Influence of hypocalcemia on the prognosis of patients with multiple trauma

BACKGROUND Hypocalcemia is highly common in hospitalized patients,especially in those with trauma,On the other hand,abnormal calcium metabolism is an important metabolic challenge;however,it is often neglected and untreated,and certain factors may induce serious neurological and cardiovascular complications.AIM To retrospectively analyze the impact of hypocalcemia on the prognosis of patients with multiple traumas.METHODS The study was conducted from January 2020 to December 2021.Ninety-nine patients with multiple injuries were treated at the critical care medicine department of Fuyang People’s Hospital.The selected indicators included sex,age,and blood calcium and hematocrit levels.Many indicators were observed,including within 24 h of hospitalization,and the prognosis was collected after 28 d.Based on the blood calcium levels,the patients were divided into the following two groups:Normocalcemia and hypocalcemia.Of the 99 patients included,81 had normocalcemia,and 18 had hypocalcemia.Separate experiments were conducted for these two groups.RESULTS There was an association between serum calcium levels and the prognosis of patients with polytrauma.CONCLUSION Clinically,the prognosis of patients with multiple traumas can be preliminarily evaluated based on serum calcium levels.

C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

Objective C-reactive protein(CRP)/albumin ratio(CAR)is a new inflammation-based index for predicting the prognosis of various diseases.The CAR determined on admission may help to predict the prognostic value of multiple trauma patients.Methods A total of 264 adult patients with severe multiple trauma were included for the present retrospective study,together with the collection of relevant clinical and laboratory data.CAR,CRP,albumin,shock index and ISS were incorporated into the prognostic model,and the receiver operating characteristic(ROC)curve was drawn.Then,the shock index for patients with different levels of CAR was analyzed.Finally,univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients.Results A total of 36 patients had poor survival outcomes,and the mortality rate reached 13.6%.Furthermore,after analyzing the shock index for patients with different levels of CAR,it was revealed that the shock index was significantly higher when CAR was≥4,when compared to CAR<2 and 2≤CAR<4,in multiple trauma patients.The multivariate logistic analysis helped to identify the independent association between the variables CAR(P=0.029)and shock index(P=0.019),and the 28-day mortality of multiple trauma patients.Conclusion CAR is higher in patients with severe multiple trauma.Furthermore,CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients.The shock index was significantly higher when CAR was≥4 in multiple trauma patients.

Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND:To analyze early changes in white blood cells(WBCs),C-reactive protein(CRP)and procalcitonin(PCT)in children with multiple trauma,before secondary inflammation develops.METHODS:This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU).According to the prognostic outcome of 28 d after admission to the PICU,patients were divided into survival group(n=141)and non-survival group(n=36).Characteristics between the two groups were compared.Receiver operation characteristic(ROC)curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.RESULTS:The percentages of children with elevated WBC,CRP,and PCT levels were 81.36%,31.07%,and 95.48%,respectively.Patients in the non-survival group presented a statistically significantly higher injury severity score(ISS)than those in the survival group:37.17±16.11 vs.22.23±11.24(t=6.47,P<0.01).WBCs were also higher in non-survival group than in the survival group([18.70±8.42]×109/L vs.[15.89±6.98]×109/L,t=2.065,P=0.040).There was no significant difference between the survival and non-survival groups in PCT or CRP.The areas under the ROC curves of PCT,WBC and ISS for predicting 28-day mortality were 0.548(P=0.376),0.607(P=0.047)and 0.799(P<0.01),respectively.CONCLUSIONS:Secondary to multiple trauma,PCT levels increased in more patients,even if their WBC and CRP levels remained unchanged.However,early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Altered Nutrition State in the Severe Multiple Trauma Patients Undergoing Adjuvant Recombinant Human Growth Hormone Nutritional Support Therapy

In order to observe the nutrition state in the severe multiple trauma patients undergoing adjuvant recombinant human growth hormone (rhGH) nutritional support therapy, 45 patients with severe multiple traumas (ISS>25) were randomly divided into 3 groups. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two rhGH-treated groups in which rhGH was 0.2 and 0.4 U/(kg·d) respectively, and the resting group served as control one. The levels of nitrogen balance, prealbumin and safety variables (blood sugar, Na+, TT3 and TT4) were observed and com- pared among the three groups. The levels of nitrogen balance on the postoperative day (POD) 3 and 5 in the rhGH-treated groups were -1.28±3.19, 5.45±2.00 and -0.18±2.55, 6.11±1.60, respectively, which were significantly higher than those in the control group (-5.17±1.68 and -1.08±3.31, P<0.01). The values of prealbumin on the POD 3 and 5 in the rhGH-treated groups were 180.19±27.15, 194.44±50.82 and 194.94±29.65, 194.11±16.17, respectively, which were significantly higher than those in the control group (117.42±19.10 and 135.63±28.31, P<0.01). There was no sig- nificant difference between the rhGH 0.2 U/(kg·d) group and rhGH 0.4 U/(kg·d) group in both of the levels of nitrogen balance and prealbumin. It is concluded that the nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple trauma. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 and 0.4 U/(kg·d).

Ten-year retrospective analysis of multiple trauma complicated by pulmonary contusion

Background: This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome(ARDS). Methods: We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Military Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. Results: We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1±14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant(P=0.199, P=0.200). Separate univariate analysis of those who died and those who survived found that shock on admission(P=0.000), coagulation disorders(P=0.000), gastrointestinal bleeding(P=0.02), the need for emergency surgery on admission(P=0.000), pre-hospital intubation(P=0.000), blood transfusion within 24 hours(P=0.006), the use of mechanical ventilation(P=0.000), and concurrent ARDS(P=0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score(OR=0.708, 95%CI 0.516-0.971, P=0.032), ISS score(OR 1.135, 95%CI 1.006-1.280, P=0.039), and concurrent ARDS(OR=15.814, 95%CI 1.819-137.480, P=0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock(OR=9.121, 95%CI 0.857-97.060, P=0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P=0.039), infection(P=0.005), shock(P=0.004), coagulation disorders(P=0.006), emergency surgery(P=0.01), pre-hospital intubation(P=0.000), chest tube insertion(P=0.004), blood transfusion(P=0.000), usage of hormones(P=0.002), phlegm(P=0.000), ventilation(P=0.000) were at a significantly increased risk for ARDS complications. Conclusions: Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE Ⅱ, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score【5.5, APACHE Ⅱ score】16.5, and ISS score】20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.

Effects of enteral immunonutrition on immune function in patients with multiple trauma

BACKGROUND：Enteral immunonutrition （EIN） refers to addition of some specific nutrients in enteral nutrition （EN）, which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients. METHODS：Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups： an enteral immunonutrition group （EIN group, n=16） and an enteral nutrition group （EN group, n=16）. EIN suspension （RuiNeng produced by Sino-Swed Co., Ltd） and ordinary nutrition liquid （RuiSu produced by Sino-Swed Co., Ltd） were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count （TLC）, immunoglobulin （IgG, IgM, IgA）, and T-lymphocyte subsets （CD3, CD4, CD8, CD4 / CD8） were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support. RESULTS： TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day （P〈0.05）, and continually increased with a prolonged time of EIN. The parameters of immune function in the EN group on the 7th day didn＇t change significantly compared with those on the 1st day after grouping; on the 14 th day, TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher than those on the 1st day after grouping （P〈0.05）, but were significantly lower than those in the EIN group on the 14th day （P〈0.05）. CONCLUSION： Compared with the general formula EN, EIN is more helpful for the recovery of humoral and cellular immune function in the early post-multitraumatic phase.

Effect of ω-3 Polyunsaturated Fatty Acid on Toll-like Receptors in Patients with Severe Multiple Trauma

This study examined the effects of ω-3 polyunsaturated fatty acid（ω-3PUFA） on the expression of toll-like receptor 2（TLR2）,toll-like receptor 4（TLR4） and some related inflammatory factors in peripheral blood mononuclear cells（PBMCs） of patients with early-stage severe multiple trauma.Thirty-two patients who were admitted to the Department of Traumatic Surgery,Tongji Hospital（Wuhan,China） between May 2010 and November 2010,and diagnosed as having severe multiple trauma with a injury severity score（ISS） no less than 16,were enrolled in the study and divided into two groups at random（n=16 in each）：ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days.Peripheral blood from these patients was collected within 2 h of admission（day 0）,and 1,3,5 and 7 days after the nutritional support.PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively,the levels of NF-κB by quantum dots-based immunofluorescence assay,the levels of TNF-α,IL-2,IL-6 and COX-2 by ELISA,respectively.The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support（both P0.05）.The levels of TNF-α,IL-2,IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day（P0.05 for all）.It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2,TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma,which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.

DNA damage and cell death assessment in patients with severe multiple trauma using comet assay

Purpose: To determine the DNA strand breaks, oxidative DNA damage and cell death in blood and plasma total antioxidant status (TAOS) in 22 patients with severe multiple trauma. Materials and methods: The DNA comet assay was used to measure DNA strand breakage, 8-oxoguanine levels and apoptotic and necrotic nuclei in after admission (day 0) and on days 3, 5, 7 and 15. TAOS was determined by colorimetric method. Results: Trauma patients had high DNA damage at admission (p < 0.01), that further increased with maximum value on day 5 (p < 0.001). On day 15 the degree of DNA damage remained significantly elevated (p < 0.01). No significant difference in the 8-oxoguanine levels at all days examined was found. Patients had a high percentage of apoptotic and necrotic comets at admission, with maximum values on days 3 and 5. A significantly lower TAOS was observed in patients on admission and days 3, 5, 7 and 15 (p < 0.001 in all cases). A decreasing of TAOS on days 7 and 15 compared to that on admission (p < 0.05) was observed. Conclusions: Blood cells from severe trauma patients’ display increased DNA damage associated with apoptosis and necrosis. Reduced plasma TAOS and a tendency to increase of 8-oxoguanine in DNA was observed.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

Early changes of plasma angiopoietin-2 in patients with multiple trauma

BACKGROUND： This study was undertaken to investigate the early changes of plasmalevels of angiopoietin-2 （Ang-2） in patients with multiple trauma and the relations of plasma Ang-2,endothelial injury, and prognosis.METHODS： This study comprised 59 patients with multiple trauma who had been treated at theemergency department of Liao Cheng People!s Hospital from January 2008 to January 2010. Amongthem, 36 were male and 23 female. Their average age was 32.3±11.5 years. The 59 patients weredivided into a severe trauma group （ISS＂16 points, 29 patients） and a slight trauma group （ISS〈16points, 30 patients） by injury severity score （ISS）. Thirty healthy people aged more than 18 years withan average of 33.5±10.6 years served as controls （19 male and 11 female）. Peripheral blood （10 mL）was collected within 10 minutes after the patients arrived at the emergency department, and plasmawas separated from the blood. Enzyme-linked immunosorbent assay （ELISA） was applied to detectthe levels of angiopoietin 2, thrombomodulin （TM）, and Von willebrand factor （vWF）.RESULTS： The level of Ang-2 in the severe trauma group （ISS score＂16 points） was signifi cantlyhigher than that in the slight trauma group （ISS score〈16 points） （P〈0.05）. The levels in the twogroups were signifi cantly higher than those in the control group （P〈0.05）. The levels of angiopoietin-2in deaths were signifi cantly higher than those in survivors （P〈0.05）. The levels of angiopoietin-2 weresignifi cantly correlated with the levels of vWF and TM （P〈0.05）.CONCLUSIONS： The plasma levels of Ang-2 are significantly higher after multiple trauma,and correlated with the degree of trauma severity. The levels of angiopoietin-2 are correlated withendothelial injury after multiple trauma, and are important values for the prognosis of patients withmultiple trauma.

Acute celiac artery occlusion secondary to blunt trauma:Two case reports

BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is usually atypical,which easily causes missed diagnosis and misdiagnosis.Currently,there are only a few reports of acute traumatic occlusion of CA.The CA artery gives off branches to dominate the liver,stomach.and spleen;however,occluded CA did not cause significant organ ischemia,and the compensatory blood flow from the superior mesenteric artery(SMA)played a pivotal role.CASE SUMMARY Herein,we report two cases of acute CA occlusion secondary to severe blunt trauma.Case one was a 19-year-old male,suffered from a motorcycle crash.He complained of dyspnea,and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound.Computed tomography(CT)scan revealed hemopneumothorax,multiple rib fractures,right scapular fracture,and liver rupture.Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased,and CA was occluded.Because the hepatic hemorrhage is associated with hepatic artery injury,the CA was retrogradely opened through the SMA,and then,the right hepatic artery was embolized with coils successfully through the conventional pathway.Stent implantation was not performed,and the CA occlusion was managed by conservative treatment.A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded.Case two was a 37-year-old man,suffered injury from fall from height.He complained of lower back and bilateral heel pain.Contrast-enhanced CT examination revealed multiple rib fractures,bilateral pneumothorax,fourth lumbar(L4)vertebral burst fracture,and pelvic fractures.Furthermore,a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected.The reexamination 14 h after admission showed the CA was occluded.The patient was conservatively treated.The symptoms of nausea after meals disappeared about 4 wk later,and abdominal distension was significantly relieved after 6 wk.The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.CONCLUSION Patients with CA occlusion will have different clinical manifestations,and the dominant organ will not have obvious ischemia.Conservative treatment is safe,and the patient’s symptoms will be improved with the establishment of collateral circulation.

Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report

BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury,although elbow dislocation or fracture of the ulna and radius may occur separately.CASE SUMMARY We report the case of a 37-year-old woman with open(IIIA)fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony.After providing advanced trauma life support,damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room.Subsequently,one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling.The patient achieved good outcome at the 7 mo follow-up.CONCLUSION One-or two-stage treatment must be performed according to the type of injury;we efficiently used the“damage control principle.”

多发伤患者早期肠道菌群及其代谢产物氧化三甲胺的变化

目的:多发伤患者一旦并发脓毒症和多器官功能障碍综合征则预后不良。本研究通过观察多发伤患者早期肠道菌群及其代谢产物氧化三甲胺的变化,探讨多发伤患者并发脓毒症和多器官功能障碍综合征的可能机制。方法:选取2023年4月至9月江苏大学附属医院收治的符合纳入标准的多发伤患者25例作为多发伤组,选取同期本院体检中心符合纳入标准的健康志愿者25例作为对照组。收集多发伤组伤后1周左右的粪便标本和血浆标本,同期收集对照组体检当天的粪便标本和血浆标本。通过16S rRNA高通量测序技术检测粪便标本,分析多发伤组和对照组肠道菌群的差异。采用高效液相色谱-质谱串联技术检测血浆标本,分析多发伤组和对照组血浆氧化三甲胺水平的差异。结果:多发伤组和对照组的肠道菌群构成存在明显差异。在菌门水平上,多发伤组变形菌门的相对丰度明显高于对照组(P<0.05);厚壁菌门和拟杆菌门的相对丰度明显低于对照组(P<0.05)。在菌属水平上,多发伤组大肠埃希菌属、致病肠球菌属、梭菌属、考拉杆菌属的相对丰度均明显高于对照组(均P<0.05),普氏菌属、双歧杆菌属、瘤胃菌属、乳杆菌属、粪球菌属、布劳特菌属、丁酸弧菌属的相对丰度均明显低于对照组(均P<0.05)。多发伤组血浆氧化三甲胺水平明显高于对照组(P<0.05)。结论:与健康人群相比,多发伤患者早期肠道菌群已发生变化,专性厌氧菌相对丰度下降,兼性厌氧菌相对丰度上升,有益共生菌相对丰度减少,机会致病菌相对丰度增加,这可能与多发伤患者并发脓毒症有关。血浆氧化三甲胺的水平升高可能与肠道菌群的变化和多发伤患者并发多器官功能障碍综合征有关。

复方电解质注射液(Ⅱ)与醋酸林格液对重症创伤患者早期液体复苏效果

目的 探讨对重症创伤患者输注不同平衡盐溶液后的液体复苏效果及预后情况,为临床急救液体复苏的液体选择提供参考。方法 选取急诊科行液体复苏的重症创伤患者作为研究对象。根据急诊液体复苏时输注的平衡盐溶液类型的不同,将患者随机分为试验组(n=100)和对照组(n=98)。试验患者给予输注复方电解质注射液(SF),对照组患者给予输注醋酸林格液(RA)。采集两组患者的肾损伤指标(血肌酐及尿素氮变化及30 d内肾脏主要不良事件)、血气分析指标(pH、剩余碱(BE)值、碳酸氢根(HCO-3)和血乳酸)、机械通气撤机时间、血管活性药使用时间、重症加强护理病房(ICU)住院时长、总住院时长及28 d内的生存率。结果 两组患者在伤后96 h内的血肌酐、尿素氮变化及30 d内肾脏主要不良事件发生率比较差异无统计学意义(P>0.05)。液体复苏早期(24 h内),试验组的pH、BE值、HCO-3及血乳酸与对照组比较能较快恢复到正常范围(P<0.05)。在重要临床结局(28 d生存率、机械通气撤机时间、血管活性药物使用时间、ICU住院时长和总住院时长)上两组比较差异无统计学意义(P>0.05)。结论 与醋酸林格液比较,复方电解质溶液在重症创伤早期液体复苏过程中能较快纠正代谢性酸中毒,但这种生物化学上的优势并不能改善相关的临床结局。

血凝酶用于多发性创伤患者院前急救的价值分析

目的探讨血凝酶用于多发性创伤患者院前急救的价值。方法选取2019年4月至2022年4月北京急救中心收治的104例多发性创伤患者作为研究对象,根据患者是否应用血凝酶分为观察组(常规院前急救并应用血凝酶治疗,n=52)与对照组(常规院前急救治疗,n=52)。比较2组患者的止血时间、平均出血量、单位面积出血,比较2组患者治疗前后的血红蛋白(Hb)、红细胞压积(HCT)、血小板聚集率(PAR)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1),比较2组患者的并发症、不良反应。结果观察组止血时间、平均出血量、单位面积出血均少于对照组(P<0.05);治疗后2组Hb、HCT、PAR水平低于治疗前,观察组高于对照组(P<0.05);2组患者治疗前后,PT、APTT、FIB、D-D、PAI-1、AT-Ⅲ、t-PA水平比较差异无统计学意义(P>0.05)。治疗后,2组患者并发症总发生率比较差异无统计学意义(P>0.05),观察组病死率低于对照组(P<0.05);观察组不良反应发生率为5.77%,对照组不良反应发生率为0,差异无统计学意义(χ^(2)=3.089,P=0.079)。结论多发性创伤患者院前急救应用血凝酶可减少出血量,对患者的凝血和纤维蛋白溶解功能无影响,安全性良好,有利于患者预后的改善。

严重多发外伤患者并发脓毒症的危险因素及风险预测模型构建

目的分析严重多发外伤患者并发脓毒症的危险因素,并建立风险预测模型。方法收集南阳市第一人民医院2021年1月至2022年12月收治的120例严重多发外伤患者临床资料进行回顾性分析,依据是否并发脓毒症分为脓毒症组41例与非脓毒症组79例。采用logistic回归分析影响严重多发外伤患者并发脓毒症的危险因素,依据回归分析结果构建风险预测模型,并计算一致性指数(C-index)判断模型区分度。结果脓毒症组年龄、中性粒细胞与淋巴细胞计数比值(NLR)、活化部分凝血活酶时间(APTT)、创伤严重程度评分(ISS)、序贯器官衰竭(SOFA)评分均大于非脓毒症组,机械通气患者占比高于非脓毒症组,差异有统计学意义(P<0.05);经logistic回归分析显示,NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的独立危险因素(OR>1,P<0.05);绘制列线图构建严重多发外伤患者并发脓毒症的风险预测模型,验证模型区分度显示C-index值=0.908,区分度良好;绘制标准曲线显示,校准曲线和Y-X直线紧密贴合,模型准确度良好。结论NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的危险因素,基于上述因素构建的风险预测模型对严重多发外伤患者并发脓毒症具有较高预测价值。

基于损伤控制理论的救治管理对肝脏与胆管外伤患者救治效果的影响

目的 探究基于损伤控制理论的救治管理在肝脏与胆管外伤患者救治中的应用效果。方法 回顾性分析2022年8月—2023年3月收治的肝脏与胆管外伤102例的临床资料,根据临床处理方案分为观察组52例和对照组50例,对照组实施常规急诊救治,观察组实施基于损伤控制理论的救治管理。观察2组救治相关指标、并发症及干预前后损伤严重程度、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]变化情况。结果 观察组手术时间、术后肛门首次排气时间及住院时间均短于对照组,术中出血量少于对照组(P<0.01);干预后,观察组损伤严重程度轻于对照组(P<0.05);干预后,观察组血清MPO、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);观察组多器官功能障碍综合征、失血性休克发生率分别为3.85%(3/52)、1.92%(1/52),低于对照组的18.00%(9/50)、16.00%(8/50),差异有统计学意义(P<0.05)。结论 基于损伤控制理论的救治管理可降低肝脏与胆管外伤患者应激及损伤程度,加速康复进程,改善临床结局。

PBL模式与情景模拟相结合在多发伤急救手术培训中的应用

目的探讨PBL模式与情景模拟相结合在多发伤急救手术培训中的应用。方法成立教学培训小组,立足多发伤急救手术特点提出问题,采用PBL模式与情景模拟相结合的方式,通过相关理论授课、操作技能培训对培训对象进行培训,培训后进行考核和评价。结果培训后考核成绩明显高于培训前(P<0.01);并且提高了手术配合的满意度。结论 PBL模式与情景模拟相结合在多发伤急救手术培训中的应用,使培训对象培养了评判性思维能力,提高了多发伤急救手术配合的综合技能,增强了团队交流能力和协作精神。

碱性磷酸酶与白蛋白比值对多发伤患者创伤脓毒症的诊断及预后评估意义

目的探讨碱性磷酸酶与白蛋白比值(APAR)对多发性创伤(简称多发伤)患者创伤脓毒症的诊断及预后评估意义。方法选取2021年1月至2023年10月于该院治疗的130例多发伤患者为受试者,根据是否发生创伤脓毒症分为脓毒症组(82例)和非脓毒症组(48例)。确诊为创伤脓毒症即日起连续随访28 d,根据预后生存情况分为存活组(67例)和死亡组(15例)。采用全自动生化分析仪检测外周血中碱性磷酸酶、白蛋白水平,并计算APAR。采用受试者工作特征(ROC)曲线评估碱性磷酸酶、白蛋白、APAR对多发伤患者创伤脓毒症的预测价值。采用多因素Logistic回归分析探讨多发伤患者创伤脓毒症预后的影响因素。结果脓毒症组碱性磷酸酶水平和APAR高于非脓毒症组,白蛋白水平低于非脓毒症组(P<0.05)。碱性磷酸酶、白蛋白、APAR预测多发伤患者创伤脓毒症的曲线下面积(95%CI)分别为0.753(0.702~0.801)、0.849(0.798~0.900)、0.901(0.850~0.952),最佳临界值分别为142.12 U/L、27.89 g/L、5.24,特异度分别为55.24%、66.16%、85.43%,灵敏度分别为91.67%、91.67%、84.12%。死亡组碱性磷酸酶水平和APAR高于存活组,白蛋白水平低于存活组(P<0.05)。死亡组年龄≥60岁占比、序贯器官衰竭评分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及C反应蛋白、血乳酸、血肌酐水平高于存活组(P<0.05)。多因素Logistic回归分析结果显示,高龄(OR=2.330,95%CI 1.568~3.462)、APACHEⅡ评分高(OR=2.056,95%CI 1.448~2.921)、碱性磷酸酶高表达(OR=2.479,95%CI 1.652~3.720)、白蛋白低表达(OR=2.525,95%CI 1.543~3.288)、APAR升高(OR=2.849,95%CI 1.848~4.394)是多发伤患者创伤脓毒症预后的影响因素(P<0.05)。结论APAR可作为预测多发伤患者创伤脓毒症的生物学指标,且APAR异常升高与患者创伤脓毒症预后存在关联。