目的:分析与研究“5·12”汶川大地震所致成批胸外伤患者的特点及护理措施,为灾难性胸外伤护理方法提供有益的经验与措施。方法:回顾性分析“5·12”汶川大地震发生后10天内四川大学华西医院胸心外科普胸病区收治的75例住院患者资料,总结护理方法与效果。结果:75 例患者均有不同程度的皮肤挫裂伤和擦伤(100％),血胸75例(100 ％),血气胸24例(32％),肋骨骨折75例(100％),锁骨骨折6例(8％),肩胛骨骨折11例(14.7％),肺穿刺伤3例(4％),右主支气管断裂1例(1.33％),左侧膈肌破裂2例(2.7％),肺不张29例(38.7％)。同时伴有其它部位损伤:四肢骨折10 例(13.3％),脊柱损伤2 例(2.7％),脑损伤2例(2.7％),脾破裂2例(2.7％),胃破裂1例(1.33 ％)。住院期间死亡1例,其余患者均康复。结论:“5·12”地震胸外伤以血、气胸和肋骨骨折为主,合并严重的脏器损伤和复合伤是其主要特征,通过精心护理,可以降低死亡率和并发症的产生,促进患者康复。
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
目的总结外伤性心脏破裂的急救流程及手术治疗方法。 方法回顾性分析广元市第一人民医院2001年6月至2013年6月收治13例心脏破裂患者的临床资料，其中男11例、女2例，年龄20～45（32.0±10.5）岁；病程30 min至2 h，平均（45.0±9.6）min。立即行床旁B超检查，其中12例急诊在全身麻醉、气管内插管下行心脏修补术，同期处理合并脏器损伤。 结果1例术前死于腹腔大出血，1例死于术后弥漫性血管内凝血（DIC），术中发生恶性心律失常2例，术后发生慢性胸骨骨髓炎2例，痊愈出院11例。出院后1个月复查心脏彩色超声，发现4例少量心包积液，余未见异常。 结论对于高度怀疑心脏破裂患者，建立快速的救治通道，早期准确诊断、及时手术治疗，是挽救患者生命的关键。
ObjectiveTo investigate the clinical effects of early enteral nutrition in severe thoracic trauma patients requiring mechanical ventilation. MethodsWe randomly allocated 60 patients with thoracic trauma requiring mechanical ventilation into two groups by drawing lots including an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group in our hospital between January 2013 and September 2014 year. There were 30 patients in each group. We compared the recovery results of the patients between the two groups. ResultsAfter the treatment of 7 and 14 days, indicators in the EEN group were better than before significantly and better than those in the PN group; diarrhea rate average days of ICU and the average days of hospital decreased significantly with statistical differences (P<0.05). There was no statistical difference in ventilator-associated pneumonia or the incidence of stress ulcer between the two groups (P>0.05). ConclusionEarly enteral nutrition in severe chest trauma patients requiring mechanical ventilation may promote protein synthesis, improve the nutritional status of patients, correct negative nitrogen balance, reduce inflammation response, reduce the complications.
目的 探讨胸外伤开胸探查的手术指征及救治策略。 方法 回顾性分析我院自 2006 年 1 月至 2014 年 12 月经开胸探查救治 51 例胸外伤患者的临床资料，其中男 43 例、女 8 例，年龄 24（17～75）岁。 结果 全组损伤严重度评分（ISS）平均 19.4 分。闭合性损伤 16 例，开放性损伤 35 例，治愈 45 例（88.24%），死亡 6 例（11.76%）。死亡原因为心脏破裂、失血性休克、感染性休克、多器官功能障碍综合征（MODS）、弥散性血管内凝血（DIC）。 结论 及时就医、快速诊断、准确把握手术指征、多科室联合诊治是救治胸外伤的关键。