ABSTRACT
On April 6, 2020, a case of severe crush injuries in head, neck, chest and right upper extremity was admitted to Qingzhou Hospital Affiliated to the First Medical University of Shandong Province. In addition to the crush injuries, the case also suffered from shock, crush syndrome, trauma-induced coagulopathy (TIC), and acute respiratory distress syndrome (ARDS). The female patient was 44 years old, and was admitted to the hospital at 07:00 on April 6, 2020 due to traffic accident with head, neck, chest, right upper limb injuries with disturbance of consciousness for 1 hour. Admission physical examination: body temperature was 35.6 ℃. The patient was drowsy, with swelling and cyanosis around the right orbit and right cheek. The skin was severely abraded with blood seepage. The conjunctiva was pale. The lips were slightly cyanotic. The right chest collapsed and deformed with abnormal breathing. The skin of chest wall was blue and purple with extensive feeling of holding snow under the skin. The breath sound of right lung was low and dry and wet rales could be heard. Laboratory examination: routine blood test showed that white blood cell count (WBC) was normal, red blood cell count (RBC), hemoglobin (Hb) and platelet count (PLT) decreased, blood glucose increased; urine routine examination showed glucose +++, urine occult blood +++, urinary protein +++, visible transparent and granular tube type; coagulation indicators and blood biochemical examination were abnormal. Arterial blood gas analysis showed that pH and arterial partial pressure of oxygen (PaO 2) decreased. X-ray showed comminuted fracture of distal humerus and proximal end of right ulna and radius with dislocation of right elbow joint. CT showed swelling of soft tissue around the right orbit and depressed fracture of inner wall. After admission, single-lung ventilation, tracheotomy and prone ventilation were applied to increase oxygenation level and relieving ARDS. Fluid of damage control for resuscitation was applied to reverse shock and blood transfusion was used to control hemorrhage and TIC. According to the patient's conditions and theory of damage control surgery, right chest drainage and amputation of the right upper extremity amputation were performed in time. Then, the resection in the middle and lower part of right lung, lung repairment, and internal rib fixation were performed. Finally, selective operation was performed to cover the open wound with healing dressing, using negative pressure for suction and carrying out "stamp" skin grafting on the right chest. After treatment, the patient was out of danger, and satisfactory clinical results were achieved in the end.
ABSTRACT
Objective To study seasonal variation of blood pressure (BP) in patients with essential hypertension (EH) and its association with meteorological elements. Methods In total, 1800 patients with essential hypertension were recruited by cluster sampling from three townships and towns in Qingzhou,Shandong province, 1155 men and 645 women, with an average age of 61.3 years (ranging from 29 to 85years). BP was measured for all of them in sitting position at 8:00 in the morning every seven to 14 days during July 2008 to June 2009. Local meteorological data were collected accordingly such as temperature,humidity and atmospheric pressure, and multivariate regression analysis was performed to show their association. Results In general, BP in patients with EH presented a decreasing trend during the first half year of observation, with the lowest in the summer ( May to August). From September to October, their BP began to increase gradually, and reached the peak in the winter ( November to February nest year). There was significant difference in systolic BP (SBP) and diastolic BP (DBP) between various seasons (Pspring-summer = 0.002 and 0.000, Pwinter-spring = 0.001 and 0.000, Psummer-autumn = 0.045 and 0.000,Psummer-winter =0. 000 and 0. 000, Pautumn-winter =0. 000 and 0. 000, respectively), except for those between the spring and autumn. Both SBP and DBP reversely associated with outdoor air temperature and room temperature(beta= -0.08, t = -2.39, P ＜0.05 and beta = -0.24, t = -6.21, P ＜0.01,respectively), (beta = -0.08, t = -2.39, P ＜0.05 and beta = -0.24, t = -6.21, P ＜0.01,respectively). Conclusions BP in patients with EH reveals seasonal variation, with the lowest in the summer and the highest in the winter and evident fluctuation in the spring and autumn, especially in SBP,which associates with room temperature and their blood vessel elasticity.