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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Flail chest is a severe chest trauma that is commonly associated with lung contusion, resulting in acute respiratory distress syndrome and respiratory failure, which brings challenges in clinical management. It has become a clinical consensus that surgical treatment of flail chest can rapidly restore thoracic stability, eliminate paradoxical breathing, and maintain stability of respiratory and circulatory functions. However, non-surgical interventions continue to be crucial in further improving the prognosis of patients with flail chest, such as pain management and respiratory management. In this study, the authors review the research progress in pain control and respiratory management during comprehensive treatment of patients with flail chest for better understanding of pain management and lung injury care, which may provide references for clinical treatment and further improvement of clinical prognosis and quality of life for patients with flail chest.
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Multiple trauma is complex and difficult to treat. The trauma at each site may obscure or delay the manifestation of each other. The severity of injury also exceeds the simple superposition of each injured site. There are numerous definitions of multiple trauma worldwide, with most regarding multiple trauma as major trauma. The definition of multiple trauma in China has evolved several times; however, it is currently still controversial, especially on whether the definition should be based on the nine body regions of the Abbreviated Injury Scale (AIS) or the six body regions of the Injury Severity Score (ISS). The absence of uniform anatomic region criteria in the definition of multiple trauma can lead to discrepancies in multiple trauma patients, causing the clinical application of the definition to be problematic. In this study, the authors elaborate the development and application status of the defination of multiple trauma at home and abroad, discuss the existed problems or controversies and put forward feasible suggestions on the definition of multiple trauma to further normalize the diagnosis and treatment of multiple trauma.
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Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.
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Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.
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Objective:To study the dynamic changes of cellular immune function in peripheral blood of trauma patients and its role in the evaluation of traumatic complications.Methods:A prospective cohort study design was conducted. Patients with blunt trauma admitted to Chongqing Emergency Medical Center from November 2019 to January 2020 were consecutively enrolled. The peripheral blood samples were collected at 1, 3, 5, 7, and 14 days after injury. The expressions of CD64, CD274, and CD279 on the surface of neutrophils, lymphocytes, and monocytes as well as CD3 +, CD4 + and CD8 + T lymphocyte subsets were measured by flow cytometry. The trauma patients were divided into different groups according to the injury severity score (ISS) and sepsis within 28 days after injury, respectively. The dynamic changes of cellular immune function in different time points after injury and differences between different groups were compared. Furthermore, the correlation with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), and ISS were evaluated by Pearson correlation analysis. Results:A total of 42 patients with trauma were finally enrolled, containing 8 severe trauma patients with ISS greater than 25 scores, 17 patients with ISS between 16 and 25 scores, and 17 patients with ISS less than 16 scores. The sepsis morbidity rates were 14.3% (n = 6) within 28 days after injury. CD64 index and CD4 +T lymphocyte subsets were significantly increased at different time points after trauma (H = 15.464, P = 0.004; F = 2.491, P = 0.035). The CD64 index and positive rates of CD279 in neutrophils, lymphocytes, and monocytes were increased with the severity of injury at day 1 and day 3 after injury, respectively. At the first day after injury, CD64 index were 2.81±1.79, 1.77±0.92, 3.49±1.09; positive rate of CD279 in neutrophils were 1.40% (0.32%, 2.04%), 0.95% (0.44%, 2.70%), 12.73% (3.00%, 25.20%); positive rate of CD279 in lymphocytes were 3.77% (3.04%, 5.15%), 4.71% (4.08%, 6.32%), 8.01% (4.59%, 11.59%); positive rate of CD279 in monocytes were 0.57% (0.24%, 1.09%), 0.85% (0.22%, 1.25%), 6.74% (2.61%, 18.94%) from mild to severe injury groups, respectively. The CD64 index in severe injury group was significantly higher than that in moderate group, and the positive rates of CD279 in neutrophils, lymphocytes and monocytes of severe injury patients were higher than those in other two groups (all P < 0.05). At 3rd day after injury, compared to moderate group, severe injury patients had significantly higher CD64 index and positive rate of CD279 in lymphocytes [4.58±2.41 vs. 2.43±1.68, 7.35% (5.90%, 12.28%) vs. 4.63% (3.26%, 6.06%), both P < 0.05]. Compared with the non-sepsis patients, the sepsis patients had significantly higher CD64 index and positive rate of CD279 in monocytes at day 1 after injury [4.06±1.72 vs. 2.36±1.31, 3.29% (1.14%, 12.84%) vs. 0.67% (0.25%, 1.48%), both P < 0.05], and positive rate of CD279 in lymphocytes significantly higher at 3rd day after injury [8.73% (7.52%, 15.82%) vs. 4.67% (3.82%, 6.21%), P < 0.05]. In addition, correlation analysis showed that positive rate of CD279 in lymphocytes was positively correlated with SOFA and ISS, respectively (r values were 0.533 and 0.394, both P < 0.05), positive rate of CD279 in monocytes was positively correlated with APACHEⅡ, SOFA and ISS scores, respectively (r values were 0.579, 0.452 and 0.490, all P < 0.01), positive rate of CD279 in neutrophils was positively correlated with APACHEⅡ and ISS, respectively (r values were 0.358 and 0.388, both P < 0.05). Conclusions:CD64 index and CD279 expression in neutrophils, lymphocytes, and monocytes are significantly related to the severity and prognosis of trauma. Dynamic monitoring the cellular immune function may be helpful for assessing the prognosis of trauma patients.
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Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.
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To meet the requirement on trauma database construction and trauma care quality evaluation for trauma center by National Health Commission of the People’s Republic of China, the authors put forward the basic fields of trauma database and determine the basic content of trauma database V4.0 by referring to the National Trauma Database content of US based on the fields of trauma database V3.0 and guided by the requirement of trauma care quality control and clinic research. This database consists of 137 fields, covering the whole process of trauma occurrence, first aid, diagnosis, treatment and outcome. Thirty-five quality control indices for trauma care are established. Preliminary application of trauma database V4.0 shows that it meets the basic requirements of trauma center construction and clinical research in China.
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Objective@#To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI).@*Methods@#All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed.@*Results@#Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05).@*Conclusions@#For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.
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Objective@#To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury.@*Methods@#43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7).@*Results@#Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition.@*Conclusion@#Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly.
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Objective To explore early diagnosis， surgical intervention and efficacy for blunt cardiac injury. Methods 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, pre-operative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years be-tween September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48. 8％(21/43);and steering wheel injury accounted for 71. 4％(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock;and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27. 9％(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases;relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy( EDT) with a resuscitative rate of 42. 9％(3/7). Results Overall mortality rate was 32. 6％(14/43);4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases( associated with transected aorta in 1 case);and associated injuries in 5 cases including liver trauma ( 3 cases ) , brain trauma ( 1 case ) , and cervical spinal trauma ( 1 case) . In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 ca-ses, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively;and other 2 restored spontaneously which were ensured by echocardiography. Postoperative com-plications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent tho-racotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advoca-ted. If it is necessary, EDT should be exercised decidedly.
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Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury (BCI).Methods All BCI patients from September 2003 t9 August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group (n=305) and operative group (n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3％ of 1 903 patients with blunt thoracic injury (BTI),and the mortality rate was 10.1％.The main cause of injury was traffic accident with an incidence of 48.3％.The diagnostic methods included electrocardiogram (ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9％.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6％.The incidence of negative ECG between the two groups was not significantly different (16.7％ vs 11.6％,P＞0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P＜0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P＜0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.
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Objective To investigate the expression change and their clinical role of triggering receptor expressed on myeloid cells-1 (TREM-1) in patients with severe thoracic trauma.Methods A prospective cohort study was conducted to analyze the clinical data of 52 patients with severe thoracic trauma (trauma group) hospitalized from October 2016 to May 2017.The peripheral anticoagulant blood samples were collected at days 1,3,5,7 and 14 after trauma.Meanwhile,10 healthy volunteers were enrolled in control group and their blood samples were collected once.According to injury severity score (ISS),the patients were divided into ISS low-score group (＜ 20 points,n =15) and high-score group (≥20 points,n =37).The patients were assigned to traumatic non-sepsis group (n =34) and traumatic sepsis group (n =18) by the latest definition and standard of sepsis 3.0 issued by the Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM).The expressions of TREM-1 on neutrophils and monocytes were measured by flow cytometry.Pairwise comparisons were done between trauma group and healthy volunteers,ISS low-score group and ISS high-score group,and traumatic sepsis group and non-sepsis group,respectively.The accuracy of traumatic sepsis prediagnosis by TREM-1 was evaluated by the area under receiver operating characteristic curve (AUC).Results Trauma group had 41 males and 11 females,with age of (45.9 ± 12.4) years,Abbreviated Injury Scale (AIS) of (3.5 ± 0.6) points and Injury Severity Score (ISS) of (23.6 ± 8.5) points.Control group had eight males and two females,with the age of(29.1 ± 2.8) years.Compared to control group,trauma group had slightly lower TREM-1 expressions in neutrophils and significantly higher expressions in monocytes at days 1 to 14 (all P ＜ 0.01).ISS high-score group had slightly lower TREM-1 expressions in neutrophils than ISS low-score group at days 1 to 7,with significant difference at day 1 (P ＜ 0.05).ISS high-score group had slightly higher TREM-1 expressions in monocytes than ISS lowscore group at days 1 to 14,with significant difference at day 14 (P ＜ 0.05).Compared to traumatic non-sepsis group,traumatic sepsis group had significantly lower TREM-1 expressions in neutrophils at days 1 to 14 (all P ＜ 0.05).Traumatic sepsis group had slightly lower expressions in monocytes than traumatic non-sepsis group at days 1 to 7,with significant difference at day 3 (P ＜ 0.05).AUC and 95％ CI evaluating the role of neutrophils TREM-1 in traumatic sepsis prediagnosis were 0.852 (0.738,0.966) at day 1,0.835 (0.721,0.948) at day 3,0.797 (0.654,0.939) at day 5,0.756 (0.599,0.914) at day 7,and 0.707 (0.525,0.888) at day 14,respectively.Conclusions After severe thoracic trauma,the expressions of TREM-1 are decreased in neutrophils but increased in monocytes.TREM-1 might be used to assess the injury severity and has certain value in prediagnosis for traumatic sepsis.
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Objective To summarize the medical rescue of Chinese Government Medical Team (Chongqing) in Nepal earthquake region in order to explore the work pattern of transnational medical rescue,and improve the rescue efficiency.Methods From the experience about the post-earthquake medical rescue of Chinese Government Medical Team (Chongqing) in Nepal in 2015,several aspects were worthy to summarize such as the establishment of medical team,the layout of camp site,the work algorithm and process,with the analysis of injury feature and outcome of treatment.Results Under the setting of efficient organization and rational assignment of professional work,special working rules,the mutual transfer treatment and multi-disciplinary treatment were employed for 737 emergency patients.Of them,128 patients were hospitalized (including 63 patients completely recovered,56 patients were of clinical improvement,and 9 patients were critically ill transferred to other hospital for advanced treatment),and post-traumatic complication occurred in 48 cases without death.In addition,148 operations were carried out successfully.Conclusions The earthquake disaster has specific feature such as suddenness,a host of casualties and poor rescue conditions,and overseas rescue is with the presence of the language barrier,the difference in living habit,and the lack of coordination with local rescue system,therefore,rationally assigning personnel and resources and establishing work pattern with flexibility,orderly and good communication are the key to promote the efficiency of transnational medical rescue for the injured patients in earthquake region.
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Objective To detemine the value of cardiac troponin in early diagnosis of severe myocardial contusion in the dog.Methods Twelve dogs weighing (11.4 ± 1.5) kg were subjected to severe myocardial contusion by impacting the chest area with BIM-Ⅱ biological impact machine.Electrocardiogram,cTnT and cTnI were measured before,immediately,and 2,4,6 and 8 hours after injury.Animals were then killed and the serum was separated for gross examination and triphenyl tetrazolium chloride (TTC) staining.Results Supraventricular tachycardia,ventricular tachycardia,ventricular premature beat,myocardial ischemia,atrial fibrillation,and ventricular fibrillation were seen on the electrocardiogram 2,4,6 and 8 hours after the injury,which suggested a high sensitivity but low specificity.cTnT and cTnI levels revealed no specific changes at postoperative 2 and 4 hours,but cTnT and cTnl were significantly increased to (0.130 ± 0.052) ng/ml and (1.615 ± 0.371) ng/ml at postoperative 8 hours,significantly higher than that immediately after operation (P ＜ 0.01).Sensitivity and specificity of cTnT and cTnI were both 100％,while the specificity of the TTC staining was (39.78 ± 9.07)％.Conclusion Cardiac troponin is of high sensitivity and specificity in early diagnosis of severe myocardial contusion and has good correlation with pathological changes,which exhibits great potential in clinical application.
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Objective To investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.
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Objective To explore the variations in category of internal diseases in order to plan out strategies to deal with during pre-hospital period in Chongqing urban area.Methods The category of internal diseases of pre-hospital emergency service in Chongqing urban area from January 2004 to December 2013 was studied and the data were analyzed retrospectively.Results Firstly,the number of patients in pre-hospital emergency service continued to mount up year by year,from 6031 patients in 2004 to 12 264 patients in 2013.The ration of male to femal was 1.24∶1 to 1.68∶ 1,and the cases of female increased year after year,from 2246 to 5486.Secondly,cardiovascular disease was the leading illness in the wide varieties of internal disease (15.35％-19.36％).The number of cerebrovascular accident (9.72％-13.11％),respiratory diseases (7.48％-10.20％) and digestive diseases (8.36％-10.58％) were escalating.However,the acute poisoning cases (2.36％-6.18％) showed a tendency of decline.The peak time of the pre-hospital emergency service was stable in past ten years.Thirdly,there were seasonal variation in incidence of cardiovascular,cerebrovascular and respiratory disease,more cases occurred in January and December than in other months.Alcoholism commonly peaked before Spring Festival.Fourthly,the peak time of internal disease occurred in the past 10 years was stable,peaked during 20:00-24:00,and the trough time was during 0:00-4:00,the ratio of trough to peak ranged from 30.7％ to 43.5％.Conclusion The variation of the internal disease category was associated more or less with seasonal rotation,the improved living standards,and stress of modern life,and the incidence of emergency illness were escalating year by year,thus the corresponding measures should be instituted to deal with those major changes.Improving pre-hospital emergency response capacity and efficacy of treatment is of great significance.Strengthening the prophylaxis and healthcare,and establishing a professional capability for triage classification of diseases during emergency service are great essential for promoting the swiftness of prehospital emergency response.
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Objective To sum up the experience on diagnosis and treatment of blunt bronchial injuries .Methods From January 2002 to December 2009 ,18 patients with blunt broncheal injuries were admitted .The definitive diagnosis was confirmed by fibro-bronchoscopy .Twelve patients suffered from main bronchial injuries and the remaining 6 patients from lobe bronchial injuries .All patients managed with surgical therapies .Emergent operation was performed in 15 patients and elective operation in 3 patients .End to end bronchial anastomosis was performed in 15 patients and primary repair in 3 patients .Results There was no death in this group .One patient after emergent primary repair developed ischic necrosis in the repair site on 3 the postoperative day and under-went resection of the necrotic tissue followed by end to end anastomsis .Thirteen patients had no complications and were able to take part in normal activities .Anastomotic stricture occurred in 5 patients and managed with granulation tissue resection and cryothera-py .Four patients were healed but one patient underwent lobectomy 6 months later as a result of recurrent stricture and severe dysp-nea .Conclusion Fibrobronchoscopy is able to define the blunt bronchial injuries immediately .Early surgery after trauma can im-prove the successful rate of treatment .
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Objective To assay the early quality of life and posttraumatic stress disorder (PTSD) and relating influential factors in patients with severe blunt chest trauma (sBCT).Methods Demographic and clinical data of sBCT patients treated between January 2011 and December 2011 were collected.Early quality of life and PTSD symptom level at posttraumatic months 1,3,and 6 were analyzed by using short form 36 health survey (SF-36) and impact of event scale-revised (IES-R) respectively.Furthermore,logistic regression analysis was performed to identify the risk factors associated with quality of life of the patients.Results A total of 107 patients were included in the study.Ultimately,83 patients were available to the 6-month follow-up.A low score for SF-36 remained at posttraumatic 6 months and one-third of the 83 patients sustained mild or severe PTSD symptoms.Major influential factors to posttraumatic quality of life included age,ISS ≥ 20,combined craniocerebral injury,combined spinal and pelvic injuries,posttraumatic complications,and PTSD.Conclusions Early quality of life in sBCT patients is poor.Therefore,the early intervention with identification of specific risk factors is contributive to better quality of life.
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Objective To investigate clinical effect of damage control surgery (DCS) in treatment of patients with flail chest combined with severe multiple injuries.Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments:DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs ; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib.Complications,mortality,and main parameters before and after operation in each group were analyzed and compared.Results Complications including pulmonary infection (32 cases),atelectasis (38 cases),and acute lung injury (ALI)/ARDS (39 cases) were found.Twenty-two cases died,including 13 deaths from ARDS,two from tension pneumothorax,one from massive hemoptysis,three from cardiac shock,two from craniocerebral injury,and one from liver trauma and thus the overall death rate occupied 11.8％.Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P ＜ 0.01),but the change of OI was inappreciable in Group B.Mortality,complication rate,cases treated with mechanical ventilation,tracheotomy or fiberoptic bronchoscopy,and average length of ICU and hospital stay were the lowest in the DCS Group,followed by a relatively higher result in Group B and a much higher result in Group A (P ＜ 0.01).Conclusion DCS decreases mortality and complications dramatically when appolied to treat flail chest combined with severe multiple trauma.