ABSTRACT
Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.
ABSTRACT
Objective To explore the correlation between the pathogenesis of coronary heart disease and the polymorphism of methylenetetrahydrofolate reductase ( MTHFR ) .Methods 130 cases of coronary heart disease diagnosed and treated in Heze Municiple Hospital from July 2015 to July 2017 were selected as observation group .At the same time,130 healthy people were selected as control group .The serum folate and homocysteine ( HCY) levels were compared between the two groups .At the same time, polymerase chain reaction -restriction fragment length polymorphism was used to analyze the MTHFR gene polymorphisms .The distribution of MTHFR gene polymorphism was compared between the two groups .Results The level of serum folic acid in the observation group was (5.76 ± 2.14)g/L,which was significantly lower than (7.34 ±2.43)g/L in the control group (t=5.64,P<0.05).The level of serum HCY in the observation group was (15.46 ±5.74)μmol/L,which was significantly higher than (10.28 ± 4.38)μmol/L in the control group (t=6.43,P<0.05).The frequencies of TT type,TC type and CC type of MTHFR gene in the observation group were 36.92％,46.92％and 16.15％,respectively.The frequencies of TT type,TC type and CC type of MTHFR gene in the control group were 21.54％,55.38％ and 23.08％,respectively.The frequency of TT type in the observation group was significantly higher than that of the control group (χ2 =8.25,P<0.05). There were no statistically significant differences in folic acid levels among different gene types in the observationgroup(t=1.31,0.55,0.73,all P>0.05),but the serum HCY level of TT type was significantly higher than that of CT type and CC type in the observation group (t=5.33,4.62,all P<0.05).Conclusion Serum folic acid level, HCY level and homozygous mutations of MTHFR gene type have certain relationship with the occurrence of coronary heart disease ,the body serum folic acid level and the distribution of MTHFR genotypes can affect the concentration of HCY,thus affecting the occurrence of coronary heart disease .