眼底血管荧光造影在评估视网膜挫伤预后方面临床研究

目的：评价眼底血管荧光造影（FFA）在视网膜挫伤预后评价中的应用。方法选取视网膜挫伤患者51例为研究对象,分别采用视觉诱发电位（VEP）、FFA进行检查,并全部随访51例患者的视力变化。结果挫伤的眼睛其VEP P100波振幅明显降低,潜伏期明显延迟;治疗后VEP P100波振幅、潜伏期均明显改善（P＜0.05）;FFA检查混合性损伤32眼,单纯性损伤19眼,其中38眼表现为视网膜震荡,14眼表现为视网膜出血,5眼表现为脉络膜裂伤,4眼表现为黄斑裂孔,8眼表现为视神经挫伤。治疗后1个月复查眼底血管荧光造影显示,51眼中,视盘渗漏1眼,周边视网膜血管仍有渗漏者3眼,视网膜新生血管未退行1眼。结论VEP、F-ERG及FFA检查均可对眼挫伤患者进行有效的诊断及预后评估,临床应用中可根据患者情况联合或单独应用。     

血痛定巴布贴治疗军事训练急性软组织挫伤60例临床观察

目的观察血痛定巴布贴治疗军事训练急性软组织挫伤的临床效果。方法将60例患者随机分为两组,对照组给予常规镇痛、理疗、制动等方法治疗;治疗组在对照组基础上,外敷血痛定巴布贴治疗。结果治疗组有效率达100.0%,优于对照组,差异具有统计学意义（P〈0.05）。结论血痛定巴布贴是治疗军事训练急性软组织挫伤的有效方法,值得进一步研究和推广。     

血必净对肺挫伤患者D-二聚体及C-反应蛋白的影响

[目的]探讨血必净注射液对肺挫伤患者D-二聚体及C-反应蛋白(CRP)的影响。[方法]80例肺挫伤患者随机分为观察组及对照组,对照组给予常规治疗,观察组在常规治疗基础上给予血必净静点,两组分别在第1,3,7天抽血,比较D-二聚体、CRP及白细胞(WBC)水平的变化。[结果]肺挫伤患者D-二聚体、CRP及WBC水平升高,治疗后逐渐下降;与对照组比较,观察组D-二聚体、CRP及WBC水平在3 d及7 d明显下降(P0.05)。[结论]血必净注射液有助于降低肺挫伤患者D-二聚体、CRP及WBC水平,促进肺挫伤的恢复。     

Myocardial contusion presented as acute myocardial infarction after chest trauma

A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. Echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. Coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. Cardiopulmonary resuscitation was unsuccessful.     

N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma

Cardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum h-FABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3±2.10 ng/L versus 15.4±3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of BCC.     

水通道蛋白-4在人脑挫裂伤早期脑水肿的作用机制探讨

目的探讨人脑挫裂伤后早期AQP4在脑水肿形成中的作用机制,为颅脑损伤后脑水肿的治疗和预后提供客观依据。方法选取经颅脑CT证实为脑挫裂伤且需手术治疗的患者。手术过程中切取脑挫裂伤区组织标本60例为观察组,10例非功能区相对正常脑组织标本为对照组。对照组不做任何处理,观察组按伤后时间分为2h、6h、8h、12h、24h、72h6个亚组,每组10只（n=10）。采用免疫组化和图像分析技术测定各组相应时间点水肿区AQP4的表达水平,同时用干湿重法检测脑水肿含水量。结果与对照组相比较,观察组在伤后2hAQP4表达开始增加（P〈0．05）,6h、8h、12h明显增加（P〈0．01）,24h-72h达到最高（P〈0．01）。AQP4表达与脑含水量的变化规律趋于一致（r=0．912,P〈0．01）。结论脑挫裂伤后AOP4表达明显增强,提示AQP4可能与颅脑损伤的发生、发展过程密切相关,在损伤后脑水肿的形成过程中起重要作用。     

Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries

AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files. RESULTS: A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected.During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001). CONCLUSION: During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.     

肺挫伤患者多层螺旋 CT 影像学表现与预后

目的探讨肺挫伤（occuhpulmonarycontusion,OPC）患者多层螺旋CT（multi-slicespiralCT,MSCT）影像学表现与预后。方法对143例胸部钝性伤后行常规胸部正位平片和MSCT检查患者影像及临床资料进行回顾性分析。结果共87例患者检出肺挫伤,其中显性挫伤58例,24例继发肺炎,13例继发脓胸,16倒继续发展为急性呼吸窘迫综合征（ARDS）;隐匿性肺挫伤（OPC）29例,6例继发肺炎,1例发展为ARDS,末见继发脓胸患者;其余56例中7例继发肺炎,1例继发ARDS,未见继发脓胸患者。在OPC患者中,所有挫伤局限于一个肺叶的患者临床预后均较好;所有继发肺炎的患者挫伤范围均大于两个肺叶。结论OPC患者总体临床预后较好,MSCT能可靠的评价挫伤的范围,对OPC患者的临床治疗具有一定的指导意义。     

GFAP、MBP 在早期脑挫裂伤诊断中的价值

目的：探讨血清神经胶质纤维酸性蛋白（GFAP ）、髓鞘碱性蛋白（MBP ）联合检测在早期脑挫裂伤患者诊断中的价值。方法采用酶联免疫吸附实验（ELISA）法检测血清 GFAP、MBP 浓度,多组间比较采用单因素方差分析,两两比较采用 q 检验分析脑挫裂伤患者与健康人群间的差异。结果血清 GFAP、MBP 浓度,轻、重型颅脑损伤组与健康对照组3组间统计学分析差异有统计学意义（P ＜0．05）;对照组与轻型颅脑损伤组比较差异有统计学意义（P ＜0．05）;轻、重型颅脑损伤组比较差异有统计学意义（P ＜0．05）;对照组与重型颅脑损伤组比较差异有统计学意义（P ＜0．05）。脑挫裂伤患者早期血清 GFAP、MBP 浓度明显高于对照组,且损伤越重升高越明显。结论血清 GFAP、MBP 水平联合检测可以作为早期脑挫裂伤诊断及评估损伤程度的辅助指标。     

两种通气模式对严重肺挫伤的应用比较

目的 探讨不同模式下机械通气对严重肺挫伤患者的早期治疗效果.方法 选择35例诊断严重肺挫伤需要机械通气的患者,给予低潮气量+呼气末正压通气(PEEP)或同步间歇指令通气(SIMV)+压力支持(PSV)通气.结果 低潮气量+ PEEP组18例,SIMV+ PSV组17例.低潮气量+PEEP模式在改善低氧血症和降低吸气末峰压方面优于SIMV+ PSV模式(P ＜0.05).结论 低潮气量+ PEEP模式是减少呼吸机相关并发症的理想模式.