目的探究分析损伤控制联合外伤急救对急诊创伤性颅脑损伤患者进行抢救所产生的效果.方法随机选取2020年5月至2021年5月莆田市第一医院收治的80例急诊创伤性颅脑损伤患者作为受试者,以数字表法的规则将他们分为对照组和观察组.其中,40例...目的探究分析损伤控制联合外伤急救对急诊创伤性颅脑损伤患者进行抢救所产生的效果.方法随机选取2020年5月至2021年5月莆田市第一医院收治的80例急诊创伤性颅脑损伤患者作为受试者,以数字表法的规则将他们分为对照组和观察组.其中,40例对照组的患者采用常规的外伤急救,40例观察组的患者则在对照组的基础上另外采用损伤控制.比较评估两组患者经过对应模式干预后的抢救效率、神经功能缺损评分(National Institute of Health Stroke Scale,NIHSS)、神经残疾评分(Neurological Disability Score,NDS)以及患者满意度情况.结果观察组干预后的抢救成功率(95.00%)比对照组的(72.50%)高(P<0.05);在NIHSS评分上,与对照组相比,观察组干预后的意识水平、肢体共济运动以及构音障碍的评分均较低(P<0.05);在NDS评分上,通过对比可知,观察组干预后的脑神经、肌无力以及反射与感觉的评分比对照组低(P<0.05);经过干预后,观察组患者的满意度比对照组高(P<0.05).结论应用损伤控制联合外伤急救能够提高急诊创伤性颅脑损伤患者的抢救效率,有助于患者各方面功能的恢复,同时改善了患者的预后结果,增加其对抢救工作的满意度,具有较明显的效果.展开更多
Objective： To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome （ARDS） in intensive care unit （ICU）. Methods： A retrospective ...Objective： To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome （ARDS） in intensive care unit （ICU）. Methods： A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American- European Consensus Conference （ AECC ）. Acute physiology and chronic health evaluation Ⅲ （APACHE Ⅲ）, multiple organ dysfunction syndrome score （MODS score）, and lung injury score （LIS） were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation. Resnits ： Totally, 131 patients （ 2. 5% ） developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases （62 males and 53 females, aged 22-75 years, 58 years on average ） left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was （11.27±7.24） days and APACHE HI score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE （base excess ）. The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS ≥2.76. Conclusions： ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.展开更多
The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe i...The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.展开更多
Objective: To improve the outcome of treatment in patients with craniocerebral firearm wound. Methods: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi Jing Hospital of Fourth Mil...Objective: To improve the outcome of treatment in patients with craniocerebral firearm wound. Methods: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi Jing Hospital of Fourth Military Medical University with a diagnosis of craniocerebral firearm wound during a period of 27 years from July 1970 to July 1997. All the patients had acute craniocerebral firearm wound. Of these, it consisted of 81 males (87.1%) and 12 females (12.9%) ranging from 3 months to 58 years in age (median 24.6 years). The lesion included 16 tangential wounds, 58 tubular wounds and 19 through and through wounds. The cases were urgent and in serious and unstable condition. All the patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. Results: After emergency treatment and operation, 9 cases died (9.7%). Follow up studies at three months postoperative showed that 56 cases (66.7%) had made good recovery. Rates of moderate disability, severe disability or vegetative state in this series were 19.0%, 10.7% and 3.6 %, respectively. Long term follow up studies (median 5.5 years) found that 42 (50.0%) were capable of resuming their occupation. Conclusions: Craniocerebral firearm wounds are often severe, needing urgent treatment for the patients. Timely, proper and thorough initial debridement are crucial for avoiding rapid neurological deterioration.展开更多
文摘目的探究分析损伤控制联合外伤急救对急诊创伤性颅脑损伤患者进行抢救所产生的效果.方法随机选取2020年5月至2021年5月莆田市第一医院收治的80例急诊创伤性颅脑损伤患者作为受试者,以数字表法的规则将他们分为对照组和观察组.其中,40例对照组的患者采用常规的外伤急救,40例观察组的患者则在对照组的基础上另外采用损伤控制.比较评估两组患者经过对应模式干预后的抢救效率、神经功能缺损评分(National Institute of Health Stroke Scale,NIHSS)、神经残疾评分(Neurological Disability Score,NDS)以及患者满意度情况.结果观察组干预后的抢救成功率(95.00%)比对照组的(72.50%)高(P<0.05);在NIHSS评分上,与对照组相比,观察组干预后的意识水平、肢体共济运动以及构音障碍的评分均较低(P<0.05);在NDS评分上,通过对比可知,观察组干预后的脑神经、肌无力以及反射与感觉的评分比对照组低(P<0.05);经过干预后,观察组患者的满意度比对照组高(P<0.05).结论应用损伤控制联合外伤急救能够提高急诊创伤性颅脑损伤患者的抢救效率,有助于患者各方面功能的恢复,同时改善了患者的预后结果,增加其对抢救工作的满意度,具有较明显的效果.
文摘分析损伤控制理念在多发伤合并失血性休克患者急救中的应用价值。方法 时间为2022年9月—2023年2月,研究对象选择某市三级医院接收的多发伤合并失血性休克病患,数量是80例,基于随机数字表完成1:1分配,将其分成两组,即对照组、观察组,两组的人数都为40例,也就是n=40。对照组、观察组采取的方案分别是传统、损伤控制的急救方案,并对抢救效率、预后情况、并发症发生率等因素进行深入研究比较。结果 观察组就检查、接诊、手术、住院等时间来说,对照组都高于观察组(P<0.05)。在刚开始进入医院时,两组患者格拉斯哥昏迷(Glasgow Coma Scale,GCS)、伤情严重程度(Injury Severity Score,ISS)、慢性健康状况Ⅱ(Acute Physiology And Chronic Health Evaluation Ⅱ,APACHEⅡ)的评分不存在显著的差异(P>0.05);术后第1天,观察组GCS评分高于对照组,ISS、APACHE Ⅱ评分低于对照组(P<0.05)。观察组并发症发生率1例(2.80%)低于对照组6例(15.00%)(P<0.05)。结论 损伤控制理念在多发伤合并失血性休克患者急救中能够有效缩短急救时间,改善患者预后,降低患者术后并发症发生率,具有较高的应用价值。
文摘Objective： To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome （ARDS） in intensive care unit （ICU）. Methods： A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American- European Consensus Conference （ AECC ）. Acute physiology and chronic health evaluation Ⅲ （APACHE Ⅲ）, multiple organ dysfunction syndrome score （MODS score）, and lung injury score （LIS） were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation. Resnits ： Totally, 131 patients （ 2. 5% ） developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases （62 males and 53 females, aged 22-75 years, 58 years on average ） left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was （11.27±7.24） days and APACHE HI score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE （base excess ）. The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS ≥2.76. Conclusions： ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.
文摘The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.
文摘Objective: To improve the outcome of treatment in patients with craniocerebral firearm wound. Methods: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi Jing Hospital of Fourth Military Medical University with a diagnosis of craniocerebral firearm wound during a period of 27 years from July 1970 to July 1997. All the patients had acute craniocerebral firearm wound. Of these, it consisted of 81 males (87.1%) and 12 females (12.9%) ranging from 3 months to 58 years in age (median 24.6 years). The lesion included 16 tangential wounds, 58 tubular wounds and 19 through and through wounds. The cases were urgent and in serious and unstable condition. All the patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. Results: After emergency treatment and operation, 9 cases died (9.7%). Follow up studies at three months postoperative showed that 56 cases (66.7%) had made good recovery. Rates of moderate disability, severe disability or vegetative state in this series were 19.0%, 10.7% and 3.6 %, respectively. Long term follow up studies (median 5.5 years) found that 42 (50.0%) were capable of resuming their occupation. Conclusions: Craniocerebral firearm wounds are often severe, needing urgent treatment for the patients. Timely, proper and thorough initial debridement are crucial for avoiding rapid neurological deterioration.
