Risk factors of perioperative heart failure in elderly patients with femoral shaft fracture / 中国骨伤

<p><b>OBJECTIVE</b>To study the risk factors of perioperative heart failure in the elderly patients with femoral shaft fracture by the regression analysis, so as to provide relevant clinical reference.</p><p><b>METHODS</b>From July 2012 to April 2017, 143 elderly patients with femoral shaft fracture who underwent surgical treatment in our hospital were retrospectively studied. Among them, 25 patients with perioperative heart failure included 10 males and 15 females with a mean age of (77.2±12.5) years old; 118 patients without heart failure included 54 males and 64 females with a mean age of (71.1±10.6) years old. The data of the time from injury to operation, hypertension history, heart disease history, disturbance of consciousness, preoperative renal function, operation method, operation time, anesthesia mode, perioperative fluid volume difference, perioperative pain score, postoperative hemoglobin were collected and recorded. The various factors of the two groups were compared, and a multiple factor Logistic regression analysis was performed on the meaningful results in order to identify the independent risk factors.</p><p><b>RESULTS</b>Univariate analysis showed that age, heart disease history, preoperative renal function and perioperative fluid volume had statistical difference between the two groups(<0.05). Multivariate analysis showed that the independent risk factors of perioperative heart failure were age[=0.016,=2.789(1.208, 6.439)], heart disease history[=0.011,=2.878(1.269, 6.527)], preoperative renal function[=0.043,=2.410(1.027, 5.654)], the perioperative fluid volume difference[=0.022,=4.215(1.230, 14.439)].</p><p><b>CONCLUSIONS</b>The age, heart disease history, preoperative renal function and perioperative fluid balance are the risk factors of perioperative heart failure in elderly patients with femoral fracture. During the perioperative period, we should pay full attention to and evaluate the hazards of these risk factors and adopt effective and effective prevention and treatment measures.</p>

Use of bronchofiberscopy in management of severe thoracic trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic effect of bronchofiberscopy in the management of severe thoracic trauma.</p><p><b>METHODS</b>A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal incision (282), nasal cavity (149) and oral cavity (57). Intensive SaO2 monitoring as well as blood gas analysis were performed pre-, intra- and postoperatively. Simultaneously oxygen therapy or ventilatory support was given. Sputum culture was done intraoperatively.</p><p><b>RESULTS</b>Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was positive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery (both P less than 0.05). Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death.</p><p><b>CONCLUSION</b>Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and sputum crust in the airway, manage obstructive atelectasis and pneumonia, and significantly improve respiratory function and treatment outcome.</p>

Relationship between expression of COX-2, TNF-α, IL-6 and autoimmune-type recurrent miscarriage

OBJECTIVE@#To investigate the roles of COX-2, TNF-α, IL-6 in the pathogenesis of autoimmune-type recurrent spontaneous abortion (RSA).@*METHODS@#RT-PCR was used to detect the mRNA of COX-2, TNF-α, IL-6 in the trophoblast cells of murine RSA and normal pregnant models. The COX-2, TNF-α, IL-6 protein expressions were determined by using immunohistochemisry staining method. The COX-2, TNF-α, IL-6 protein expressions were determined by ELISA.@*RESULTS@#The embryo loss rates in experiment group was significantly higher than that in normal pregnancy control group, the expression of COX-2, TNF-α, IL-6 in the trophoblast cells of murine RSA and normal pregnant models. The expression of COX-2 in autoimmune-type recurrent spontaneous abortion was significantly lesser than in normal pregnant models. The expression of TNF-α, IL-6 in autoimmune-type recurrent spontaneous abortion was significantly higher than in normal pregnant models. There was a positively correlation between TNF-α and IL-6. There was no relationship between COX-2, TNF-α and IL-6.@*CONCLUSIONS@#The abnormal expression of COX-2, TNF-α and IL-6 may result in RSA.

Management of multiple trauma with mainly thoracic and abdominal injuries: a report of 1166 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries.</p><p><b>METHODS</b>A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries.</p><p><b>RESULTS</b>Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% (119/804) and 83.5% (710/850) respectively (X(2) equal to 780.683, P less than 0.01). The operation rates of blunt and penetrating thoracic injuries was 6.8% (42/617) and 40.6% (76/187) respectively (X(2) equal to 131.701, P less than 0.01). The operation rates of blunt and penetrating abdominal injuries were 77.1% (434/563) and 96.1% (276/287) respectively (X(2) equal to 50.302, P less than 0.01). The operation rates of blunt thoracio-abdominal injuries were 6.8% (42/617) in thoracic region and 77.1% (434/563) in abdomen respectively (X(2) equal to 544.043, P less than 0.01). Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% (39/41). Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% (62/854) and 2.9% (9/312) (X(2) equal to 6.51, P less than 0.005). The deaths were mainly due to large volume of blood loss.</p><p><b>CONCLUSIONS</b>When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.</p>

Application of damage control orthopedics in 41 patients with severe multiple injuries / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To probe the feasibility and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries.</p><p><b>METHODS</b>A retrospective analysis was made on the clinical data of 41 patients (31 males and 10 females, aged 18-71 years, mean: 36.4) with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005.</p><p><b>RESULTS</b>As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% (5/41) with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured.</p><p><b>CONCLUSIONS</b>Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.</p>

Management of severe pelvic fracture associated with injuries of adjacent viscera / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.</p><p><b>METHODS</b>The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.</p><p><b>RESULTS</b>To cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.</p><p><b>CONCLUSIONS</b>Prompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.</p>