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创伤与急诊电子杂志

创伤与急诊电子杂志

Journal of Trauma and Emergency(Electronic Version)
《创伤与急诊电子杂志》是经国家新闻出版署批准，国家卫生健康委员会主管，人民卫生出版社有限公司主办，国内急诊医学学科带头人林才经教授担任主编，具有国内统一刊号（CN 11-9332/R）和国际标准连续出版物编号（ISSN 2095-5316）的一本正式发行的创伤与急诊专业国家杂志。 现已入选“福建省卫生系列高级专业技术职务学术期刊”目录并被《中国核心期刊（遴选）数据库》《中文科技期刊数据库》《中国知识资源总库》收录。 本刊以广大急诊与灾害医学及相关学科工作者为主要阅读对象，设置了临床研究、病例讨论和创伤与急诊医学影像等临床医师感兴趣的栏目，同时他山之石栏目收录的是英文刊物摘要翻译，旨在为广大读者提供国际研究资讯，了解学科前沿动态。由人民卫生电子音像出版社出版有限公司，面向全国公开发行。 本刊设有述评、学科进展、论著、综述、热点追踪、疑难病分析、继续教育园地、叙事医学、政策解读、管理学等栏目。
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  • 发文量：491
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  • 国内刊号/CN：11-9332/R
    国际刊号/ISSN：2095-5316
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创伤与急诊电子杂志 >2023年第3期

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  • 摘要：《创伤与急诊电子杂志》经国家新闻出版广电总局批准、具有标准国内刊号（CN11—9332／R）的一本正式发行的国家级创伤与急诊专业杂志。由中华人民共和国卫生和计划生育委员会主管，人民卫生出版社主办，人民卫生电子音像出版社出版，福建省立医院承办，国内急诊医学学科带头人林才经教授担任主编，季刊，全年4期、大16开。
  • 摘要：Objective To summarize the experience in treating patients with severe traumatic brain injury combined with cerebral hernia and disseminated intravascular coagulation (dic).Method in 101 cases of severe traumatic brain injury from may 2013 to may 2014, 9 cases with cerebral hernia and dic were selected, which were retrospectively analysed and summarized.Resultnone of the 9 cases was cured, among which the condition of 1 patient improved;2 patients presented plant survival status, while 6 patients died after operation and the mortality was about 66.7%.Conclusion The death rate in patients with severe traumatic brain injury combined with cerebral hernia and dic is obviously high.it is proved that correcting dic with faster speed perioperatively,and operating more safely and effectively cooperated with postoperative hypothermia treatment may be beneficial to reduce the patient's mortality.%目的：总结颅脑损伤合并脑疝及弥散性血管内凝血（disseminated intravascular coagulation，dic）患者的诊治经验，为临床实践提供参考。方法收集本院2013年3月至2014年3月期间重型颅脑损伤101例患者，其中出现脑疝及dic的病例共9例，回顾分析诊治经过。结果本组9例重型颅脑损伤合并脑疝及dic，经手术后治愈0例，好转1例，植物生存2例，死亡6例，死亡率约66.7%。结论重型颅脑损伤患者合并脑疝及dic死亡率极高，在围手术期更快纠正dic、更安全有效进行手术治疗，配合术后亚低温治疗，以降低患者的死亡率。
  • 摘要：Objective To explore the method of care and nursing in the cases of acute severe organophosphorus pesticide poisoning.Method a retrospective analysis of clinical data of 48 patients with acute severe organophosphorus pesticide poisoning has been conducted in our department since 2005.Result The correct understanding and treatment of contraindications to gastric lavage, "atropinization" "intermediate syndrome" is the key to successful rescue. Conclusion as for rescuing severe organophosphorus poisoning patients, medical staff should create conditions for transforming contraindications to indication; make a correct discernment of "atropinization" and "intermediate syndrome" and optimize nursing.%目的：探讨急性重度有机磷中毒救治与护理的方法。方法回顾性分析2005年以来，我科成功救治的48例急性重度有机磷中毒患者的临床资料。结果正确认识及处理洗胃禁忌证“阿托品化”“中间型综合征”是成功救治的关键。结论对于重度有机磷中毒患者的救治，医护人员应创造条件，化禁忌证为适应证；正确识别“阿托品化”和“中间型综合征”，优化护理。
  • 摘要：缺血修饰白蛋白（ischemia modified albumin，ima）作为一项反映心肌缺血的敏感生化指标，具有反应时效短、灵敏度和特异性高、价格低廉等优点，并且ima对心血管疾病患者是否存在心肌缺血具有较高的阴性预测值。本文就近年来ima在心血管疾病领域中的研究进展进行综述。
  • 摘要：Objective To analyze the relationship between the efficacy of hemostasis and the decreased magnitude of blood pressure by observing 67 cases of patients with hypertension complicated by epistaxis and emergency antihypertensive treatment of epistaxis process.Method 67 cases of patients with hypertension complicated by epistaxis were observed in the emergency room. intravenous nitroglycerin was used to control blood pressure in 4 steps under blood pressure and Ecg monitoring and, the number of epistaxis’ hemostasis in 4 different steps was counted according to the time of hemostasis. The relationship between the decreased magnitude of blood pressure and the number of epistaxis’ hemostasis cases was analyzed.Result in the 67 cases of patients with hypertension complicated by epistaxis, the relationship between the decreased magnitude of blood pressure and the number of epistaxis’ hemostasis cases is directly correlated.Conclusion for patients with hypertension complicated by epistaxis, the decreased magnitude of blood pressure is an influencing factor of epistaxis’ hemostasis. Therefore, emergency antihypertensive therapy and decrease in blood pressure will promote epistaxis’ hemostasis.%目的：观察高血压病并发鼻衄的67例患者，急诊降压治疗与鼻衄止血的过程，分析降压幅度与止血效果的关系。方法67例高血压病并发鼻衄患者均于急诊观察室在血压、心电监测下，静脉滴注硝酸甘油，分4个阶段控制降压、同时根据止血时间，统计4个阶段止血的病例数；分析血压下降幅度与止血病例数的关系。结果67例高血压病并发鼻衄患者，血压下降幅度与止血病例数呈正相关。结论高血压病并发鼻衄患者血压下降幅度是鼻衄止血的影响因素，急诊降压治疗，平稳控制血压下降，可促进鼻衄止血。
  • 摘要：本发明公开一种用于人体骨骼应力测试的无线应力传感器及其测试方法，利用非晶铁磁纤维的巨应力阻抗效应和巨磁阻抗效应，将非晶铁磁短纤维置于传感器基底中，制成软体薄膜型应力传感器，将应力传感器粘贴在伤骨的端面或侧面。测试时，人体置于磁场环境中，对应力传感器安置部位发射电磁波信号，激发非晶铁磁纤维内部产生高频交流电流，电磁波的回波信号与发射信号相比有衰减，且衰减程度与应力的大小有一定的关系，通过事先的标定，就可以探知骨应力的大小。本发明中应力传感器不需电源与导线进行连接，尺寸小而薄，且无毒腐作用，可以永久置于体内而不影响人体的生理功能；测试的过程不需导线，且对人体不会造成损害，操作方便。
  • 摘要：简介：拔管是指拔除气管内导管，这是患者脱离机械通气的最后一步。本文阐述了拔管之前我们需要考虑的问题：拔除气管插管的程序以及拔管的管理策略，并探讨拔管的预后，复习影响脱机成功的因素和方法。
  • 摘要：压疮伤口的愈合是一个复杂的过程，其护理理念正由传统的干性愈合向现代的湿性愈合发展。从湿性愈合理论、湿性愈合伤口敷料、压疮湿性愈合疗法的临床依据三个方面综述了湿性愈合理论在压疮护理研究的进展。%The healing process of pressure ulcers is very complicated. With the development of nursing philosophy, the concept of traditional dry wound healing has been gradually renovated by the modern one--moist wound healing. This article overviews the advance of the moist wound healing theory applied to pressure ulcers in terms of three aspects: the moist wound healing theory, moist wound-healing dressings and the clinical basis of moist wound therapy in the treatment of pressure ulcers.
  • 摘要：ObjectiveTo investigate the effect of using high-dose methylprednisolone (mP) early on functional recovery of patients after cervical spinal cord injury without fracture and dislocation(csciWfd).Method from december 2009 to september 2013, 30 patients were enrolled in this study.The patients were assigned to 2 groups: 16 patients constituting group a were applied high does of methylprednisolone combined with anterior decompression operation, while 14 patients who can not be applied methylprednisolone due to various reasons constitute group B and underwent the anterior decompression operation only. The Joa score and improvement rate of spine function in the two groups at the time of admission and 3 weeks after operation were compared.Result comparing Joa scores on admission and 3 weeks as well as 6 months after operation, the Joa score and improvement rate of the spinal cord function 6 months after operation in group a was found better than that in group B 6 month. Conclusion csciWfd,as a special type of cervical spinal cord injury,should be diagnosed as soon as possible according to the physical examination before X-ray and cT showed fracture or dislocation. When this injury was diagnosed, high doses of mP should be applied according to nascisⅢrole in order to obtain the best recovery of spinal cord function in the patients.%目的：探讨早期应用甲泼尼龙冲击无骨折脱位型颈脊髓损伤（csciWfd）对后期脊髓功能恢复的影响。方法回顾性分析本院自2009年12月至2013年9月收治的30例csciWfd患者，分为a组：16例按nascis iii行甲泼尼龙冲击＋手术治疗，B组：14例因各种原因无法行甲泼尼龙冲击，单纯行手术治疗，比较其入院时与术后3周、6个月Joa评分及改善率。结果通过对比入院时Joa评分及术后3周、6个月时Joa评分，发现a组术后6个月Joa评分及脊髓功能改善率高于B组。结论 csciWfd作为一种特殊型颈髓损伤，根据临床经验应及早作出诊断，并开始进行甲泼尼龙冲击，以利于患者后期脊髓功能获得最佳恢复效果。
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  • 摘要：目的：比较带导槽与无导槽视频喉镜用于侧卧位时气管插管的效果。方法选取择期行全身麻醉气管插管手术的患者160例，性别不限，年龄18～65岁，asaⅠ～Ⅲ级，采用随机数字表法将患者随机分为带导槽右侧卧位组（a组）、带导槽左侧卧位组（B组）、无导槽右侧卧位组（c组）和无导槽左侧卧位组（d组），每组40例。a、B组采用airtraq®视频喉镜引导气管插管，c、d两组采用鑫泰科视频喉镜引导气管插管。记录气管插管成功率，插管次数及气管插管成功时间以及相关并发症情况。结果所有患者均完成气管插管。插管时间比较，a、B两组时间明显短于c、d组（P＜0.05）。插管次数比较，c组插管次数多于a、B两组（P＜0.05）。各组并发症情况差异无统计学意义（P＞0.05）。结论带导槽与无导槽视频喉镜都适用于侧卧位的气管插管术，而带导槽视频喉镜可减少插管次数、减少插管所需时间，使得侧卧位等特殊体位下气管插管更为安全和有效。%Objective The aim of the present study is to compare the applicability and efficacy of two alternative techniques: intubation of patients in the lateral decubitus position using video laryngoscopes with or without guide channel.Method160 patients presenting for surgeries requiring tracheal intubation were randomly assigned to 4 groups: group a, B, c, d (n=40 respectively). in group a and B, intubation was performed by the airtraq ® video laryngoscope, while in group c and d, intubation was performed by the Xintaike video laryngoscope. Patients in group a and c were intubated in right lateral decubitus, while patients in group B and d in left lateral decubitus. The success rate, time needed for successful intubation, number of attempts and complications were recorded.Result all patients were successfully intubated. intubation in group c and d were completed with significantly longer time than group a and B (P<0.05).The number of attempts were greater in group c when compared with those of group a and B (P<0.05). There was no difference in complications (P>0.05).Conclusion Video laryngoscopes, with or without guide channel, are applicable for tracheal intubation in lateral decubitus position. The laryngoscope with guide channel could reduce the time needed for successful intubation and number of attempts, making it safer and more effective on intubation in some non-conventional positions like lateral decubitus position.
  • 摘要：目的：分析合并糖尿病对骨科患者术后吗啡镇痛的影响。方法接受骨科手术患者40例，分成两组。一组为糖尿病患者20例，二组为非糖尿病患者20例，术后所有患者均采用吗啡静脉自控镇痛（patient controlled intravenous analgesia，Pcia），记录两组患者的吗啡用量、Pcia的按压次数、术后48小时内患者静息状态下的疼痛视觉模拟（Vas）评分、血糖水平和吗啡的相关不良反应。结果术后48小时内糖尿病患者吗啡消耗量高于非糖尿病组(P＜0.05),Vas评分糖尿病组高于非糖尿病组（P＜0.05），术后48小时Pcia按压次数糖尿病组明显高于非糖尿病组（P＜0.05），48小时不良反应糖尿病组高于非糖尿病组（P＜0.05）。结论糖尿病患者术后镇痛效果差，达到效果需增加剂量控制好血糖。
  • 摘要：目的：通过对2例甲状腺功能减退（甲减）导致的呼吸或循环衰竭的临床病例报告，复习甲减导致呼吸、心力衰竭的机制等，进而提高对甲减相关性呼吸、心力衰竭的诊治水平。方法回顾性分析福建省立医院收治的2例以呼吸衰竭、心力衰竭为主要表现的2例甲减患者的临床特点，并进行相关文献回顾。结果病例1报道了患者先后两次间隔9个月均因甲减危象并发呼吸衰竭而入院诊治的过程。病例2报道了甲减患者以心力衰竭主要并发症诊治过程。结论两例均为女性患者，均因肺部感染导致急性发病，但分别以呼吸、心血管系统不同程度受累为主要表现，提示甲减首发危及生命的并发症可能跟个体心肺代偿功能，甲减发展速度、严重程度等相关。同时，甲减导致呼吸衰竭、心力衰竭是临床中少见且容易漏诊、误诊的危重症，应引起临床医师的重视。%Objective in order to improve the accurate diagnosis rate as well as the treatment in the hypothyroid related critical illness, two cases of respiratory and heart failure caused by severe hypothyroidism were emphasized and the mechanism was reviewed in the literature.Method Two typical cases of hypothyroid which respectively caused the critical injury of the respiratory and circulatory systems were extracted from fujian Provincial Hospital databases of inpatients. They were retrospectively analysed and reviewed.Resultcase 1 shows a 60-year-old woman who presented mainly as refractory respiratory failure of unknown origin in the two admissions with an interval of nine months, which finally turned out to be the complication of the underlying disease- hypothyroidism crisis. case 2 shows a 84 -year-old lady manifested as hypothyroid related heart failure. Both patients have recovered from the replacement of levothyroxine.Conclusion The respiratory and circulatory system injury triggered by pulmonary infection were separately present in the two cases of female patients. it indicates that the life-threatening complications as the first presentation of hypothyroidism are likely to be associated with the individual pulmonary and cardiac function, the developing speed of hypothyroidism and its severity. it requires clinicians to pay more attention to the critical illness and emergency state of respiratory and heart failure resulting from hypothyroidism which can be easily overlooked and misdiagnosed .
  • 摘要：《创伤与急诊电子杂志》经原国家新闻出版广电总局批准、具有标准国内刊号(CN11-9332/R)的一本正式发行的国家级创伤与急诊专业杂志。由国家卫生健康委员会主管,人民卫生出版社有限公司主办,人民卫生电子音像出版社有限公司出版,国内急诊医学学科带头人林才经教授担任主编,季刊。本刊采用多媒体光盘作为载体,以图文声像多种形式,介绍国内外创伤医学和急诊医学新进展新动向,交流医学理论与技术发展成果,促进创伤与急诊医学知识创新和诊疗水平的提高。
  • 摘要：Objective To explore the feasibility and time required for lightwand-guided tracheal intubation used in the emergency cases.Methodan experienced anesthesiologist underwent training for an airway management technique that involved lightwand-guided tracheal intubation via laryngoscope. The use of muscle relaxant and sedatives drug depended on the condition of the 45 patients who was in need of tracheal intubation. direct lightwand-guided tracheal intubation was applied for patients with cardiac arrest and deep coma while those who were conscious or in light coma were intubated by muscle relaxant and sedatives drugs. The duration of the intubation process was recorded.Result success rate of lightwand-guided tracheal intubation is 97.78%(44/45).intubation under laryngoscope was applied in one case instead because the patient’s mouth was full of food scraps. Time for the lightwand-guided tracheal intubation is(16.13±3.86)seconds. conclusion lightwand-guided tracheal intubation used in emergency cases is simple and feasible and makes it easier to get access to the patients with small mouth opening and limited neck mobility. it can also help maintain a stable circulatory function in patients, while laryngeal mask airway(lma) and laryngoscope are still needed in case of contingency.Conclusion lightwand-guided tracheal intubation used in emergency cases is simple and feasible,making it easier to get access to the patients with small mouth opening and limited neck mobility. it can also help maintain a stable circulatory function in patients, while laryngeal mask airway(lma) and laryngoscope are still needed in case of contingency.laryngoscope are still needed in case of contingency.%目的：探索lightwand光棒气管插管用于急救插管的可行性及所需的时间。方法由熟练掌握光棒技术气管插管的麻醉医师进行插管，45例急救患者根据患者病情决定是否使用镇静剂和肌松剂诱导插管。呼吸心跳骤停和深度昏迷没有明显吞咽反射的患者直接使用光棒插管。浅昏迷或清醒的需要气管插管辅助机械通气的患者采用静脉诱导后插管，记录从开始提下颌操作到气管导管置入的时间和一次成功率。结果应用光棒插管成功率是97.78%(44/45)，1例因饱胃大量胃内容物堵塞口腔改为喉镜明视下插管。光棒插管所用时间是（16.13±3.86）秒。结论光棒插管技术简便易行，可用于开口度小和头颈部活动受限的患者，对于操作者空间要求不高，但是仍然需要预备好喉罩喉镜等应急措施。
  • 摘要：目的：探讨近年来的子宫动脉栓塞术(uterine artery embolization，uaE)在治疗剖宫产术后导致的子宫瘢痕妊娠(cesarean scar pregnancy，csP)中的疗效及临床安全性。方法回顾性分析，探讨本院2010年1月至2013年6月75例剖宫产术后瘢痕妊娠患者的诊疗经过资料。结果74例患者行子宫动脉栓塞术成功，3例因大出血急诊行子宫动脉栓塞成功，其中1例不成功行次全子宫切除术。其中40例同时行甲氨蝶呤(mTX)动脉灌注，均在栓塞术后48～72小时行超声介导下刮宫术；74例患者术后随访6～36个月，清宫后无1例再次阴道大出血，均未出现继发性闭经或卵巢早衰。结论 csP早期行uaE治疗，有效保留子宫，提高生活质量，能明显减少出血量，是治疗csP安全、有效的方法。%ObjectiveTo investigate the clinical analysis of uterine artery embolization in the cases of cesarean scar pregnancy.Method 75 cases of cesarean scar pregnancy in fujian Provincial Hospital from January 2010 to June 2013 were included,and their clinical data were analyzed to summarize treatment experience.Result 74 cases of cesarean scar pregnancy succeeded in uterine artery embolization, and 40 cases succeeded in mTX uterine artery embolization, and the curettages were done after 48~72 hours. 3 cases succeeded in emergency uterine artery embolization.1 case did not succeed and was done by subtotal hysterectomy. amenorrhoea or ovarian failure were not present in 74 cases 6~36 months after operation. Conclusion The early uterine artery embolization in the cases of scar pregnancy is safe and highly recommended.
  • 摘要：目的：观察乌司他丁对重症肺炎患者的心肌损伤的保护作用。方法选择125例重症肺炎伴有心肌损害患者，按治疗方法不同分为对照组(62例)和实验组(63例)。对照组采用常规治疗方法，实验组在常规治疗基础上加用乌司他丁20万u,2次/天，连用7天；分别于治疗前、治疗后第2天及治疗后第6天采静脉血测量心房利钠肽（BnP）、血清肌酸激酶(cK)、肌酸激酶同工酶(cK-mB)、肌钙蛋白Ⅰ(cTn i)，并与对照组进行对比，同时对两组患者治疗前、治疗后第2天及第6天心排量进行比较。结果所有患者血清BnP、cK、cK-mB、cTn i含量较治疗前均明显下降，有统计学意义(P<0.05)，乌司他丁组改善更明显；实验组患者的心排量(co)较对照组改善明显，有统计学意义(P<0.05)。结论应用乌司他丁注射液，可减轻重症肺炎患者的心肌损害，改善患者心功能。%ObjectiveTo investigate the influence of ulinastatin on myocardial protection of severe pneumonia patients.Method 125 patients with severe pneumonia were divided into control group (62cases) and experimental group (63cases) based on the treatment. The patients who were in control group were treated conventionally, and the patients who were in experimental group received similar therapy plus intravenous injection of ulinastatin 200,000u, twice a day for 7 days; The venous blood sample was collected before treatment, 2 days, 6 days after treatment separately to measure the concentration of serum brain natriuretic peptide( BnP),creatine kinase (cK),creatine kinase-mB (cK-mB) and cardiac troponin i(cTn i) all the values were compared between the two groups and the cardiac output of the two groups were observedResult The concentration of serum BnP,cK,cK-mB,cTn i values which decreased dramatically after treatment is statistically significant(P<0.05),especially in the experimental group.The cardiac output of experimental group improved significantly compared with that of control group(P<0.05).Conclusion ulinastatin in combination with routine therapies can reduce myocardial damage and improve cardiac function of severe pneumonia patients.
  • 摘要：在颅脑外伤急性期，患者神经内分泌调节功能异常，引起血压波动，出现病理性血压变异(blood pressure variability，BPV)。本文就脑血流的调节、颅脑外伤急性期血压改变、颅脑外伤急性期血压变化机制及其对机体的影响和BPV与脑损伤的关系等方面展开综述，对颅脑外伤急性期血压变异性与近期预后的关系进行探讨。
  • 摘要：目的：总结四季豆中毒急诊救治经验。方法回顾分析本院急诊科2012年1月至2013年6月救治的三起84例四季豆中毒患者临床资料，探讨四季豆中毒机制与防治方法。结果82例经综合救治后痊愈出院；1例因多脏器功能衰竭，1例因溶血性贫血、急性肾功能衰竭而中毒死亡。结论煮熟炒透可预防四季豆中毒；在抢救四季豆中毒时，按中毒轻中重施救，尽早促进毒物排泄、对症支持及采用维生素C联合纳洛酮、血液透析等综合治疗可提高抢救成功率。
  • 摘要：人类文明的发展历程也是人与自然灾害斗争的历程。古往今来，许多大的灾难事件均伴随着人类的文明进步历程，无论是中国古代两汉时期的震灾、14世纪欧洲鼠疫流行、19世纪霍乱大流行，还是20世纪北美黑风暴、智利大海啸、唐山大地震、切尔诺贝利核事故，以及近些年发生的“9·11”恐怖事件、印尼海啸、SARS流行、汶川和青海玉树地震等；均给人类带来巨大的灾害和磨难，同时又促使人类更加自觉地去认识和把握自然规律，增强抵御自然灾害的能力，进而推动人类文明进步。正如恩格斯所说，“没有哪一次巨大的历史灾难，不是以历史的进步为补偿的”。这些灾难警醒人们必须建立完善的永久性公共卫生防御体系，采取积极措施科学应对，最大限度减少灾害带给人类的伤害，从而灾难医学应运而生。
  • 摘要：Objective The purpose of this study is to assess clinical diagnostic value of sonographic pneumothorax detection as a part of extended focused assessment with sonography for trauma(EFAST) in patients with post-traumatic pneumothoraces.Method In a prospective study, a sonographic search for pneumothoraces was performed as part of a standard EFAST examination by critical care medicine doctors.from Sep. 2012 to Mar. 2014.98 Multiple trauma patients admitted to the third department of critical care medicine were enrolled and EFAST was performed. Pneumothorax was diagnosed when the signs of “lung point” appeared or“lung sliding” and “comet tail”sign disappeared.Chest computed tomography (CT)scan and bedside radiography were done within three hours. The result of CT was regarded as a golden standard, and the values of ultrasonography(US) and radiography were compared with it.Result 36 hemi thoraces of 32 patients among 98 patients had pneumothorax at CT.32 hemi thoraces of 29 patients of these pneumothoraces were detected at US ,and 16 hemi thoraces of 14 patients were seen at supine chest X ray or clinical diagnosis.The corresponding data of sensitivity,specificity, positive predictive value(PPV), negative predictive value NPV and accuracy (DA)of ultrasonography vs radiography were 88.6% v.s. 45.7%, 98.5% v.s. 100%, 96.9% v.s. 100%, 94.4% v.s. 78.2%, 95.1% v.s. 81.6%, respectively.Conclusion In this study ,US was more sensitive than supine chest X ray and as sensitive as CT in the detection of post-traumatic pneumothoraces.%目的：探讨超声检测气胸作为扩大的创伤重点超声评估法（extended focused assessment with sonography for trauma，EFAST）的一部分在多发伤患者气胸中的临床诊断价值。方法2012年9月至2014年3月收住本院重症三科的多发性创伤患者98例，均予EFAST检查（EFAST组），以“肺点”出现或“肺滑行”和“彗尾征”消失诊断气胸。在超声检查前后3小时内行胸部CT（CT组）和床旁X线检查或临床穿刺抽气检查（混合组）。结果CT检查结果证实气胸32例36侧，其中EFAST诊断29例32侧，仰卧位胸片和临床穿刺抽出气体诊断气胸14例16侧。超声检查对气胸的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为：88.6%、98.5%、96.9%、94.4%和95.1%；而混合组的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为：45.7%、100%、100%、78.2%、81.6%。结论本研究结果表明，EFAST对外伤性气胸的诊断敏感性、阴性预测值和准确度比仰卧位X线胸片和临床诊断好，和CT检查结果基本一致。
  • 摘要：外伤后即刻种植牙是指一种外伤引起的牙缺失，即在拔牙创伤口处同期植入种植体的技术，在临床上有效的帮助外伤导致的牙齿缺失的患者缩短了治疗疗程，同时也拥有创口小、恢复快、防止牙槽骨吸收等优势。有效推广治疗后的护理存在极大的必要性，也能帮助患者在治疗后更好恢复。
  • 摘要：急诊医学是近30年来发展起来的一门新兴综合性临床二级学科，其主要职责是及时、高效地抢救各类危重急症病人。急诊患者病情危重，复杂多变，患者及家属心理也常常发生剧烈波动，使得急诊医务人员常常站在医患矛盾激化的风口浪尖上。这要求急诊科医务人员不仅要有精湛的医术，而且要有良好的人文素质，以提高急诊质量，避免急诊医疗纠纷。本文从加强人文素质建设对保障急诊医疗质量安全的重要性、迫切性及具体举措等方面进行了初探。
  • 摘要：Traumatic brain injury may cause acute brain dysfunction. It is an important reason for disability or death. The targets of neural function monitoring are to discover and diagnose secondary brain injury, guide treatment, and evaluate therapeutic effect. The methods of neural function monitoring include intracranial pressure monitoring, brain tissue oxygen tension, cerebral microdialysis, electrophysiological monitoring, transcranial doppler ultrasonography et al. Monitoring targets vary with different techniques, which are complementary and can not replace each other. These techniques have important implications for preventing further injury and improving prognosis. With the development of science and technology, neural function monitoring would turn to the direction which is noninvasive, continuous and multimodal.%颅脑创伤可导致急性脑功能障碍，是致残、致死的重要原因。神经功能监测的目标是早期发现和诊断继发性脑损伤，指导治疗和评价治疗效果。神经功能监测技术包括颅内压监测、脑组织氧监测、微透析技术、脑电监测、经颅多普勒超声等，不同技术各有不同的监测方向，各项技术相辅相成，不可相互替代。这些技术对防止病情恶化、改善预后有重要意义。随着科技的进步，神经功能监测将朝向无创性、连续性、多元化监测发展。
  • 摘要：多器官功能衰竭（multiorgan failure，MOF）是多器官功能障碍综合征（multiple organ dysfunction syndrome, MODS）的最严重阶段，在大多数重症监护病房已经达到很高的发病率，并迅速成为首要死亡原因，其病死率随着衰竭器官的数目增加而增高。在过去的二十年，尽管病因治疗和器官功能支持技术取得了显著的进步，但是MOF患者仍有极高的死亡率。很显然，阻断MODS向MOF发展，以提高MODS患者的生存率，已成为新的治疗策略。本文将对阻断MODS向MOF发展的若干国内外治疗进展进行综述，以期对MODS的治疗策略有更进一步的提高。%Multiple organ failure (MOF) is the most serious stage of multiple organ dysfunction syndrome (MODS) with a very high incidence rate and quickly becomes the leading cause of death in most ICU. Its mortality increases with the number of organ failure. In the past two decades, despite the significant progress of antibiotics and organ support technology have made, the mortality rate of patients with MOF is still high. Obviously,blocking the development of MODS to MOF has become a new treatment strategy to improve the survival rate of patients with MODS nowadays. Therefore, this paper will review the advances in treatment which blocks the development of MODS to MOF in order to further improve treatment strategy for MODS.
  • 摘要：目的：探讨创伤弧菌脓毒症病情变化及预后。方法回顾性分析5例创伤弧菌感染患者的临床表现及治疗效果。结果5例患者发病早期各异，特征性表现为皮肤破溃、坏死，迅速发展为多器官功能障碍。5例均行抗感染、床旁血液滤过等综合治疗，其中1例联合血浆置换术(therapeutic plasma exchange,TPE)的患者救治成功。结论创伤弧菌脓毒症病情进展迅速，病死率高，早期鉴别诊断、尽早综合性治疗可能改善其预后。
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  • 摘要：《创伤与急诊电子杂志》经原国家新闻出版广电总局批准、具有标准国内刊号(CN11-9332/R)的一本正式发行的国家级创伤与急诊专业杂志。由国家卫生健康委员会主管,人民卫生出版社有限公司主办,人民卫生电子音像出版社有限公司出版,国内急诊医学学科带头人林才经教授担任主编,季刊。本刊采用多媒体光盘作为载体,以图文声像多种形式,介绍国内外创伤医学和急诊医学新进展新动向,交流医学理论与技术发展成果,促进创伤与急诊医学知识创新和诊疗水平的提高。

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