目的 观察乌司他丁对多发伤患者的治疗作用和对肝、肾功能的保护作用。方法 46例多发伤患者随机分为治疗组（23例）和对照组（23例）。治疗组从入院第1天开始，每天静脉点滴乌司他丁10万单位+生理盐水100 ml，每8 h 1次，连续用药6 d，观察患者的临床指标判断疗效，并在入院时以及术后第1、3、5、7天检测谷丙转氨酶（ALT）、谷草转氨酶（AST）、血尿素氮（BUN）、血肌酐（Scr）、血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）以及白细胞介素-8（IL-8）含量的变化。结果 多发伤患者治疗组平均住院时间及平均住ICU时间均低于对照组，差异有显著性意义（P＜0.05）； 治疗组术后血浆ALT、AST、BUN及Scr浓度均明显低于对照组（P＜0.05）； 治疗组术后血浆TNF-α水平逐渐降低，对照组维持在较高水平； IL-2、IL-6及IL-8水平低于对照组（P＜0.05）。结论 乌司他丁对多发伤有治疗作用，并能减轻机体的全身炎症反应程度，有保护和改善肝、肾功能的作用。
Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.
目的:总结汶川大地震期间合并有多发伤的脊柱骨折的临床特点和治疗经验。方法:回顾分析汶川大地震期间四川大学华西医院收治的281例脊柱骨折,其中223例合并有多发伤,分析其临床特点和治疗方式。结果:223例合并多发伤的脊柱骨折中单纯椎体骨折138例,单纯附件损伤37例,椎体+附件骨折48例;平均年龄43.45±14.05岁;椎体分布以下胸段和腰段为主,胸腰段占60%左右;致伤原因中砸伤占82.1%;脊柱手术治疗35例,占需手术治疗的27.8%;合并伤共267例次;严重并发症127例次;合并脊髓或马尾神经损伤101例,占45.3%,有15例在搬运中发生脊髓损伤。结论:汶川大地震发生在山区,地震烈度高,伤员多为复合伤,存在严重的并发症,受累椎体多,治疗的重点首先放在处理开放伤、感染、并发症上,影响了脊柱骨折的治疗;早期救援时正确施救才能有效防范继发性脊髓损伤。
ObjectiveTo study the value of revised trauma scores (RTS), major trauma outcome study (MTOS)-RTS scores and point of care test (POCT) in the early forecast of survival time in severe multiple trauma patients. MethodsMultiple trauma patients treated in the Emergency Department of our hospital between September and December 2015 were included in our study. We collected such data as the basic information on admission, physical signs (breath, blood pressure, state of consciousness) and POCT indexes, including pH value, hemoglobin, base excess, hematocrit value, lactic acid, sodium, anion gap, and blood glucose. We calculated each patient's RTS and MTOS-RTS scores. According to the 30-day prognosis, the patients were divided into survival group and death group. Risk factors for survival time were screened by Cox regression risk model. ResultsSeventy-five multiple trauma patients were included in our study. Among them, there were 51 males and 24 females. Fourteen of them died. The multivariate analysis in the Cox regression risk model showed that the risk factors for the death of multiple trauma patients included MOTS-RTS score [RR=0.726, 95%CI (0.608, 0.867), P < 0.001) and POCT lactic acid level [RR=1.139, 95%CI (1.010, 1.324), P=0.037]. ConclusionMOTS-RTS combined with lactic acid level may be used in the early forecast of survival time in severe multiple trauma patients.
Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.
Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury (AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission (20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs. (11.13±3.41) d], rate of renal replacement therapy (35.0% vs. 0.0%), and 28-day mortality rate (25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group (P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group (P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98 (0.96, 1.00), 0.92 (0.83, 1.00), and 0.87 (0.78, 0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.