严重前臂及手部外伤的急诊修复

目的探讨急诊修复严重前臂及手部外伤的治疗方法和疗效。方法对36例严重前臂及手部外伤患者采用下述方法一期修复：重建血循环18例,带蒂组织转移覆盖创面5例,游离移植软组织覆盖创面23例,组合移植覆盖创面6例。结果 36例均获得随访,随访时间为6个月-8年,平均20个月。末次功能评定：优14例,良16例,可4例,差2例,优良率为83.3%。结论对一些严重前臂及手部外伤,可以采用合理显微外科方法急诊修复来保留肢体的功能。

闭合性腹部损伤64例临床分析

目的探讨闭合性腹部损伤的临床诊治方法。方法回顾性总结64例闭合性腹部损伤患者临床资料，分析闭合性腹部损伤的临床特点。结果闭合性腹部损伤的男女比是2：1，青壮年男性是高发人群，有100％的明确外伤史，车祸挤压伤31例（48．4％），CT、超声检查诊断48例（75％），腹腔穿刺诊断59例（92．3％），64例患者其中手术治愈49例，非手术治愈12例，死亡3例。2例患者因多器官功能障碍死亡，1例患者因合并脑外伤死亡。结论详细询问外伤史十分重要，CT、超声检查应为首选检查，腹腔穿刺简单易行，反复穿刺可提高诊断率，闭合性腹部损伤以手术治疗为主。

Hemolysis results in impaired intestinal microcirculation and intestinal epithelial cell injury

AIM:To study the effect of circulating cell-free oxy-hemoglobin(FHb) on intestinal microcirculation and intestinal epithelial injury in a rat model. METHODS:To induce elevated intravascular circulating FHb,male Sprague-Dawley rats received water or FHb infusion.Microcirculatory changes in jejunum,ileum and colon were evaluated using fluorescent microspheres.Intestinal injury was quantified as plasmatic release of ileal lipid binding protein(iLBP) and verified by histological analysis of the ileum. RESULTS:Water and FHb infusions resulted,when compared with saline infusion,in reduced intestinal microcirculation(after 30 min P<0.05,or better;after 60 min FHb infusion P<0.05 for jejunum and colon) .Circulating FHb levels correlated significantly with release of iLBP(Spearman r=0.72,P=0.0011) .Epithelial cell injury of the villi was histologically observed after water and FHb infusions. CONCLUSION:This study shows that circulating FHb leads to a reduction in intestinal microcirculatory blood flow with marked injury to intestinal epithelial cells. These data support the hypothesis that circulating FHb contributes to the development of intestinal injury.