严重胸腹部创伤96例回顾性分析

回顾分析96例严重胸腹部创伤临床资料，认为严重胸腹伤应加强抢救，早期诊断，尽早手术。通过积极治疗、防治并发症，提高生存率。     

加强战备建设，提高卫勤保打赢能力

为落实军委交付我部的战备任务，以保“打赢”为目标，全面贯彻落实《沈阳军区卫生战备建设“十五”规划》，狠抓卫生战备建设，较好地提高了部队综合卫勤保障能力。现将我们的主要做法总结如下。     

联合登岛战役第二梯队集团军作战准备阶段卫勤保障难点与对策

联合登岛战役期间，第二梯队集团军由于驻地距预定集结地区较远，首先面临着如何将齐装满员的重兵集团投送到预定集结地区。在应急扩编、机动准备，跨区机动、战役集结与筹划等作战准备各阶段，卫勤保障存在很多难点，解决好这些难点，可以大大提高部队战斗力。     

积极发挥医院药事管理在单病种管理中的作用

随着现代医学模式的转变，医院功能发生变化，医院药事管理也从对“物”的管理，转变为以对患者合理用药为中心的药事管理，向着多功能、标准化、制度化方面发展。保证和提高民众用药的安全性、有效性、经济性和适当性，也即保证和提高合理用药水平已成为医院药事管理的根本目标和任务。单病种管理是建立在疾病分级的基础上，对单一病种从确诊人院、治疗至治愈出院而进行的管理。     

氢溴酸高乌甲素局部痛点封闭治疗膝骨关节炎

目的评价氢溴酸高乌甲素（注射液）局部痛点封闭治疗膝骨关节炎（osteoarthritis，OA）的临床疗效。方法门诊选取有局部压痛点的由膝OA所引发的慢性膝关节疼痛病人80例，随机分成两组，治疗组40例，对照组40例。治疗组应用氢溴酸高乌甲素注射液，对照组应用醋酸泼尼松龙＋利多卡因，均单纯行关节外痛点注射，每2周门诊随访1次，总观察时间3个月，两组疗效进行对比。结果全部病例完成治疗，无失访及治疗中断者。治疗组有效缓解率85％，对照组有效缓解率80％，两者相比无显著性差异（P〉0．05）。治疗组未发现不良反应。结论以氢溴酸高乌甲素替代传统的醋酸泼尼松龙行局部痛点封闭，可有效缓解膝OA病人痛点的慢性疼痛，镇痛效果良好，安全性高。     

严重创伤患者早期凝血功能变化及与血浆血栓调节蛋白、蛋白C的关系

目的 探讨严重创伤患者早期凝血功能变化及与血浆血栓调节蛋白(thrombomodu1in,TM)、蛋白C水平的关系及其临床意义. 方法 选择早期多发伤患者64例,按严重创伤程度评分( ISS)分为重伤组(ISS≥16分)和轻伤组(ISS＜ 16分),比较分析各组凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)变化,同时检测血浆TM和蛋白C水平,分析与凝血功能变化的相关性.另选择30例健康人为正常对照组.比较分析死亡和生存患者血浆TM和蛋白C水平的变化. 结果 重伤组PT和APTT较轻伤组及正常对照组明显延长(P＜0.05),与血浆TM和蛋白C的水平变化均有明显的相关性(P＜0.05).死亡患者血浆TM水平明显高于生存患者,蛋白C明显低于生存患者. 结论 严重创伤患者早期出现凝血功能异常,与血浆TM和蛋白C的活化相关,血浆TM和蛋白C水平对预后有重要的预测价值.     

加强卫生员队伍建设 提高部队卫生工作水平

卫生员是基层部队卫生力量的重要组成部分 ,是军队卫生工作的重要方面。因此 ,加强卫生员队伍建设 ,对全面提高部队卫生工作水平有着极其重要的意义。几年来 ,我部在卫生员队伍建设上严格把关、科学培训、大胆管理和使用 ,取得了一定成效 ,部队卫生工作水平有了较大幅度的提高。1　严格选拔卫生员队伍素质的高低在很大程度上取决于其文化层次、思想道德水平。基于这一点 ,我们一直将文化层次高、思想素质好、作风纪律优良、安心部队工作作为选拔卫生员的基本条件 ,采取本人申请、连队推荐、旅 (团 )军务和卫生部门审查 ,并通过上级组织的统…     

某部114例军事训练伤调查分析

军队训练伤是部队军事劳动中最常见的损伤之一 ,直接影响军队训练和执勤 ,并损害指战员的健康。为此 ,我们对 1995年度收治的某部 114例军事训练伤进行了分析。结果报告如下。1　资料与方法　 (1)资料 :来源于某部 1995年发生军事训练伤的 114名战士 ,年龄 18～ 2 2岁 ,入伍年限 1～ 4年 ,分别来自该部工程、技术和后勤分队等。(2 )方法 :采取回顾性调查和跟踪调查相结合的方法 ,根据《全军军事训练伤诊断标准》 ,以医院门诊诊断为依据 ,确保调查结果的可靠性。2　结果与分析　 (1)训练伤发生与入伍年限分布 :在 114例训练伤人员中 ,入伍 1…     

多发伤患者早期血浆血管生成素2水平变化与内皮损伤和预后的关系

目的 探讨多发伤患者早期血浆血管生成素2(angiopoietin2,Ang2)的水平变化与血管内皮损伤和预后的关系及临床意义.方法 为前瞻性观察研究,选择2008年1月至2010年1月收入聊城市人民医院急诊科的多发伤患者59例,纳入标准:创伤至入院时间在1 h以内;年龄大于18周岁;既往身体健康,排除有心、脑、肝、肾等器质性疾病,糖尿病、高血压,肿瘤;急慢性感染性疾病;严重颅脑损伤(GCS<12分);两周前用过抗凝及溶栓类药物患者.共纳入59例患者包括男36例,女23例,年龄(32.3±11.5)岁.按创伤严重度评分(ISS)分为重伤组(ISS≥16分,29例),轻伤组(ISS<16分,30例)2组.另取30例健康人为健康对照组,均为接受体检的健康人.其中男19例,女11例,年龄均大于18周岁,年龄(33.5±10.6)岁.各组性别、年龄构成均具有可比性.患者到达急诊科后10 min内抽取外周静脉血 10 mL,分离血浆.应用酶联免疫吸附法(ELISA)测定血浆Ang2的水平.同时测定血浆冯·维勒布兰德因子(Von Willebrand factor,vWF)、血栓调节蛋白(thrembomodulin,TM)的水平.统计数据用均数±标准差(-x±s)表示,所有数据采用SPSS 13.0统计软件进行统计分析.应用单因素方差分析和两两比较的Q检验(Newman-Keuls法)比较分析各组Ang2的水平差异.采用成组资料t检验比较分析死亡和生存患者Ang2的水平.采用pearson相关分析法分析Ang2水平与血浆vWF,TM的相关性.以P<0.05为差异具有统计学意义.结果 重伤组(ISS≥16分)血浆Ang2水平明显高于轻伤组(ISS<16分)(P<0.05),两组均明显高于正常对照组(P<0.05).死亡组血浆Ang2水平明显高于生存组(P<0.05).创伤后Ang2水平变化与血浆vWF,TM水平均有明显相关性(P<0.05).结论 血浆Ang2水平在多发伤早期明显增高,和创伤严重程度相关,和创伤后内皮损伤相关,其对预后有重要的预测价值.

Abstract：

Objective To investigate the early changes of plasma levels of angiopoietin2 in patients with multiple trauma and the relationship between plasma levels of angiopoietin2 (Ang2) and endothelial injury as well as prognosis of patients in order to determine their clinical significance. Methods Patients with multiple trauma admitted to emergency department from January 2008 to January 2010 were enrolled. A total of 59 casualties met the criteria(admission within 1 h after trauma and age > 18 years), and were eligible for enrollment. Patients with heart, brain, liver, kidney and other organic diseases, diabetes, hypertension, tumor, acute and chronic infectious diseases , severe brain injury (CCS < 12 points) , anticoagulant and thrombolytic medicine used two weeks before trauma were excluded. Among 59 patients, 36 were males and 23 females. The average age was(32.3 ±11.5) years. Patients were divided into severe trauma group (ISS ≥16 points,n =29) , moderate trauma group (ISS < 16 points, n =30 ) judged by using injury severity score (1SS). Thirty healthy subjects were selected as controls, 19 male and 11 female, with age > 18 years and an average age of(33.5 ±10.6) years. All groups had comparable gender proportion and average age. The 10 mL peripheral blood sanple was collected within 10 minutes after arrival of patients to emergency department and the plasma was separated from blood. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of angiopoietin2, and the plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) were also detected. Data were expressed as mean ± standard deviation and were statistically analyzed by using SPSS version 13.0 statistical software. The differences in plasma levels of angiopoietin2 of patients in each group were analyzed by ANOVA and Newman-Keuls test. Levels of angiopoietin2 in fatal patients and survival patients were also compared by using t test. The relationships between angiopoietin2 and plasma levels of vWF as well as levels of TM were analyzed by Pearson correlation analysis. Changes were considered as statistically significant if P value was less than 0.05. Results The plasma levels of angiopoietin2 in severe trauma group (ISS scored 16 points) were significantly higher than those in moderate trauma group (ISS < 16 points) ( P < 0.05 ), and those in trauma patients of the two groups were both significantly higher than those in control group (P < 0.05). The plasma levels of angiopoietin2 in fatal patients were significantly higher than those in survivors (P < 0.05). Plasma levels of angiopoietin2 were significantly correlated with plasma levels of vWF and TM (P < 0.05). Conclusions The plasma levels of angiopoietin-2 significantly increase after multiple trauma, and correlate with the degree of trauma severity. The plasma levels of angiopoietin2 correlate with endothelial injury after multiple trauma, having important prognosis value in patients with multiple trauma.