ABSTRACT
Objective To observe the effects of limited fluid resuscitation (LFR) on immune function and inflammatory mediators in patients with multiple bone fracturescomplicated with traumatic hemorrhagic shock. Methods One hundred and two patients with multiple bone fractures complicated with traumatic hemorrhagic shock admitted to the Affiliated Hospital of Medical College of Ningbo University from January 2014 to June 2016 were enrolled, and they were divided into a LFR group and a early sufficient routine fluid resuscitation (RFR) group by random number table, each group 51 cases. After admission, the patients in the two groups underwent bandaging and hemostasis at the traumatic sites and preoperative management was prepared. The patients in RFR group were treated with early sufficient RFR, while LFR group was treated with LFR. The changes of hematocrit (HCT), blood platelet count (PLT), prothrombin time (PT), blood lactic acid and immune cells, inflammatory mediators and micro RNA-155 (miR-155) were observed in patients of the two groups at 4 hours after resuscitation.Results Compared with RFR group, the resuscitation time (hours: 3.67±1.45 vs. 5.14±1.61), levels of PT (s: 11.43±2.21 vs. 15.73±2.52), serum lactic acid (mmol/L: 3.35±0.15 vs. 3.81±0.25), tumour necrosis factor-α [TNF-α (ng/L): 14.10±3.39 vs. 16.28±3.47], interleukin [IL-10 (ng/L): 31.43±10.51 vs. 40.09±13.23, IL-6 (ng/L): 490.10±55.13 vs. 610.30±63.15] and endothelin-1 [ET-1 (pg/L): 183.35±30.51 vs. 250.01±31.23] in LFR group were significantly decreased (allP < 0.01), while PLT (×109/L: 134.58±28.13 vs. 108.12±30.35), HCT (×10-2: 0.34±0.04 vs. 0.24±0.05), miR-155 (0.15±0.02 vs. 0.08±0.02) and CD4+CD25+ regulatory T cell [CD4+CD25+Treg (×10-2): 2.28±0.47 vs. 2.10±0.39] in LFR group were obviously increased (allP < 0.01).Conclusions Using LFR in the emergency treatment of patients with multiple bone fractures complicated with traumatic hemorrhagic shock can effectively shorten the resuscitation time, regulate the patients' coagulation function, reduce the unnecessary excessive liquid infusion, improve immune status and decrease the degree of inflammatory reaction.
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Objective To investigate the clinical effect of salmon calcitonin in the treatment of senile osteoporosis , and to observe the effect of salmon calcitonin on bone mineral density ( BMD ) and pain.Methods 180 cases of patients diagnosed as osteoporosis from September 2015 to September 2016 in our hospital were retrospectively analyzed, the patients were divided into control group and treatment group according to the random number table method.The clinical efficacy and side effects of the two groups were evaluated.The bone mineral density (BMD) of the lumbar vertebrae, femur and radius were measured by dual energy X-ray absorptiometry.The VAS was used to evaluate the two groups before and after the treatment.( ODI) were used to evaluate the functional status of the patients before and after treatment.The self-made questionnaire was used to evaluate the quality of life of the patients before and after treatment.Results The total effective rate of treatment group was 94.44%, significantly higher than the control group 75.56%(P<0.05).After treatment, the treatment group of lumbar spine bone mineral density, bone mineral density and radial bone mineral density was significantly higher than the control group (P<0.05).After treatment, spontaneous low back pain, flexion extension pain, turn over pain and weight pain were significantly lower in the treatment group than in the control group (P<0.05).The ODI index of the treatment group was significantly lower than that of the control group (P<0.05).After treatment, the quality of life scores in the two groups were significantly higher than those before treatment, and the treatment group was higher than the control group(P<0.05).No significant adverse reactions occurred in two groups during the treatment.Conclusion Salmon calcitonin treatment of osteoporosis in elderly patients with a significant effect, help to improve bone mineral density, reduce pain and improve its dysfunction, and has high security.
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Objective To explore the treatment characteristics and effect of hip fracture in aged patients. Methods A retrospective analysis was performed in 143 elderly patients with hip fracture, aged 75 years and over. 28 cases received non-surgery treatment and 115 cases received surgery treatment. Much of them had at least one chronic disease. The complications, preoperative preparation, operative indications, internal fixation devices, postoperative management, mortality rate and recovery rate were reviewed. Results The mortality rate of nonoperative management patients was 39.3% (11/28) in one year, and that of operative management patient was 8.7% (10/115). The recovery rate of nonoperative management patients was 28.5% (8/28) in one year, and that of operative management patients was 75.3% (79/115). Conclusions If full attention is paid to preoperative treatments, hip fracture of aged patients treated by operation is safe and effective.