An experimental model of low-energy chest wall impact demonstrates that commotio cordis events are due largely to the exquisite timing of blows during a narrow window within the repolarization phase of the cardiac cycle, 15 to 30 msec prior to the peak of the T wave.     

颅脑创伤后外周血白细胞的动态变化及意义

目的研究颅脑创伤（TBI）后不同时间患者外周血白细胞（WBC）的动态变化规律及其临床意义。方法测定77例TBI患者伤后不同时间点外周血WBC的动态变化,分析WBC变化的影响因素。结果重型组受伤后第1、4、7天的WBC明显高于轻型组;感染组整体变化趋势明显高于无感染组,且第7、14天WBC与无感染组比较均有统计学差异（P均〈0．01）;病情恶化组第1、4、7、14天的WBC均明显高于治疗好转组（P〈0．05或〈0．01）。结论WBC的早期升高与伤情有关;伤后4d内WBC升高不能作为判定是否感染的指标,伤后1—2周仍持续升高者可作为判定感染的指标之一;伤后1周内WBC明显升高者预后较差。反之预后较好。     

颅脑外伤病人的PT、APTT、FIB、TT参数的变化

目的探讨颅脑损伤疾病时凝血4项:PT(凝血酶原时间)、APTT(活化部分凝血活酶时间)、TT(凝血酶时间)、FIB(纤维蛋白原)的变化及临床意义。方法美国库尔特ACL Futura plus全自动血凝分析仪检测,收集GCS评分13~15分18例;9~12分26例;3~8分42例;对照组30例。结果PT、APTT、TT与正常对照组有显著性差异;发现颅脑损伤不同程度发生凝血功能障碍不同,它们发生凝血功能异常的程度与疾病严重程度相关。结论检测PT、APTT、TT可以了解颅脑损伤患者的凝血功能,判断疾病的严重程度,及时了解有无出血倾向,有助于颅脑损伤疾病的诊断和治疗。     

腹部创伤患者肠内营养喂养不耐受预警评估指标体系的构建

目的 构建腹部创伤患者喂养不耐受预警评估指标体系,为早期识别腹部创伤患者喂养不耐受风险提供参考。方法 基于循证,结合临床护理实践,采用德尔菲专家咨询法对16名专家进行2轮专家咨询,并对调查数据进行统计分析,最终确定方案。结果 专家的积极性分别为94%、100%;专家权威系数为0.906;2轮重要性及准确性的变异系数分别为0~0.265、0~0.255及0.084~0.250、0.068~0.178,肯德尔协调系数差异有统计学意义。最终形成患者基本状况、实验室指标、临床治疗措施、临床用药以及肠内营养相关因素5个维度,32个条目。结论 构建的腹部创伤患者喂养不耐受评估预警指标内容较为全面,具有科学性,临床实用性强,可为临床早期识别腹部创伤患者喂养不耐受风险提供参考。     

我国儿童药研制的制约因素分析及政策建议——基于医药企业的视角

目的：为完善我国儿童药供应保障政策提供依据。方法：基于医药企业视角通过文献综述、问卷调研梳理药品全生命周期中儿童药研制的制约因素,分析其集中和迫切程度。结果：儿童药的主要制约因素包括：儿童临床试验开展难度大;注册审批规则中缺乏对儿童药特殊性的考虑和专门的材料要求;生产激励政策落地缺乏实施细则和措施;市场利益机制尚不完善等。其中,研发和使用支付是问题相对集中的环节。讨论及建议：建议我国开拓并合理使用儿童临床试验资源,多举措增加儿童药研发投入;制定儿童药申报的专项指南,鼓励成人药品注册时提交儿童研究计划;基于典型案例探索儿童药生产供应优化路径;在药品使用与支付规则中给予儿童药更多空间。     

Through‐and‐through gunshot wound to the head in a rare case of survival

We describe the case of a 42‐year old Caucasian male who presented for follow‐up treatment of refractory epilepsy. He suffered a cranial trauma 13 years before when a bullet from a pistol, (presumably accidentally) entered the right frontal side of the cranial vault and exited contralateral, causing severe neurological damage.     

腹腔镜诊断治疗腹部刺伤90例报告

目的：探讨腹腔镜诊断及治疗腹部刀刺伤的价值。方法：腹部刀剌伤90例患者术前探查示与腹腔相通,应用腹腔镜完成诊断及治疗。结果：90例患者均在腹腔镜下明确诊断。17例无腹腔内脏损伤,52例于腹腔镜下完成治疗,21例中转开腹。结论：诊断明确的腹部刀刺伤选用腹腔镜探查,多可同时完成治疗,只少部分病例需开腹手术。     

胸外伤的临床治疗分析

目的 探讨胸外伤的临床诊治措施.方法 回顾分析65例患者的临床资料.结果 65例患者中治愈62例(95.38%),死亡3例(4.62%).死亡原因:直接死于胸部伤大出血死亡1例,死于胸外伤合并ARDS 1例.合并颅头伤死亡1例.结论 胸外伤大多有合并伤,入院时病情多危重,首先要及早诊断,保持良好的呼吸道通畅,有效的抗休克治疗,积极治疗肺挫伤,可明显提高抢救的成功率.     

基于WHO/HAI标准化法的陕西省零售药店儿童基本药物可获得性及价格研究

目的:为我国儿童基本药物目录的出台及改善儿童药物使用现状提供参考。方法:采用世界卫生组织和国际健康行动组织共同制定的WHO/HAI标准化法,于2012年对陕西省6个城市的60家零售药店的28种儿童基本药物进行调研,将零售药店药品零售价格与国际参考价进行对比研究。结果:儿童基本药物在陕西省零售药店的可获得性低;原研药零售价格远高于国际参考价,而最低价格仿制药零售价格较为合理;治疗急性病的儿童基本药物的可负担性较好。结论:应尽快出台儿童基本药物目录;加大研发适宜儿童使用的剂型、规格及包装;对原研药合理定价;鼓励零售药店采购和销售基本药物。