“四大假日外伤”的流行性病学调查分析与策略

目的 :调查、分析节假日外伤的流行性病学特点。方法 :以 2 0 0 0年四大节日期间 85 0 0名户外外伤患者为调查对象 ,对其一般情况、致伤原因、外伤情况及相关因素间的关系等方面进行调查分析。结果 :其间外伤的发生率与职业、文化程度等方面间有显著差异 ,自不慎致伤、交通伤为主要致伤因素 ,外伤中重伤发生率高 ,外伤部位以四肢为多。结论 :节假日外伤不容忽视 ,公民外伤的防范意识亟待提高 ,相关管理部门的管理力度有待加强     

Accessory articulation of the transverse processes in the cervical spine

Accessory articulation between the transverse processes of the C6 and C7 vertebrae is an extremely rare anatomic variant that has only been previously described in two instances. In this report, we present the case of a 25-year-old male who sustained numerous injuries associated with a physical assault. A CT study of the cervical spine revealed a linear lucency mimicking a fracture but found on closer inspection to represent an accessory articulation between the anterior tubercles of the right transverse processes of the C6 and C7 vertebrae. In this report, we summarize this patient''s clinical course, and provide an up-to-date review of the current literature, imaging characteristics, and potential mechanisms of the development of this anatomic variant. Our case also includes an incomplete version of the anomaly contralaterally as well as features of secondary osseous stress hypertrophy; these features have not been previously described and may aid in diagnosis. Finally, we provide the first-ever augmented reality model of this variant to fully convey its geometry and facilitate its unequivocal identification.     

急性脊柱创伤诊断及治疗的临床研究

目的研究急性脊柱创伤诊断及急性脊柱创伤手术治疗方法。方法回顾34例脊柱创伤的患者的临床及影像学资料,均采用短节段椎弓根钉固定治疗。术后1月复诊,观察骨折的恢复情况,神经功能恢复按Frankel评分。结果患者术后恢复情况良好,Frankel评分有显著改变。结论手术方法的选择应参考患者骨折类型,内固定器的特点,适合的手术方法,对患者的恢复及术后并发症的减少是很有意义的。     

严重创伤院前急救中值得探讨的几个问题

院前急救是严重创伤救治链中非常重要的一环,也是创伤救治体系三环理论中的一个基本环节,是我国急救医疗服务体系中的重要组成部分,是提高严重创伤救治成功率、降低死亡率的根本保证。目前国内院前急救的模式还不统一,存在较多争议,但创伤院前急救的快、准、稳是院前急救工作者永远追求的目标。通过回顾文献、结合临床工作经历,就创伤院前急救中涉及的几个问题做一初步探讨,供同仁参考。     

创伤院前急救的气道管理

本文将有关创伤院前急救时遇到的呼吸问题和急救技术进行总结、分类,其核心是对所有严重创伤患者进行阶梯化的呼吸管理——评估、预防和干预,使伤病员获得及时、有效的呼吸支持。     

小儿重度感染性脑损伤与心肌酶谱相关性分析

目的 探讨小儿感染引起重度脑损伤后心肌酶谱改变与格拉斯哥昏迷( GCS)评分及预后的关系,指导临床治疗和护理. 方法 对30例符合重度脑损伤诊断标准的患儿,于入院当天抽血化验心肌酶谱,包括天冬氨酸转氨酶( aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBDH)、肌酸磷酸激酶( creatine phosphokinase,CPK)、心肌型肌酸激酶同功酶(MB isoenzyme of creatine kinase,CKMB).结果 患儿GCS评分3～5分组的19例患者的心肌酶浓度明显高于11例GCS评分6～8分患者(P＜0.05).治愈组11例,留有后遗症组14例,死亡组5例,三组间心肌酶浓度差异显著,死亡组的浓度最高,治愈组的浓度最低(P＜0.05). 结论 小儿重度感染性脑损伤GCS评分越低,心肌酶谱值越高,预后越差.     

Transient loss of consciousness with and without injuries

Objectives: Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting.

Methods: A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling.

Results: Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital.

Conclusions: Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.     

不同麻醉方法对重症颅脑损伤患者脑氧代谢的影响

目的 探讨三种不同麻醉方法对重症颅脑损伤患者脑氧代谢的影响.方法 选择2011年3月至2013年3月收治的45例重症颅脑损伤患者,按随机数字表法分为丙泊酚静脉麻醉组(A组)、七氟烷吸入麻醉组(B组)与静吸复合麻醉组(C组),每组15例.分别于麻醉前、插管即刻、插管后2min、手术开始后10min及30 min、术毕记录平均动脉压(MAP)、心率(HR),于麻醉诱导前、诱导完成即刻、手术开始后30 min及1h、术毕抽取桡动脉和颈内静脉球都血液行血气分析,计算各时间点的颈内静脉血氧饱和度(SjvO2)、桡动脉-颈内静脉血氧含量差(Da-jvO2)以及脑氧摄取率(CERO2).结果 三组患者手术开始后30 min、手术开始后1h及术毕SjvO2均显著高于麻醉诱导前(A组:0.662±0.077、0.689±0.067、0.685±0.066比0.623±0.083;B组:0.661±0.074、0.681±0.072、0.661±0.069比0.598±0.092;C组:0.715±0.072、0.743±0.070、0.713±0.075比0.631±0.078),差异有统计学意义(P＜0.05),而手术开始后30 min、手术开始后1h及术毕Da-jvO2、CERO2均显著低于麻醉诱导前[A组Da-jvO2:(41.2±6.3)、(41.6±8.1)、(41.2±6.3) ml/L比(49.2±9.2)ml/L,CERO2:(33.0±1.9)％、(32.7±2.0)％、(32.3±1.9)％比(36.0±2.3)％;B组Da-jvO2:(41.8±5.6)、(40.2±6.9)、(41.8±5.6) ml/L比(51.3±8.6) ml/L,CERO2:(33.2±2.1)％、(33.0±2.6)％、(32.8±2.1)％比(34.7±3.1)％;C组Da-jvO2:(39.5±6.8)、(38.7±7.0)、(40.2±6.8) ml/L比(48.8±9.7) ml/L,CERO2:(31.8±2.9)％、(31.5±3.1)％、(32.9±2.3)％比(35.1±2.9)％],差异有统计学意义(P＜0.05),且C组CERO2降低更为显著,差异有统计学意义(P＜0.05).三组不同时间点MAP、HR比较差异均无统计学意义(P＞0.05).结论 丙泊酚静脉麻醉与七氟烷吸入麻醉均能有效地降低重症颅脑损伤患者围手术期脑氧代谢率,而且两者复合麻醉的效果更佳,血流动力学稳定.     

Trauma Care Training for National Police Nurses in Colombia

Abstract

Introduction. In response to a requirement for advanced trauma care nurses to provide combat tactical medical support, the antinarcotics arm of the Colombian National Police (CNP) requested the Colombian National Prehospital Care Association to develop a Combat Tactical Medicine Course (MEDTAC course). Objective. To evaluate the effectiveness of this course in imparting knowledge and skills to the students. Methods. We trained 374 combat nurses using the novel MEDTAC course. We evaluated students using pre- and postcourse performance with a 45-question examination. Field simulations and live tissue exercises were evaluated by instructors using a Likert scale with possible choices of 1 to 4. Interval estimation of proportions was calculated with a 95% confidence interval (95% CI). Differences in didactic test scores were assessed using a t-test at 0.05 level of statistical significance. Results. Between March 2006 and July 2007, 374 combat nursing students of the CNP were trained. The difference between examination scores before and after the didactic part of the course was statistically significant (p < 0.01). After the practical session of the course, all participants (100%) demonstrated competency on final evaluation. Conclusions. The MEDTAC course is an effective option improving the knowledge and skills of combat nurses serving in the CNP. MEDTAC represents a customized approach for military trauma care training in Colombia. This course is an example of specialized training available for groups that operate in austere environments with limited resources.