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OBJECTIVE:To compare the effects of equilibrium amino acid and it rich in branched chain amino acid on nutrition metabolism after surgery and prognosis of severe abdominal trauma patients. METHODS:A total of 60 severe abdominal trauma patients selected from our hospital during Sept. 2016-Jun. 2017 were divided into group A and B according to block randomization,with 30 cases in each group. Both groups were all given iso nitrogenous and iso caloric parenteral nutrition support on the basis of surgery and routine treatment after surgery;group A was additionally given 8.5％ Compound amino acid injection (18AA-Ⅱ)1.2 g/(kg·d)for 12 h each day at least;group B was additionally given 10％ Compound amino acid injection(20AA) 1.2 g/(kg·d)for 12 h each day at least. Both groups were treated for 7 d. The levels of nitrogen balance and serum protein(total protein,albumin,prealbumin and transferrin),plasma amino spectrum were observed in 2 groups before and after treatment. Hospitalization time,survival rate,the occurrence of complication and ADR were compared between 2 groups. RESULTS:Two patients of group A and one patient of group B were discharged,and totally of 57 patients completed the study. Before treatment, there was no statistical significance in the levels of nitrogen balance,serum protein or plasma amino spectrum (P>0.05). After treatment,the cumulative nitrogen balance of group B was significantly better than that of group A. The level of nitrogen balance was increased significantly in observation group 3-7 d after treatment and control group 5-7 d after treatment. Since 4 d after treatment,the level of nitrogen balance in group B was significantly better than control group,with statistical significance (P<0.05). The levels of albumin,prealbumin and transferring in group A were decreased significantly,and were significantly lower than group B, with statistical significance (P<0.05). The levels of glycine and threonine in 2 groups were increased significantly. The level of arginine in group B was decreased significantly, while the levels of valine and branched chainaimino acid were increased significantly;those indexes of group B were significantly lower or higher than those of group A respectively,with statistical significance(P<0.05). The incidence of gastrointestinal complications and disruption of wound,total incidence of complications in group B were significantly lower than group A,with statistical significance(P<0.05). There was no statistical significance in hospitalization time,survival rate or the incidence of infection between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Compared to equilibrium amino acid,equilibrium amino acid rich in branched chain amino acid can further improve and maintain the nitrogen balance,the levels of serum protein and plasma amino acid of severe abdominal trauma patients after surgery with low incidence of complication.
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Objective To discuss the application indications of emergency thoracotomy (ET) and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score (ISS) was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases (80 .00% ) manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room (6 cases) and the operative room (29 cases) .The time of admission to surgery in all cases was<30 min .12 cases (34 .29% ) died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases (65 .71% ) survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% (18/23) and 41 .67% (5/12) respectively .The occurrence rate of complications in the survivals was 39 .13% (9/23) .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .
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Objective To summarize diagnostic methods and surgical management experience of penetrating chest trauma . Methods The clinical data of 603 patients in our department during the past 10 years were analyzed retrospectively in respects of features of injury ,diagnostic methods ,surgical management and outcome ,etc .Results Location of the wounds :the wounds on the left anterior chest wall had 151 cases ,on the left posterior chest wall 134 cases ,on the right anterior chest 137 cases ,on the right posterior chest 108 cases ,on the bilateral chest 22 cases ,on the root of the neck 35 cases ,on the upper abdome 16 cases .In 453 ca‐ses examined by CT ,96 .03% of these cases were found to be abnormal .In 252 cases examined by X ray ,71 .03% of these cases were found to be abnormal .166 underwent thoracotomy ,26 underwent VATS(Video assisted Thoracoscopic Surgery ) .411 under‐went non operative management .583 were cured ,76 cases developed complications .20 were died .Conclusion Multi spiral CT is a rapidly and accurate diagnostic method to penetrating chest trauma .Incision of thoracotomy is employed according to the lethal damage and the most serious injury organ .