Objective To investigate the injury types, dysfunction situation and rehabilitation deamnd of the Lushan earthquake victims. Methods The rehabilitation demand of 208 Lushan earthquake victims in the West China Hospital of Sichuan University were investigated using a questionnaire. Results Bone fractures accounted for the largest proportion of injury types, followed by combined injuries, soft tissue injuries, pulmonary contusion, and amputation. Most victims suffered from the motor dysfunction, balance disorder and restrictions in activities of daily living. More than 80% of victims had pain. A few victims had paresthesia and respiratory disorder. Most victims needed rehabilitation assistant devices and hospitalization treatment. Conclusion The injury types and dysfunction situation of Lushan earthquake victims are associated with the demand of rehabilitation assistant device. The tailored rehabilitation regimen can be made in combination with victim’s rehabilitation demand. The early intervention of rehabilitation medicine is extremely beneficial to the recovery of earthquake victims.
Objective To investigate the injury characteristics of 33 children of Lushan earthquake victims no more than 14 years old treated in the West China Hospital of Sichuan University, and to put forward the early rehabilitation strategy. Methods A total of 33 earthquake children victims were investigated with the modified barthel index score (MBI) and analyzed in following aspects: age, causes, and injury. Results a) The 33 children victims accounted for 10.28% of the total earthquake victims treated in the hospital, they were all no more than 14 years old, and the average age was 7.24 years old. 17 cases were fractures of trunk and limbs, six were traumatic brain injury, and four were soft tissue injury. b) The main traumatic causes were crush by falling objects and heavy stuffs; and some children rarely suffered from hurt, burn and fall injury when running. c) Most children victims were simple open injuries and fractures, especially the limbs fractures accounted for 51.51% of the total cases, and there was only one case suffered from abdominal organ injuries. d) Among 33 children victims, 30 (90.9%) were from the towns and villages. They mainly got injured by the collapse of house or courtyard walls which were not as ber as the house in the cities, so the incidence of severe injury was lower, the degree of injury was milder, and the injury of major organ was rarer. Conclusion Early rehabilitation treatment is helpful to prevent the complications and early recover the functions. It suggests the early rehabilitation treatment should be carried out for the earthquake children victims in order to promote the fracture healing and functional recovery, as well as to prevent the complications. In addition, attention should also be paid to the psychological problems while concerning rehabilitation training.
Objective To explore the traumatic situation and transfer methods of the in-patients injured in Lushan Earthquake, and to provide evidence for treating injured mass in future. Methods The information of the patients injured in Lushan Earthquake who were admitted in Chengdu Military General Hospital were collected by “No. 1 Military Medical Project” hospital information system and a self-edited “Questionnaire for Hospitalized Patients Injured in 4.20 Lushan Earthquake”. Results A total of 65 patients were admitted in this hospital: 63 (96.92%) patients were injured in the main shock; 28 (43.08%) patients were injured by building collapse; 23 (35.38%) patients got injured due to falls or got bruised when escaping; and 14 (21.54%) patients were accidentally injured. Rescue methods: 32 (49.23%) patients were saved by themselves; 23 (35.38%) patients were mutually helped; 10 (15.38%) patients were rescued by local non-military rescue team; 34 (52.31%) patients were rescued by military rescue teams; and 26 (44.83%) patients were transferred by air transport. Conclusion In order to cope with emergencies and major disasters (e.g. earthquake) and to treat injured mass scientifically in the future, we should set up emergency wards scientifically and reasonably, carry out education on earthquake prevention and disaster mitigation widely, reinforce self-care and mutual aid in the stricken area, quickly send rescue and medical teams, and organize training for air transportation of patients.
Objective To investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemiareperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirtyone HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16)， 1×105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P＜0.05). On the first postoperative day, the plasma CRP concentration in the UTI group was significantly lower than that in the control group(P＜0.01). The plasma cortisol level in the control group markedly increased compared with the level before operation(P=0.046). However, there was no significant difference in the UTI group between before and after operation. Conclusion Ulinastatin can effectively protect liver from ischemia/reperfusion injury in HCC patients undergoing hepatectomy performed after hepatic inflow occlusion. Also, it can relieve the surgical stress for patients.
Objective To establish a new model on isolated human cadaver testes with ischemiareperfusion (I/R). MethodsThirteen isolated cadaver testes contributed by 13 persons were preserved under 0℃-4℃ hypothermia and then reperfused under 37℃. Histological and histochemical changes were observed. Results4℃ cold ischemia in 12 hours induced only trivial swelling and vascular degeneration of endothelial cells (ECs), obvious pathologic changes occurred after 24 hours, including detachment of ECs, separation between basement membrane and seminiferous epithelium, degeneration and detachment of spermatogenous cell and edema of mesenchyme. Injury was worse along with the prolongation of cold preservation time. Changes of LDH and SDH activities were found by histochemical staining. Reperfusion following 6 hours ischemia induced tissue injury and unusual enzyme activity. All changes were more obvious after reperfusion following 12,18,24 or 36 hours cold ischemia.Conclusion This new model on isolated cadaver testes with ischemiareperfusion is successful, it can substitute other solid organs of human beings for I/R injury study.
Objective To comment the diagnosis and treatment the bile leakage from the injuried abnormal minute biliary in our laparosicopic cholecystectomy (LC) practice. Methods Fourteen cases of minute biliary duct injury in 2 050 cases of LC were studied retrospectively. Among them, 6 cases had been found the points of leakage during operation, and the points were treated by titanium nips. In 4 cases even though the bile leakage could be seen, but the points of leakage could not found, and were treated by drainage. Four cases with peritonitis, 1 needed to be explored, and treated with suture ligature, 1 was explored by laparoscopy again, another two cases were treated with multiple hole catheters to drainage of the abdominal cavities through stab wounds. Results All 14 cases recovered. Conclusion Small bile leakage in LC is almost inevitable. It is the best that the bile leakage can be discovered during operation and to be treated. If it is discovered after operation, an open or laparoscopic exploratory laparotomy and adequate drainage would be needed. In the case of small amount of leakage, catheter drainage through stab wound is feasible.
Incidences of injuries to peripheral veins indicated certain proportions among vascular injuries, most of venous injuries were accompanied by arterial injuries. Elevated venous pressure is an important factor which cause a compression syndrome in muscular compartment of the extremities when the injured major veins are ligated or not repaired. Persistent red deep color bleeding at wound site, diffusive subcutaneous hematoma, edema and cyanosis of the extremities are characteristics of the venous injuries. The examinations of Dopplor ultrasound and phlebography would be available for diagnosis of the venous injuries. The repair means include lateral sutere, vein pathch grafts, end-to-end anastomosis and autogenous venous grafts. The venous thrombosis may occur at the early phase after repair operations and also could be prevented.
ARDS 是引起重症患者呼吸衰竭的主要原因, 尽管医疗技术有了很大的进步, 但对ARDS 的治疗只局限在器官支持层面, 其病死率仍高达40% [ 1] 。ARDS的主要病理改变为肺泡上皮细胞和毛细血管内皮细胞受损, 通透性增加, 富含蛋白质的液体渗出积聚于肺间质和肺泡。因此促进损伤肺毛细血管内皮细胞和肺泡上皮细胞的有效修复可能是ARDS治疗的关键所在。随着干细胞工程学的发展, 间充质干细胞( MSC) 作为一种理想的组织修复来源, 在ARDS 治疗中的应用受到越来越多的关注, 这可能为ARDS 的治疗开辟一条新的途径。
Objective To assess the impact of earthquake magnitude scale on injury characteristics of patients admitted to an earthquake rescue hospital，and provide references for rescue strategy formulation and medical resourceallocation. Methods We retrospectively analyzed clinical data of patients injured in 2008 “5 • 12” Wenchuan earthquakeand 2013 “4 • 20” Lushan earthquake who were admitted to West China Hospital of Sichuan University. Patient gender，age，time of admission，mechanisms，types and severity of injury and their prognosis were compared between the 2 groups.Results A total of 1 856 patients who were injured in Wenchuan earthquake，including 974 male and 882 female patients with their age of 45.8±22.7 years，and 316 patients who were injured in Lushan earthquake，including 174 male and 142 female patients with their age of 43.0±23.1 years，were enrolled in our study. No significant difference was found in genderor age between these 2 groups （P＞0.05）. Peak time of admission of Wenchuan earthquake patients was significantlylater than that of Lushan earthquake patients，and transfer duration of Wenchuan earthquake patients was significantly longerthan that of Lushan earthquake patients. The percentage of patients with crash injury of heavy objects or buried trauma ofWenchuan earthquake patients was significantly higher than that of Lushan earthquake patients. Injury severity and in-hospitalmortality of Wenchuan earthquake patients were significantly higher than those of Lushan earthquake patients. The proportionof patients with chest or cerebral injury of Lushan earthquake patients was significantly higher than that of Wenchuanearthquake patients. Conclusions Earthquake magnitude scale has a significant influence on mechanisms，types andseverity of injury of patients injured in earthquakes，as well as their timely transfer，management and prognosis. In earthquakeswith a comparatively lower magnitude scale，more thoracic surgeons and neurosurgeons are needed to ensure timelymanagement for patients with chest or cerebral injury.
Spinal cord injury is one of severe complications after thoracic aortic surgery. The degree and time of spinal cord ischemia during surgery, reconstruction of the blood supply of spinal cord ,biochemistry factors ,ischemiareperfusion injury, etc. are considered as factors influence on the complication of spinal cord after surgery. At present, to improve the surgical technique, to increase the blood supply of spinal cord, such as the mechanical dynamic blood perfusion, arterial shunt and cerebrospinal fluid shunt, to degrade the metabolic rate of spinal cord using hypothermia, and to prevent the ischemia-reperfusion injury using drugs are the methods for spinal cord protection during the aortic surgery. The feature of blood circulation of spinal cord, mechanisms of spinal cord injury and the latest progress of spinal cord protection is reviewed in this article.