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1.
Article in Chinese | WPRIM | ID: wpr-884266

ABSTRACT

Hemorrhagic shock and lethal massive hemorrhage are leading causes of death in both combat and civilian trauma casualties, accounting for more than 80% of deaths in operating rooms and 70% of deaths within 24 hours after trauma. Management of such patients is the main challenge and core competence in establishment of a trauma center. Damage-control resuscitation measures in pre-hospital settings include following ABCs rules, implementing appropriate transfusion and infusion strategies based on pre-hospital transport time, maintaining blood pressure based on a specific injury, and using tranexamic acid. The core of damage-controlled resuscitation in in-hospital settings is early correction of traumatic coagulopathy by massive transfusion. Damage-control surgery in pre-hospital settings consists mainly in cervical spine protection, pelvic band fixation, thoracic drainage, direct compression hemostasis, etc. Resuscitation aortic balloon occlusion for non-compression lethal hemorrhage is the most promising life-saving means. Damage-control surgery in in-hospital settings includes damage control laparotomy, thoracotomy, orthopedic surgery and craniotomy. Only a combination of damage-control surgery and damage-controlled resuscitation in prime time can ultimately save patients with such severe trauma.

2.
Article in Chinese | WPRIM | ID: wpr-910017

ABSTRACT

Objective:To evaluate a new type of draw-bar skin stretcher in repair of full-thickness skin defects.Methods:From May 2015 to January 2019, 52 patients with full-thickness skin defects were repaired with a new type of draw-bar skin stretcher at Daping Hospital, Army Medical University. They were 40 males and 12 females, aged from 4 to 61 years (average, 37.1 years). Their skin was stretched for primary wound closure. When primary wound closure failed, skin stretching was performed again to close the wound depending on the wound condition. When the Pinch test was negative after skin stretching, the wound was sutured directly. In cases of positive Pinch test, a skin graft or flap was used to repair the remaining wound. At 12 months after surgery, scar contracture and size of skin graft or flap were observed and wound healing after skin stretching was evaluated in comparison with the original wound.Results:After skin stretching, one-stage wound closure was achieved in 36 cases and multi-stage wound closure in 8 cases; of the remaining 8 cases, 2 were repaired by skin graft and 6 by skin flap after their wounds were reduced by skin stretching. In one-stage closed wounds, infection occurred in 3 cases and marginal necrosis in 5 cases; in the wounds repaired by skin graft or flap, no infection or necrosis was observed. The 12-month follow-up for all the patients showed fine healing of all the wounds after one-stage or multi-stage closure, linear scar, absence of scar contracture, and smaller wound sizes than the original ones after skin graft or flap repair.Conclusions:Skin stretching using our new type of draw-bar skin stretcher is an effective treatment for skin wounds. It can replace traditional skin grafting and flap surgery in some cases, but its indications should be strictly followed to avoid related complications.

3.
Chinese Journal of Trauma ; (12): 865-875, 2021.
Article in Chinese | WPRIM | ID: wpr-909950

ABSTRACT

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.

4.
Chinese Journal of Trauma ; (12): 11-14, 2021.
Article in Chinese | WPRIM | ID: wpr-909826

ABSTRACT

Trauma score, trauma registry and construction of trauma database are the cornerstones for the quality improvement of trauma centers. Abbreviated injury scale (AIS)/injury severity score (ISS) has been used as the basis for evaluation of trauma centers in lots of countries since 2008, and has now developed into a globally recognized trauma scoring system. The authors introduce the changes in the number of codes and the setting of scores in the nine versions of AIS released since 1971, as well as the application effects of the AIS/ISS scoring system in recent years. Combined with the actual clinical cases, the errors in the current clinical application of AIS/ISS are analyzed. The construction of trauma registry and database in China has just started. The current focus is not to propose new trauma scores, but to correctly and accurately apply AIS/ISS scores first.

5.
Chinese Journal of Trauma ; (12): 1-7, 2020.
Article in Chinese | WPRIM | ID: wpr-811514

ABSTRACT

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.

6.
Chinese Journal of Trauma ; (12): 726-728, 2020.
Article in Chinese | WPRIM | ID: wpr-867776

ABSTRACT

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.

7.
Chinese Journal of Trauma ; (12): 455-462, 2020.
Article in Chinese | WPRIM | ID: wpr-867730

ABSTRACT

Objective:To investigate the role of basic fibroblast growth factor (bFGF) in decreasing intracranial pressure in rats after intra-abdominal hypertension (IAH).Methods:A total of 60 healthy SD rats were selected for the experiment. Secondary IAH rat models were established by hemorrhagic shock/resuscitation, followed by injecting nitrogen into the peritoneal cavity of the rats to maintain an intra-abdominal pressure of 12mmHg and above. According to the random number table, the rats were divided into control group, IAH group, IAH+ bFGF group (bFGF group) and IAH+ bFGF+ PD173074 group (antagonist group), with 15 rats per group. Indicators were measured 4 hours after injury, including intracranial pressure, brain morphological observation, apparent diffusion coefficient (ADC) value, lactic acid content of brain MRI, brain water content and Evans blue exudation. Immunofluorescence staining, Western blotting and PCR were used to detect the expressions of phosphorylate-fibroblast growth factor receptor 1, 2 (p-FGFR1, 2), Zonula occludens-1 (ZO-1), β-catenin, matrix metalloproteinases 9 (MMP9), interleukin-1β (IL-1β) in brain microvascular endothelial cells (BMECs).Results:The intracranial pressure in IAH group [(5.52±0.45)mmHg] gradually increased 4 hours after injury compared control group [(3.36±0.30)mmHg]. Compared with IAH group, the intracranial pressurein bFGF group [(4.46±0.41)mmHg] was decreased ( P<0.05). Compared with bFGF group, the intracranial pressure in antagonist group [(5.36±0.44)mmHg] was enhanced ( P<0.05). Brain morphological observations in IAH group showed swelling and obvious cerebral edema, accompanied with a small amount of subarachnoid hemorrhage. Compared with IAH group, cerebral edema and brain swelling were relieved in bFGF group, while the antagonist group still showed cerebral edema and obvious brain swelling. At 4 hours after injury, MRI examination showed that the relative ADC value in IAH group (cortex: 0.82±0.11, corpus callosum: 1.26±0.17) was lower than that in control group (cortex: 1.00±0.13, corpus callosum: 1.43±0.15)( P<0.05). Compared with IAH group, the relative ADC value in bFGF group (cortex: 0.94±0.16, corpus callosum: 1.36±0.16) was increased ( P<0.05). Compared with bFGF group, the relative ADC value in antagonist group (cortex: 0.87±0.13, corpus callosum: 1.30±0.14) was decreased ( P<0.05). Relative lactic acid content in IAH group (cortex: 15.50±2.14, corpus callosum: 10.82±1.90)was higher than that in control group (cortex: 1.00±0.23, corpus callosum: 0.70±0.20)( P<0.05). Compared with IAH group, the relative lactic acid content in bFGF group (cortex: 10.85±1.42, corpus callosum: 6.96±1.30) was decreased ( P<0.05). Compared withbFGF group, the relative lactic acid content in antagonist group (cortex: 13.71±1.61, corpus callosum: 9.12±1.52) was increased ( P<0.05). The brain water content in IAH group [(87.9±0.8)%] was higher than that in control group [(76.3±0.9)%]. Compared with IAH group, the brain water content in bFGF group [(83.2±1.0)%] was decreased( P<0.05). Compared with bFGF group, the brain water content in antagonist group[(85.4±0.8)%] was increased ( P<0.05). Evans blue exudation in IAH group [(3.22±0.29)μg/ml] was greater than that in control group [(0.42±0.22)μg/ml]( P<0.05). Compared with IAH group, the Evans blue exudation in bFGF group [(2.04±0.25)μg/ml] was decreased ( P<0.05). Compared with bFGF group, the Evans blue exudation in antagonist group [(2.92±0.20)μg/ml] was increased ( P<0.05). Compared with control group, the expression of p-FGFR1 in BMECs in IAH group was weakened 4 hours after injury, but p-FGFR2 remained unchanged, the expressions of ZO-1, β-catenin protein and mRNA were weakened, and the expressions of MMP9, IL-1β protein and mRNA were enhanced ( P<0.05). Compared with IAH group, the expressions of p-FGFR1, ZO-1, β-catenin protein and mRNA were enhancedin bFGF group, and the expressions of MMP9, IL-1β protein and mRNA were weakened as well ( P<0.05). However, the expressions of p-FGFR1, ZO-1 and β-catenin protein and mRNA in antagonist group were weaker than those in bFGF group, and the expressions of MMP9 and IL-1β protein and mRNA were stronger than those in the bFGF group ( P<0.05). Conclusion:After IAH, the rat model presents damaged blood-brain barrier, increased cerebral edema, and increased intracranial pressure, and the use of bFGF can improve these symptoms. FGFR1 of BMECs is a key receptor for bFGF to play a protective role, and its receptor inhibitor PD173074 can attenuate the protective effect of bFGF.

8.
Chinese Journal of Trauma ; (12): 97-103, 2020.
Article in Chinese | WPRIM | ID: wpr-867684

ABSTRACT

Epidemic of corona virus disease 2019 (COVID-19) has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the COVID-19 patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the COVID-19 patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of COVID-19, providing a basis for the clinical treatment of such kind of patients.

9.
Chinese Journal of Trauma ; (12): 1130-1137, 2019.
Article in Chinese | WPRIM | ID: wpr-824400

ABSTRACT

Objective To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training(CTCT)" by investigating the trainees who participated in the course.Methods A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study.Through questionnaires,the general information(gender,occupation,professional title,discipline source,length of time engaged in trauma treatment),the situation of trauma treatment in their hospitals(hospital level,trauma treatment mode,number of severe trauma cases each year),the recommended model of trauma treatment,learning methods of trauma treatment knowledge,and the trauma training interval were obtained.The trainees took tests before and after the training,and the test results were used to evaluate the training effect and analyze the influencing factors.Results(1)There were 1 230 males(74.10%),1 356 physicians(81.93%),1 247 with intermediate title or lower levels(75.12%),756 from emergency department/emergency surgery(45.54%),and 899 who were engaged in trauma treatment for more than five years(54.16%).(2)There were 1 068 trainees from tertiary hospitals(64.34%).The main mode of severe trauma treatment in hospitals was "emergency+consultation+triage"(1 198 trainees,72.17%).A total of 1014 trainees treated less than 200 severe trauma patients each Year(61.08%).A total of 1210 trainees recommended emergency/emergency surgery(72.89%)and 350 trainees recommended trauma surgery/trauma hospital(21.08%)as the main mode of treatment.(3)There were various approaches to acquire trauma treatment knowledge,including 1 029 person-times(61.99%)through department internal guidelines,924 person-times(55.66%)through case discussion,879 person-times(52.95%)through self-teaching,767 person-times(46.20%)through lectures,382 person-times(23.01%)through trauma courses and 285 person-times through further studies at home and abroad(17.17%).A total of 951 trainees recommended 1-2 years as the training interval(57.3%).(4)The average test score before training was(67.5±14.5)points,which were influenced by the hospital level,discipline source,title of trainees,length of time engaged in trauma treatment,and amount of severe trauma cases each year in their hospitals.The hospitallevel and discipline source were the main effect factors.(5)The average test score after training was(83.8±11.6)points,which was significantly higher than that before training(P<0.01),and the scores of trainees in different subgroups were all improved.The main factors influencing the test score included hospital level,number of severe trauma cases each year,discipline source,professional title,number of severe trauma cases each year treated in the hospital.The major effect factor was the amount of severe trauma cases each year.Conclusions The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+decentralized treatment".Few trainees have received systematic trauma treatment training,and their trauma treatment knowledge level and the test scores before training is influenced by hospital level,the case number of severe trauma treatment,discipline source,and trainees' qualifications.Mter the standardized and standardized trauma treatment training course "CTCT",the scores of students from different backgrounds have been significantly improved,and the gap between students has been significantly narrowed.

10.
Chinese Journal of Trauma ; (12): 1130-1137, 2019.
Article in Chinese | WPRIM | ID: wpr-799891

ABSTRACT

Objective@#To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training (CTCT)" by investigating the trainees who participated in the course.@*Methods@#A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study. Through questionnaires, the general information (gender, occupation, professional title, discipline source, length of time engaged in trauma treatment), the situation of trauma treatment in their hospitals (hospital level, trauma treatment mode, number of severe trauma cases each year), the recommended model of trauma treatment, learning methods of trauma treatment knowledge, and the trauma training interval were obtained. The trainees took tests before and after the training, and the test results were used to evaluate the training effect and analyze the influencing factors.@*Results@#(1) There were 1 230 males (74.10%), 1 356 physicians (81.93%), 1 247 with intermediate title or lower levels (75.12%), 756 from emergency department/emergency surgery (45.54%), and 899 who were engaged in trauma treatment for more than five years (54.16%). (2) There were 1 068 trainees from tertiary hospitals (64.34%). The main mode of severe trauma treatment in hospitals was "emergency+ consultation+ triage" (1 198 trainees, 72.17%). A total of 1014 trainees treated less than 200 severe trauma patients each year (61.08%). A total of 1210 trainees recommended emergency/emergency surgery (72.89%) and 350 trainees recommended trauma surgery/trauma hospital (21.08%) as the main mode of treatment. (3) There were various approaches to acquire trauma treatment knowledge, including 1 029 person-times (61.99%) through department internal guidelines, 924 person-times (55.66%) through case discussion, 879 person-times (52.95%) through self-teaching, 767 person-times (46.20%) through lectures, 382 person-times (23.01%) through trauma courses and 285 person-times through further studies at home and abroad (17.17%). A total of 951 trainees recommended 1-2 years as the training interval (57.3%). (4) The average test score before training was (67.5±14.5)points, which were influenced by the hospital level, discipline source, title of trainees, length of time engaged in trauma treatment, and amount of severe trauma cases each year in their hospitals. The hospital level and discipline source were the main effect factors. (5) The average test score after training was (83.8±11.6)points, which was significantly higher than that before training (P<0.01), and the scores of trainees in different subgroups were all improved. The main factors influencing the test score included hospital level, number of severe trauma cases each year, discipline source, professional title, number of severe trauma cases each year treated in the hospital. The major effect factor was the amount of severe trauma cases each year.@*Conclusions@#The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+ decentralized treatment" . Few trainees have received systematic trauma treatment training, and their trauma treatment knowledge level and the test scores before training is influenced by hospital level, the case number of severe trauma treatment, discipline source, and trainees’qualifications. After the standardized and standardized trauma treatment training course "CTCT" , the scores of students from different backgrounds have been significantly improved, and the gap between students has been significantly narrowed.

11.
Chinese Journal of Trauma ; (12): 853-859, 2019.
Article in Chinese | WPRIM | ID: wpr-797411

ABSTRACT

Objective@#To investigate the effect of papaverine on wound healing of full-thickness skin defect after skin stretching in swine.@*Methods@#Eight Bama pigs were prepared. Standard full-thickness skin defect for 7 cm×7 cm was produced in the middle part of each pig's forelimb, and skin traction was used to close the wound. According to random number table method, the pigs were divided into experiment group and control group, with four pigs in each group. Percutaneous oxygen partial pressure (TcPO2) was compared preoperatively and postoperatively. Wound healing clinical score was evaluated four and 10 days after operation. Weidner counting method was employed to determine the microvascular density (MVD) of the wound edge tissue 0 and 10 days after operation. Immunohistochemistry was used to observe the expression of hypoxia inducible factor 1-α (HIF- 1α) and vascular endothelial growth factor (VEGF) 0, 4 and 10 days after operation.@*Results@#There was no statistically significant difference in TcPO2 between the experiment group [(55.1±5.4)mmHg] and the control group [(54.7±5.9)mmHg] before skin stretching (P>0.05), while statistically significant difference was found after stretching [(22.7±3.3)mmHg vs. (16.4±3.4)mmHg] (P<0.01). There was no statistically significant difference in clinical wound healing scores between the control group and experiment group 4 days after skin stretching [(2.6±0.7)points vs. (2.1±0.4)points] (P>0.05), but better result was found in experiment group compared with the control group in 10 days [(1.3±0.5)points vs. (4.6±0.7)points] (P<0.01). MVD of skin tissue showed no statistically significant difference between the control group (8.5±1.3) and the experiment group (9.3±1.2) immediately after skin stretching (P>0.05), while the MVD of wound skin tissue in the experiment group (29.5±4.8) was significantly higher than that in the control group (21.1±3.4) 10 days after skin stretching (P<0.01). After skin stretching, the HIF-1 alpha expression in experiment group was significantly higher than the control group 4 days after skin stretching [(50.0±7.0) vs. (38.6±7.0)] (P<0.01), but no statistical significance was found between that at 0 day and 10 days(P>0.05). The expression of VEGF in the wound skin tissues of the experiment group was significantly higher than that of the control group [(49.9±10.8) vs. (39.2±6.3)] at 4 days after skin stretching (P<0.05), while no statistically significance was found at 0 and 10 days (P>0.05).@*Conclusion@#For full-thickness skin defect after skin stretching in pigs, papaverine can alleviate small vessel spasm, improve skin edge oxygen supply, and promote the growth of microvessels, thus promoting the healing, which might be associated with the increase of HIF-1ɑ and VEGF expression.

12.
Chinese Journal of Trauma ; (12): 776-779, 2019.
Article in Chinese | WPRIM | ID: wpr-797399

ABSTRACT

In the early days after the founding of People's Republic of China (PRC), trauma was only treated as a surgical disease, and the discipline construction was obviously lagging behind. The development of modern trauma medicine in China commenced after the reform and opening-up, with the gradual establishment of trauma department at some hospitals. The 2008 Wenchuan earthquake made traumatology highly valued. The Notice on Further Enhancing the Ability of Trauma Rescue issued by the National Health Commission in 2018 marked a historical period for the best opportunity of traumatology development. The author briefly describes the achievements made in trauma discipline (trauma center), academic platform, professional training, database construction and rescue ability in the past 70 years since the founding of People's Republic of China. Meanwhile, the author proposes to build a national trauma medical system, standardize and intellectualize trauma registration, and establish a national trauma database.

13.
Chinese Journal of Trauma ; (12): 853-859, 2019.
Article in Chinese | WPRIM | ID: wpr-754724

ABSTRACT

Objective To investigate the effect of papaverine on wound healing of full-thickness skin defect after skin stretching in swine. Methods Eight Bama pigs were prepared. Standard full-thickness skin defect for 7 cm × 7 cm was produced in the middle part of each pig 's forelimb, and skin traction was used to close the wound. According to random number table method, the pigs were divided into experiment group and control group, with four pigs in each group. Percutaneous oxygen partial pressure ( TcPO2 ) was compared preoperatively and postoperatively. Wound healing clinical score was evaluated four and 10 days after operation. Weidner counting method was employed to determine the microvascular density (MVD) of the wound edge tissue 0 and 10 days after operation. Immunohistochemistry was used to observe the expression of hypoxia inducible factor 1-α ( HIF- 1α) and vascular endothelial growth factor (VEGF) 0, 4 and 10 days after operation. Results There was no statistically significant difference in TcPO2 between the experiment group [(55. 1 ± 5. 4)mmHg] and the control group [(54. 7 ± 5.9)mmHg] before skin stretching (P>0.05), while statistically significant difference was found after stretching[(22.7±3.3)mmHg vs. (16.4±3.4)mmHg] (P <0.01). There was no statistically significant difference in clinical wound healing scores between the control group and experiment group 4 days after skin stretching [(2.6 ±0.7)points vs. (2.1 ±0.4)points] (P>0.05), but better result was found in experiment group compared with the control group in 10 days [(1. 3 ± 0. 5)points vs. (4. 6 ± 0. 7)points] (P<0. 01). MVD of skin tissue showed no statistically significant difference between the control group (8. 5 ± 1. 3) and the experiment group (9. 3 ± 1. 2) immediately after skin stretching ( P>0. 05), while the MVD of wound skin tissue in the experiment group (29. 5 ± 4. 8) was significantly higher than that in the control group (21. 1 ± 3. 4) 10 days after skin stretching (P<0. 01). After skin stretching, the HIF-1 alpha expression in experiment group was significantly higher than the control group 4 days after skin stretching [(50. 0 ± 7. 0) vs. (38. 6 ± 7. 0)] (P < 0. 01), but no statistical significance was found between that at 0 day and 10 days(P>0. 05). The expression of VEGF in the wound skin tissues of the experiment group was significantly higher than that of the control group [(49. 9 ± 10.8) vs. (39.2 ±6.3)] at 4 days after skin stretching (P<0.05), while no statistically significance was found at 0 and 10 days (P>0. 05). Conclusion For full-thickness skin defect after skin stretching in pigs, papaverine can alleviate small vessel spasm, improve skin edge oxygen supply, and promote the growth of microvessels, thus promoting the healing, which might be associated with the increase of HIF-1ɑand VEGF expression.

14.
Chinese Journal of Trauma ; (12): 776-779, 2019.
Article in Chinese | WPRIM | ID: wpr-754712

ABSTRACT

In the early days after the founding of People's Republic of China ( PRC) , trauma was only treated as a surgical disease, and the discipline construction was obviously lagging behind. The development of modern trauma medicine in China commenced after the reform and opening-up, with the gradual establishment of trauma department at some hospitals. The 2008 Wenchuan earthquake made traumatology highly valued. The Notice on Further Enhancing the Ability of Trauma Rescue issued by the National Health Commission in 2018 marked a historical period for the best opportunity of traumatology development. The author briefly describes the achievements made in trauma discipline ( trauma center) , academic platform, professional training, database construction and rescue ability in the past 70 years since the founding of People's Republic of China. Meanwhile, the author proposes to build a national trauma medical system, standardize and intellectualize trauma registration, and establish a national trauma database.

15.
Chinese Journal of Trauma ; (12): 150-155, 2019.
Article in Chinese | WPRIM | ID: wpr-745034

ABSTRACT

Objective To evaluate the predictive value of ultrasonography of the respiratory variability index of inferior vena cava internal diameter (IVC-RVI) in preoperative fluid responsiveness evaluation of hip fracture in geriatric patients.Methods A retrospective case-control study was used to analyze 39 cases of elderly hip fractures admitted to the Daping Hospital of Army Medical Center from August 2017 to February 2018,including 15 males and 24 females,aged 65-92 years [(80.9 ±7.9)years].The heart rate (HR),mean arterial pressure(MAP),cardiac output (CO),and cardiac stoke volume (SV)were recorded five minutes after the patient entered the operating room and within 5 minures after capacity load test.The inferior vena cave during expiration (IVCe) and inferior vena cave during inspiration (IVCi) were measured by ultrasound before and after volume load test and the difference in IVC-RVI was calculated.Volumetric positive group were the cases of SV change (△SV) ≥15% (positive group,n =21),and volume negative group were the cases of △SV < 15% (negative group,n=18).The correlations between various ultrasonic parameters and SV were analyzed by comparing HR,MAP,CO,SV,SV,IVCe,IVCi and IVC-RVI before and after the capacity load test.The predictive value of IVC-RVI for preoperative volumetric reactivity in elderly patients with hip fractures was evaluated by using the receiver operative characteristic (ROC) curve and Pearson correlation analysis.Results Prior to the volumetric load test,no significant difference was observed between the two groups concerning HR,MAP,CO,SV,and IVCe (P > 0.05),IVCi in the positive group was significantly smaller than that in the negative group (P < 0.05),and IVC-RVI in the positive group was significantly larger than that in the negative group (P < 0.05).After the volumetric load test,there was no statistically significant difference between the two groups in CO,IVCe,IVCi,and IVC-RVI (P > 0.05),HR in the positive group was smaller than that in the negative group (P < 0.05),and MAP and SV in the positive group were significantly larger than that in the negative group (P < 0.05).Compared with that before capacity load test,MAP,CO,and SV in the positive group increased after the capacity load test (P < 0.05),while the HR difference was not statistically significant (P > 0.05).HR,MAP,CO,and SV showed no significant difference in the negative group before and after capacity test (P > 0.05).IVC-RVI assessed the area under the curve (AUC) was 0.80 ± 0.08 for preoperative volumetric responsiveness in elderly hip fractures (P < 0.05),with a critical point of 20.69%,sensitivity of 77.78%,and specificity of 76.19%.After Pearson correlation analysis,IVC-RVI was positively related to △SV (OR =0.367,P < 0.05).Conclusion Ultrasonography of the respiratory variability of IVC can predict the preoperative fluid responsiveness of hip fracture in geriatric patients and guide for clinical rehydration.

16.
Article in Chinese | WPRIM | ID: wpr-618377

ABSTRACT

With the widely use of tourniquet in battlefield, the mortality of limbs bleeding has decreased remarkably. However, torso hemorrhage has become the leading cause inducing battlefield mortality. In present paper, the concept and features of torso hemorrhage were introduced, and the scheme, equipment and techniques of emergency control of torso hemorrhage were also described systematically, including local hemostatic materials, cavity foam materials, hemostasis device and aortic compression technique, etc. At the present stage, it is the key of reducing tactics mortality to actively research and develop the tactical stage equipment and technology for emergency treatment of tactical torso injuries. We should draw lessons from foreign army and positively face the severe challenges on torso trauma to enhance our ability in tactical trauma care.

18.
Chinese Journal of Trauma ; (12): 55-58, 2016.
Article in Chinese | WPRIM | ID: wpr-490584

ABSTRACT

Objective To investigate the effect of damage control laparotomy in multiple trauma care.Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015.Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years).The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case.Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points).All cases presented abdominal injury.Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases.All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery.Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation.Results Twenty-nine cases had primary fascial closure 5-12 d after surgery.Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia.Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD).Hospital length of stay was 21-70 d (mean, 31.4 d).There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment.Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage.All cases were discharged from hospital smoothly.Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury.

19.
Article in Chinese | WPRIM | ID: wpr-470201

ABSTRACT

Reducing the misdiagnosis rate and negative exploratory rate is still a challenge in the diagnosis and treatment process for abdominal trauma.In this article,the diagnosis and treatment are processed based on the hemodynamic and injury mechanism,and the injury evaluation techniques including physical examination,focused abdominal sonography for trauma,computed tomography,diagnostic peritoneal lavage and urgent treatment strategies for blunt trauma and penetrating trauma,as well as the exploratory techniques in the laparoscopy and laparotomy are introduced.

20.
Chinese Journal of Trauma ; (12): 597-601, 2013.
Article in Chinese | WPRIM | ID: wpr-438266

ABSTRACT

Objective To investigate the significance of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypovolemic shock in severe traumatic patients.Methods Clinical and spiral CT image data of 63 patients with severe trauma treated between January 2008 and December 2011 were reviewed retrospectively.According to the occurrence of shock at 24 hours after spiral CT scan,the patients were divided into shock group (34 cases) and stable group (29 cases).Blood pressure,heart rate,ISS,blood pH value,blood lactate (Lac),and buffer excess (BE) and other indices on admission were analyzed and compared between the two groups.Diameter of abdominal great vessels including aorta,inferior vena cava,superior mesenteric artery and superior mesenteric vein were measured on enhanced spiral CT images as well as their CT values in both early and delayed phase of enhancement.Results The shock group showed significantly higher ISS and blood Lac level,but significantly lower BE as compared with the stable group (P < 0.05).Inferior vena cava in the shock group presented signs of deformity and collapse.Minimal diameters of the four abdominal levels were all shorter in the shock group than in the stable group (P <0.01).In the early enhancement on spiral CT,the CT value of superior mesenteric artery was lower in the shock group than in stable group [(133.2 ± 32.4) HU vs (186.3 ± 23.3) HU,(P < 0.05)],while the CT value of inferior vena cava above the upper edge of the liver was significantly higher in shock group than in stable group [(133.4 ± 20.3) HU vs (112.0 ± 21.9) HU,(P < 0.01)].In the delayed enhancement on spiral CT,the CT value of each vessel presented no statistical differences between the two groups.Conclusion Some hypo-perfusion signs of abdominal vessels on enhanced CT have some reference value on the early diagnosis of hypovolemic shock in severe traumatic patients.

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