Management of shock in trauma

Shock is defined as failure of the circulatory system resulting in a level of perfusion to tissues, which is inadequate to meet the oxygen demands of cellular metabolism. Haemorrhagic shock is most commonly associated with trauma. Haemorrhage is a leading cause of preventable death in trauma and over the past two decades there has been an increasing understanding of the pathophysiological processes that occur in major haemorrhage associated with trauma. This has been fundamental to the development of the current approach to management of traumatic shock, known as damage control resuscitation (DCR). DCR encompasses three key resuscitative strategies: permissive hypotension, haemostatic resuscitation (the use of blood products as primary resuscitative fluids) and damage control surgery. The implementation of DCR alongside the creation of trauma networks has been revolutionary in the management of the shocked trauma patient.     

Anaesthetic priorities in pre-hospital trauma care

Trauma is a significant cause of morbidity and mortality in the UK. Developments in the delivery of pre-hospital trauma care and advances in techniques for managing critically injured patients on scene, partly due to military medical experiences in the past two decades, have encouraged greater scrutiny of the performance of these services. In addition to the unique environmental and logistical challenges posed by pre-hospital care, the injury and physiology patterns typically associated with trauma patients necessitate a specific approach to their assessment and treatment, whereby control of catastrophic haemorrhage is prioritized before management of airway, breathing and circulation issues (<C>ABC). The time-critical casualty needs to be recognized, and immediate life- or limb-threatening complications addressed promptly, with expedited evacuation to definitive hospital care. In 2011 the General Medical Council (GMC) approved pre-hospital emergency medicine (PHEM) as a subspecialty of emergency medicine, anaesthesia, and intensive care medicine. This highlights PHEM as an area of medical expertise which requires training of its practitioners, as well as demonstration of competent, evidence-based, and meticulously audited practice.     

骨髓腔穿刺输液途径抢救产后大出血休克

目的：观察实施骨髓腔穿刺输液途径抢救产后大出血休克的临床疗效。方法：将78例产后大出血患者设为观察组,另通过回顾性医疗文献收集80例情况类似的患者设为对照组。对照组采用传统静脉穿刺输液途径．观察组实施骨髓腔穿刺输液途径。观察入院抢救开始至输液通道建成时间、开始抢救及从急救输液通道用药至血压回升时间、抢救4h内疗效、病死率等指标。结果：观察组建立通道时间、血压回升时间2项指标均低于对照组（P〈0．01）;观察组血压回升数值和每小时尿量均高于对照组（P〈0．01）;动脉血氧饱和度和静脉血氧饱和度均差异有统计学意义（P〈0．01）;观察组组织缺氧情况的改善优于对照组（P〈0．01）;观察组患者病死率低于对照组（P〈0．01）。结论：骨髓腔穿刺输液途径作为常规选择方案用于抢救产后大出血休克．可提高抢救治疗效果,降低病死率。     

Evaluation on therapeutic effects of orthotopic liver transplantation by megnetic resonance imaging in patients with portal hypertension

Background Orthotopic liver transplantation （OLT） has become the therapeutic option of choice for end-stage liver disease. The aim of this study was to investigate the changes of splenic morphology, signal-to-noise ratio （SNR）, contrast- to-noise ratio （CNR）, apparent diffusion coefficient （ADC） values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation （OLT） on portal hypertension at 1.5 Tesla MRI. Methods Twenty patients with portal hypertension undergoing OLT were included in this study. Conventional MRI and diffusion-weighted image （DWI） （b value=600 s/mm2） sequences were applied on each patient before and after OLT, and these patients were referred to as the preoperative and postoperative groups. Twenty healthy individuals were selected as the normal group. After image acquisition, the splenic width （W）, thickness （T）, length （L）, the diameter of the portal vein （PD） and splenic vein （SD） were measured and the splenic volume （V） was calculated. The SNR and CNR were measured on T2WI. The ADC maps were calculated using the bs00 in DWIs and the ADC values were measured. Results Compared with the preoperative group, the splenic V, PD and SD decreased significantly in the postoperative group （P 〈0.05）. All splenic morphological values were significantly different between preoperative and normal groups （P 〈0.05）. The splenic L and V were significantly different （P 〈0.05） between postoperative and normal groups. The SNR and CNR values were 17.66＋4.62 and 13.18＋3.12, 11.50＋1.64 and 7.44＋4.32, 4.24＋1.24 and 3.03＋2.41 in the preoperative, postoperative and normal groups, respectively. Both SNR and CNR decreased after OLT, but they was still higher than the normal values. The SNR was significantly different between any two groups （P 〈0.05）. The CNR was significantly different （P 〈0.05） between the preoperative and postoperative groups, preoperative and normal groups. The splenic AD     

超高压大块式压缩机基础设计参数分析

结合工程实例,计算分析影响超高压活塞式压缩机基础最大振幅的相关设计参数。分析结果表明：低频超高压机器基础设计时,由于其位移限制极其严格,宜使基组自振频率高于机器扰力频率,尽量浅埋基础,并根据位移控制情况选择合适的基础形式。     

硝酸甘油与垂体后叶素治疗支气管扩张伴咯血的临床疗效观察

目的探讨硝酸甘油与垂体后叶素治疗支气管扩张伴大咯血的疗效与安全性。方法选取2010年1月至2012年1月东南大学附属江阴人民医院呼吸科收治的支气管扩张伴大咯血患者80例,随机分为A组40例和B组40例,两组均给予氧疗、抗感染、祛痰等基础治疗,同时A组予以垂体后叶素治疗,B组予以硝酸甘油与垂体后叶素治疗。治疗24h时,记录两组止血的效果,同时记录与服用药物有关的不良反应,并对两组进行比较。结果B组止血总有效率为97．50％,A组总有效率为85．00％,B组的疗效显著优于A组（P〈0．05）,B组出现胸闷、高血压、心悸等不良反应显著少于对照组（P〈0．05）,而出汗、面色苍白、腹泻、腹痛的不良反应与对照组比较差异无统计学意义（P〉0．05）。结论硝酸甘油与垂体后叶素治疗支气管扩张伴大咯血的疗效确切,安全性高。     

超选择性血管栓塞治疗难治性大咯血的疗效分析

目的回顾性分析超选择性血管栓塞治疗难治性大咯血的疗效、影响疗效的因素、并发症及安全性.方法对行超选择性血管栓塞治疗的75例反复发作难治性大咯血患者进行回顾性分析.结果本组75例患者治愈56例,治愈率74.67%,显效9例,有效4例,总有效率92%,无效6例,无效率8.0%.结论超选择性血管插管栓塞治疗难治性大咯血疗效好、安全、创伤小,并发症发生率低.     

大量输血患者及时输注血浆的重要性

目的观察大量输血患者及时监测凝血四项,并及时补充新鲜冷冻血浆对其各项凝血指标的影响。方法选择大量输血的手术患者56例（24h内输入悬浮红细胞〉10U）,将仅输注悬浮红细胞未输注血浆者设为对照组,同时输注悬浮红细胞和输注血浆者设为实验组,监测术前、输血前和输血后的凝血四项和血小板等指标。结果两组患者输血后凝血功能均发生改变,PT、APTT、TT均较输血前延长,而FIB水平下降（P〈0.01）。输血后对照组PT、APTT、TT均较对照组更长,而FIB水平更低,差异具有统计学意义（P〈0.01）,对照组发生出血的危险明显高于实验组。结论在大量输血时,要及时进行机体凝血四项和血小板的监测,有条件的同时进血栓弹力图的监测,及时输注血浆补充凝血因子,以避免不必要的出血,提高输血疗效。     

医用三氧治疗急性期大面积脑梗死疗效及对血脂、血氧饱和度的影响

目的探讨医朋三氧治疗急性期大面积脑梗死的临床疗效,观察医用三氧对血脂、血氧饱和度的影响。方法将60例急性期大面积脑梗死患者随机分为医用三氧治疗组和对照组,治疗组在常规药物和康复治疗基础上行医用三氧治疗,对照组为常规药物和康复治疗,两组患者治疗前和治疗2周后应用NIHSS（美国国立卫生研究院脑卒中量表）神经功能缺损评分,治疗前后检测血脂和血气分析血氧饱和度。结果两组治疗2周后与治疗前比较神经功能评分均有明显改善,治疗后治疗组的神经功能缺损评分与对照组比较差异有统计学意义（P〈0．05）;治疗组总有效率73．3％,对照组总有效率66．7％,治疗组治疗后低密度脂蛋白胆周醇下降（P〈0．05）,血氧饱和度提高（P〈0．05）,对照组的血脂和血氧饱和度无变化。结论医用三氧能明显提高急性期大面积脑梗死患者的疗效,同时能降低低密度脂蛋白胆同醇,提高血氧饱和度。     

恶化型脑梗死超早期临床与影像学研究

目的探讨恶化型脑梗死的早期影像学诊断与治疗。方法32例临床拟诊为恶化型脑梗死患者行急诊CT、MRI弥散加权成像（DWI）检查。确认病例立即行rt-PA溶栓等治疗。梗死25例。急诊CT检出大面积脑梗死14例，DWI检出25例。断恶化型脑梗死。超早期行溶栓等治疗效果较好。回顾性研究上述病人的临床资料。结果最终确诊恶化型脑经溶栓等治疗，好转14例。死亡11例。结论DWI可准确地诊