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Introducción. El objetivo del estudio fue analizar el impacto del uso de la tomografía corporal total en la evaluación de los pacientes con trauma penetrante por proyectil de arma de fuego y hemodinámicamente inestables atendidos en un centro de referencia de trauma. Métodos. Se realizó un estudio analítico, retrospectivo, con base en un subanálisis del registro de la Sociedad Panamericana de Trauma Fundación Valle del Lili. Se incluyeron los pacientes con trauma penetrante por proyectil de arma de fuego atendidos entre 2018 y 2021. Se excluyeron los pacientes con trauma craneoencefálico severo, trauma leve y en condición in extremis. Resultados. Doscientos pacientes cumplieron los criterios de elegibilidad, 115 fueron estudiados con tomografía corporal total y se compararon con 85 controles. La mortalidad intrahospitalaria en el grupo de tomografía fue de 4/115 (3,5 %) vs 10/85 (12 %) en el grupo control. En el análisis multivariado se identificó que la tomografía no tenía asociación significativa con la mortalidad (aOR=0,46; IC95% 0,10-1,94). El grupo de tomografía tuvo una reducción relativa del 39 % en la frecuencia de cirugías mayores, con un efecto asociado en la disminución de la necesidad de cirugía (aOR=0,47; IC95% 0,22-0,98). Conclusiones. La tomografía corporal total fue empleada en el abordaje inicial de los pacientes con trauma penetrante por proyectil de arma de fuego y hemodinámicamente inestables. Su uso no se asoció con una mayor mortalidad, pero sí con una menor frecuencia de cirugías mayores.
Introduction. This study aims to assess the impact of whole-body computed tomography (WBCT) in the evaluation of patients with penetrating gunshot wounds (GSW) who are hemodynamically unstable and treated at a trauma referral center. Methods. An analytical, retrospective study was conducted based on a subanalysis of the Panamerican Trauma Society-FVL registry. Patients with GSW treated between 2018 and 2021 were included. Patients with severe cranioencephalic trauma, minor trauma, and those in extremis were excluded. Patients with and without WBCT were compared. The primary outcome was in-hospital mortality, and the secondary outcome was the frequency of major surgeries (thoracotomy, sternotomy, cervicotomy, and/or laparotomy) during initial care. Results. Two hundred eligible patients were included, with 115 undergoing WBCT and compared to 85 controls. In-hospital mortality in the WBCT group was 4/115 (3.5%) compared to 10/85 (12%) in the control group. Multivariate analysis showed that WBCT was not significantly associated to mortality (aOR: 0.46; 95% CI 0.10-1.94). The WBCT group had a relative reduction of 39% in the frequency of major surgeries, with an associated effect on reducing the need for surgery (aOR: 0.47; 95% CI 0.22-0.98). Conclusions. Whole-body computed tomography was employed in the initial management of patients with penetrating firearm projectile injuries and hemodynamic instability. The use of WBCT was not associated with mortality but rather with a reduction in the frequency of major surgery.
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Humans , Shock, Hemorrhagic , Wounds and Injuries , Single Photon Emission Computed Tomography Computed Tomography , Shock, Traumatic , Surgical Procedures, Operative , Hospital MortalityABSTRACT
Abstract Objectives To investigate the changes in the coagulation function and hemodynamic parameters in patients with Hemorrhagic Traumatic Shock (HTS) after restrictive fluid resuscitation. Methods A total of 139 patients with HTS admitted to our hospital were enrolled, among which 69 HTS patients were divided into the control group and the remaining 70 HTS patients as the observation group. Patients in the control group underwent regular fluid resuscitation, while those in the observation group underwent restrictive fluid resuscitation. Results During treatment, 70 patients in the observation group had a lower bleeding amount, infusion amount, and blood transfusion volume than those in the control group (p < 0.05). After treatment, patients in the observation group had better hemodynamic parameters and blood coagulation than those in the control group (p < 0.05), and the incidence rate in the observation group was only 12.9%, which was significantly lower than 60.87% in the control group, while the cure rate in the observation group was 100%, which was significantly higher than that in the control group (p < 0.05). Conclusions Restrictive fluid resuscitation could remarkably increase the cure rate and reduce the bleeding amount during HTS treatment, thereby benefiting the recovery of the patient's blood coagulation.
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Objective To explore the effect of establishment of green nursing channel for emergency patients with severe acute traumatic shock on quality of nursing care. Methods Fifth-six patients with severe acute traumatic shock who received nursing by green nursing channel admitted to Department of Adult Emergency of Second Affiliated Hospital of Wenzhou Medical University (Yuying Children's Hospital) from October 2016 to November 2017 were assigned in the research group, and at the same time, 42 patients with the same disease adopted conventional nursing mode from March 2015 to September 2016 were in the control group. The emergency treatment time, special inspection time, emergency to the operating room time, admission to operation time of patients, the incidences of the asphyxia and multiple organ dysfunction syndromes (MODS), and success rate of rescue in the two groups were recorded; the degree of patients satisfaction were observed. Results The emergency room treatment time (minutes: 13.51±3.62 vs. 20.84±3.96), special inspection time (minutes: 16.30±4.05 vs. 23.71±4.16) and admission to operation time (minutes:42.61±7.98 vs. 57.83±7.46) in the study group were significantly shorter (all P ＜ 0.05), the incidences of asphyxia and MODS in the study group were obviously lower than those in the control group [asphyxia: 1.79% (1/56) vs. 11.90% (5/42), MODS: 3.57% (2/56) vs. 16.67% (7/42), both P ＜ 0.05], and the success rate of rescue in the study group was significantly higher than that in the control group [100.00% (56/56) vs. 92.86% (39/42), P ＜ 0.05]; the degree of patients satisfaction in the study group was obviously higher than that in the control group [96.43% (54/56) vs. 83.3% (35/42)], and the differences between the two groups were statistically significant (all P ＜ 0.05). Conclusion The establishment of a green nursing channel for emergency patients with severe acute traumatic shock is helpful to improve the emergency working efficiency, shorten the time for nursing emergency response, and its application effect is good.
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Objective To investigate the clinical value of immediate fluid resuscitation and delayed resuscitation in patients with traumatic shock. Methods The patients with traumatic shock treated in the Critical Care Medicine Department of People's Hospital of Wenjiang District from March 2014 to March 2017 were selected. According to the number of admission cases,one hundred and twenty patients with traumatic shock were randomly divided into two groups,60 cases in each group. The control group was given early immediate fluid resuscitation,the observation group was given delayed resuscitation,and the blood coagulation and blood routine indexes of the two groups were compared before and after the fluid resuscitation in the two groups,and the amount of fluid rehydration and the fatality rate in the two groups of patients with 1 h shock were observed,and the incidence rate of acute respiratory distress syndrome ( ARDS) and multiple organ dysfunction syndrome (MODS) were compared. Results After treatment,the blood clotting and blood routine indexes of the two groups were improved (P<0. 05),of which the thromboplastin time (PT) ((11. 04±1. 17) s),activated partial thromboplastin time (APTT) ((28. 12±5. 93) s) in the observation group in the observation group were lower than those of the control group( (15. 12±1. 26) s,(36. 17±9. 05) s) (t = -15. 37,-9. 81,P<0. 05),platelet countPLT) ((146. 92±16. 85)×109 / L) was higher than that of the control group ((114. 18±10. 69)×109 / L ) (t= -9. 77,P<0. 05),and the blood routine hemoglobin (Hb) ((112. 21±9. 46) g/ L),and the base surplus (BE)((-5. 30 ± 2. 45) mmol/ L ) were all higher than those of the control group ((92. 95 ± 11. 20) g/ L, (-8. 27±3. 53) mmol/ L ) (t= -11. 46,-8. 99,P<0. 05),blood lactic acid (BL) ((2. 79±1. 12) mmol/ L ) was lower than that of the control group ((3. 54±1. 37) mmol/ L) (t = -8. 99,P<0. 05). The volume of 1 h infusion of shock in the observation group ((569. 96±187. 34) ml ) was lower than that of the control group((1957. 35±204. 14) ml) (t = 8. 725,P<0. 05). The incidence of ARDS (3. 33% (2/ 60)),MOD(3. 33%(2/ 60)) and fatality(1. 67%(1/ 60)) were lower than those of the control group(8. 33%(5/ 60),6. 67%(4/60),6. 67%(4/ 60) ( χ2 = 2. 725,3. 214,2. 985,P< 0. 05) . Conclusion The early stage of traumatic shock delayed fluid resuscitation is conducive to the protection of the blood coagulation function of patients,to improve blood indicators,to reduce the amount of 1 h infusion and to reduce the incidence of ARDS and MODS.
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Objective: To investigate the clinical efficacy of nalmefene hydrochloride in the treatment of patients with traumatic shock. Methods:Totally 62 cases of patients with traumatic shock were randomly divided into nalmefene treatment group (n=31) and the control group ( n =31 ) according to the random number table. The control group was given the conventional treatment, while nalmefene treatment group was treated with nalmefene hydrochloride additionally. The changes of hemodynamics, plasma TNF-αand vas-cular endothelial function index were compared between the groups. Results:The mean arterial pressure in 24h after the treatment signifi-cantly decreased when compared with that in 12h after the treatment of nalmefene treatment group, and the difference was statistically sig-nificant (P<0. 05);the heart rate in 12h and 24h after the treatment in nalmefene treatment group significantly decreased when com-pared with that before the treatment, and the differences were statistically significant (P<0. 05);the plasma TNF-αlevels in 24h after the treatment in nalmefene treatment group significantly decreased when compared with that in 12h after the treatment, and the difference was statistically significant (P<0. 05), and there was no significant difference in plasma TNF-α levels before the treatment and in 12h after the treatment (P<0. 05);the plasma NO and ET in 24h after the treatment in nalmefene treatment group significantly decreased when compared with that in 12h after the treatment, and the difference were statistically significant (P<0. 05);and there was no signifi-cant difference in plasma NO and ET before the treatment and in 24h after the treatment (P<0. 05);abnormality in electrocardiogram, routine blood tests, routine urine and liver and renal function examinations were not found, and no obvious adverse drug reactions were shown during the treatment course. Conclusion:Nalmefene hydrochloride combined with the conventional treatment in the patients with traumatic shock shows striking efficiency with notable effects on hemodynamics ( heart rate and mean arterial pressure) , which can reduce plasma TNF-α, NO and ET levels and shows significant research significance.
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Objective To investigate the effect and medical satisfaction of comprehensive intervention on the treatment success rate of patients with traumatic shock.Methods From February 2012 to February 2015,71 patients with traumatic shock were admitted into our hos-pital,and they were randomly divided into the observation group (36 cases)and the control group (35 cases)according to the random num-ber table method.Routine medical measures were adopted in the control group,while comprehensive intervention measures were taken on the basis of routine medical measures in the observation group.And then compared the treatment success rate,complications and medical satisfac-tion rate of the two groups.Results The treatment success rate was 94.44% in the observation group and 74.29% in the control group,the difference was statistically significant (P <0.05).The rate of complications occurred during the treatment was 16.67% (6 /36)in the obser-vation group,while it was 40% (14 /35)in the control group,and the difference was statistically significant(P <0.05).In the observation group,there was 29 cases (80.56%)of satisfied,6 cases (16.67%)of basically satisfied,and 1 cases (2.78%)of dissatisfied.In the con-trol group,there was 19 cases (54.29%)of satisfied,10 cases (28.57%)of basically satisfied,and 6 cases (17.14%of dissatisfied.The difference of satisfaction rate in the two groups was statistically significant(P <0.05).Conclusion Comprehensive inter-vention can efficiently improve the treatment success rate in patients with traumatic shock,reduce the rate of complications occurred during the treatment,help to improve the prognosis of the patients,and improve the medical satisfaction rate of patients.
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Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
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Humans , Blood Volume , Hematocrit , Isotonic Solutions/therapeutic use , Models, Theoretical , Shock, Hemorrhagic/prevention & controlABSTRACT
Objective To analyse effect of nalmefene hydrochloride adjuvant therapy on serum nitric oxide(NO), endothelin (ET) and cardiac troponin I ( cTnI) in patients with traumatic shock.Methods 48 patients who were diagnosed with traumatic shock were collected.All patients were randomly divided into experimental group and control group, 24 cases in each group.On the basis of conventional anti shock treatment, the control group were treated with naloxone, the patients in experimental group received nalmefene hydrochloride treatment, after treatment, the serum levels of NO, endothelin and cardiac troponin I were detected in all patients.Results After treatment, compared with control group, the serum level of NO was lower in experimental group(P<0.05);the serum level of ET was lower in experimental group(P<0.05);the serum level of cTnI was lower in experimental group(P<0.05).Conclusions Nalmefene hydrochloride adjuvant therapy could significantly reduce the serum levels of NO, ET and cTnI in patients with traumatic shock,control the development of the disease, prevent myocardial injury.
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Objective To investigate the effect and mechanism of Clara cell secretory protein (CC16 ) on lung injury of traumatic shock rats.Methods Thirty SD male rats were randomly assigned to three groups:sham-operation group,control group and CC16-treatment group.The rat model of traumatic shock was used in this study.Rats of sham-operation group were operated,but not treated by depletion and recovery.Rats of control group inhaled the physiological saline before fluid resuscitation.Rats of CC16-treatment group inhaled 0.1 μg/mL of recombinant human Clara cell secretory protein (rh-CCSP)before fluid resuscitation.Arterial blood gas analysis and wet/dry weight were detected in each group.The contents of malondialdehyde (MDA),myeloperoxidase (MPO)of lung tissues and lung tissue pathology changes were also studied. Results Compared with control group,pH and PaO2 value in CC16-treatment group increased significantly.Meanwhile,BE value and lung wet/dry weight ratio also decreased significantly (P<0.05).Compared with control group,contents of MDA and MPO in CC16-treatment group decreased significantly (P<0.05).Lung tissue pathology improved in the CC16 group compared with that of control group (P <0.05 ).Conclusion Inhaled Rh-CCSP may have potential protective effect on lung injury tissues of traumatic shock rats model through its antioxidative effect.
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Objective To research nitric oxide( NO) concentration, induced nitric oxide synthase( iNOS) mRNA expression and the pathological changes of lung tissue in traumatic shock rats of early stage preconditioned with heat stress. Methods A total of 98 male SD rats were equally divided randomly into heat stress untreated group and heat stress treatment group, and each group were equally divided into 7 subgroup: control group and shock 0 h group, 0. 5 h group, 1. 0 h group, 1. 5 h group, 2. 0 h group, 3 h group. To established the model of traumatic shock after heat stress pretreatment and remained lung tissue, observed the changes of pulmonary pathology, meas-ured the changes of the NO concentration and iNOS expression in lung tissues. Results The lesions of lung tissue structure were more lighter in heat stress treatment group than the corresponding time point of heat stress untreated group and lung histopathology score lower. The NO concentration of heat stress treatment group were lower than the corresponding time point of heat stress untreated group, the two groups have a rise at shock 0 h,the peak value of NO concentration in heat stress treatment group appeared later than the heat stress untreated group. INOS mRNA expression quantity of heat stress treatment group were lower than the corresponding time point of heat stress un-treated group, the peak value of heat stress untreated group in 2.0 h and heat stress treatment group in 1. 5 h, it was positively correlated with lung injury score. Conclusion Heat stress pretreatment can drop NO concentration and iNOS mRNA expression in lung tissues significantly, delayed and reduced the lung injury in traumatic shock rats of early stage.
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Objective To investigate the application of anesthesia methods and clinical experience in treatment of severe traumat-ic shock .Methods 48 severe traumatic shock patients were randomly divided into two groups by different anesthesia treatment ,in-cluding delayed resuscitation group (A group) and routine group (B group) ,24 cases in each group .Results Patients completed operation as expected with stable vital signs in the operation .Patients completely awaked and recovered the spontaneous respiration after 3~4 hours .4 cases in group A (16 .6% ) and 12 cases in group B (50% ) were died .The mortality of group A was significant-ly lower than that of group B (P<0 .05) .Conclusion The appropriate anesthetic managements for the severe traumatic shock pa-tients could maintain the function of each organ ,create favorable conditions for operation ,and improve the survival rate of critical patients .
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Objective To discuss the importance of saving the life of patients and the severity assessment in early emergency for the trauma and hemorrhagic shock patients in the first-aid of pre-hospital and emergency department.Methods Retrospective anal-ysis of the 182 patients data.Results With early and aggressive treatment,177 cases of survival,5 cases of death,and the survival rate 97.3%.Conclusion The disease of traumatic shock patients is complex,high mortality.the early detection,taking timely and effective rescue measures are the key to increase the survival rate.
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Objective To investigate the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on inflammatory response of intestine and bacteria translocation in rats with traumatic shock (TS) in order to explore the underlying mechanism.Methods A total of 36 male Wistar rats provided by Academy of Military Medical Sciences Animal Center were assigned randomly (random number) into 3 groups (n =12 in each group):sham operation group,TS model group and PUFA pretreatment group.Rat models of IS were established by comminuted fracture of femur and depletion of blood,and 2 mg/kg ω-3 PUFA or normal saline were injected 12 hours and 2 hours before modeling.Blood specimens were collected and intestinal tissue samples were obtained 120 min after modeling.The serum levels of tumor necrosis factor-o (TNF-α),IL-1β,IL-10 and 8-iso-prostaglandin F 2α (8-iso-PGF2α) were measured with ELISA.Light microscopic examination was carried out for histopathological assessment of the intestina tissue and the intestinal mucosa damage index ( IMDI ) was calculated.The number of marked bacilli found in mesenteric lymph nodes,lung,liver,spleen,and kidney tissues were counted under a fluorescent microscope.The percentages for categorical variables and mean ± SD for continuous variables were expressed. Chi-square test and unpaired t-test were used for comparisons among groups,and statistical significance defined as P ＜ 0.05.Results The levels of TNF-α,IL-1β,IL-10 and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation in TS model group were [ (325.14 ±21.17) ng/ml,(26.93 +2.58) μg/L,(7.59 ± 1.26) μg/L,(259.73 +61.32) pg/ml,(4.15 +0.37) and 58.33％,respectively] and those in PUFA group were [ (251.47 + 19.16) ng/ml,(17.81±1.94) μg/L,(9.44±1.85) μg/L,(171.44±39.25) pg/ml,(3.28±0.43) and 36.67％,respectively ].And those biomarkers in both TS group and PUFA group were higher obviously than those in sham group [ (37.02 ±5.54) ng/ml,(2.49 ±0.67) μg/L,(2.93 ±0.74) μg/L,(81.26 ± 15.18) pg/ml,(0.33 ±0.12) and 6.67％,respectively,P＜0.01].Compared with TS model group,the levels of TNF-α,IL-1β and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation were lower,and the levels of IL-10 were higher in PUFA group ( P ＜ 0.01 or P ＜ 0.05 ).Conclusions The supplementation of ω-3 PUFA lessens the injury of intestina mucosa after traumatic shock,and it may be associated with the inhibition of inflammatory response by intestine and bacteria translocation.was carried out for histopathological assessment of the intestina tissue and the intestinal mucosa damage index ( IMDI ) was calculated.The number of marked bacilli found in mesenteric lymph nodes,lung,liver,spleen,and kidney tissues were counted under a fluorescent microscope.The percentages for categorical variables and mean ± SD for continuous variables were expressed. Chi-square test and unpaired t-test were used for comparisons among groups,and statistical significance defined as P ＜ 0.05.Results The levels of TNF-α,IL-1β,IL-10 and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation in TS model group were [ (325.14 ±21.17) ng/ml,(26.93 +2.58) μg/L,(7.59 ± 1.26) μg/L,(259.73 +61.32) pg/ml,(4.15 +0.37) and 58.33％,respectively] and those in PUFA group were [ (251.47 + 19.16) ng/ml,(17.81±1.94) μg/L,(9.44±1.85) μg/L,(171.44±39.25) pg/ml,(3.28±0.43) and 36.67％,respectively ].And those biomarkers in both TS group and PUFA group were higher obviously than those in sham group [ (37.02 ±5.54) ng/ml,(2.49 ±0.67) μg/L,(2.93 ±0.74) μg/L,(81.26 ± 15.18) pg/ml,(0.33 ±0.12) and 6.67％,respectively,P＜0.01].Compared with TS model group,the levels of TNF-α,IL-1β and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation were lower,and the levels of IL-10 were higher in PUFA group ( P ＜ 0.01 or P ＜ 0.05 ).Conclusions The supplementation of ω-3 PUFA lessens the injury of intestina mucosa after traumatic shock,and it may be associated with the inhibition of inflammatory response by intestine and bacteria translocation.
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ObjectiveTo investigate the effects of different ways of fluid resuscitation on uncontrolled traumatic hemorrhagic shock. MethodsThe retrospective analysis of data from 220 casualties with uncontrolled hemorrhagic shock admitted from September 2006 to October 2010 was carried out.There were two ways of fluid resuscitation used to treat casualties with hemorrhagic shock,conventional fluid resuscitation (group A) and limited fluid resuscitation (group B).The systolic pressure was maintained at 90 ～ 135 mm Hg in the group A and at 70 ～ 90 mm Hg in the group B.The data of body temperature,central venous pressure,quantity of blood transfused,urine output,renal function,hemoglobin,blood osmotic pressure (Osm) ,MODS and DIC rates,treatment costs and mortality of two groups were statistically analyzed and compared. Results After analyses of above mentioned variables except renal function and comparison made between two groups,the method of limited fluid resuscitation was much superior over conventional fluid resuscitation (P ＜ 0.05 ).There was no noticeable difference in rate of compromised renal function between two groups ( P ＞ 0.05 ). Conclusions In the case of uncontrolled exsanguination,the method of limited fluid resuscitation can maintain blood perfusion of vital organs,reduce the blood loss and decrease the incidence of MODS and mortality.
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Objective To explore the treatment of patients with severe traumatic shock first-aid and the preventive measure of the complications caused by a large number of fast blood transfusion during surgery.Methods Retrospective analysis of 87 patients with severe traumatic shock and rapid blood transfusion given to a large number of patients for emergency medical treatment, while the load cycle, bleeding, body temperature, serum potassium, and other indicators were observed, effects and complieations of treatment and effective prevention measures were summarized.Results 87 patients after aggressive surgical treatment,the success rate was 81.61% (71/87) ;surgery circulatory overload caused massive blood transfusion, bleeding tendency,low body temperature,low blood potassium disorders such specific complications.Conclusion Patients with severe traumatic shock should be taken promptly and effective first aid treatment and.the complication caused by massive blood transfusion during surgery,and it could reduce mortality and complications.
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The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated.A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups:control group (n=56) treated with conventional therapy,and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L.White blood cells (WBC) counts,prothrombin time (PT),serum creatinine (SCr),alanine aminotransferase (ALT),serum albumin and PaO2 were measured before and at the day 1,3,5,7 and 14 after treatment.The incidence of gastrointestinal dysfunction,the incidence of MODS,hospital stay and the mortality were also observed and compared.After intensive insulin therapy,the WBC counts,SCr,ALT and PT were significantly reduced (P＜0.05),but the level of serum albumin was significantly increased (P＜0.05) at the day 3,5,7 and 14.In the meantime,the PaO2 was significantly elevated at the day 3,5 and 7 (P＜0.01) after intensive insulin therapy.The incidence of gastrointestinal dysfunction,the incidence of MODS,the length of hospital stay and the mortality were markedly decreased (P＜0.01).The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.
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El dogma galénico "Pus bonum et laudabile" fue el paradigma reinante en el manejo de heridas por casi dos mil años y estimuló el uso de tratamientos que favorecían la supuración, lo cual promovió una gran cantidad de muertes en los hospicios y en los campos de batalla debido a la sepsis. En el presente trabajo se analizará, desde una mirada kuhniana, el gradual proceso del derrocamiento de dicho dogma, desde el impacto que tuvo la entrada de las armas de fuego al combate en el siglo XIV y sus implicaciones en el desarrollo de la cirugía de guerra, hasta el nacimiento de la era microbiológica en el siglo XIX. Se observará también la evolución de las técnicas quirúrgicas, desde el desbridamiento hasta la amputación, y cómo éstas tuvieron gran impacto para reducir la incidencia y mortalidad del shock traumático y del shock séptico. En este marco de referencia se analizará la profunda ruptura epistemológica que se dio gracias a la sepsis en el siglo XIX en el campo de la microbiología, además de los paulatinos avances desde el siglo XVI que permitieron el desarrollo de la cirugía moderna. De este modo, se verá cómo todos estos avances impulsados por la sepsis tuvieron un profundo impacto en el desarrollo de la medicina contemporánea.
The galenic dogma "Pus bonum et laudabile" was the dominant paradigm in wound management for nearly two thousand years and it encouraged the use of treatments that favored the suppuration, which promoted a large number of deaths in hospices and in the battle fields due to sepsis. In this work we will analyze, from a Kuhnian view, the gradual overthrowing process of this dogma, from the impact of the entry of firearms into combat in the fourteenth century and their implications for the development of war surgery, to the birth of the microbiological era in the nineteenth century. The evolution of surgical techniques from debridement to amputation, and how they had a great impact in reducing the incidence and traumatic shock and septic shock mortality, will also be observed. In this framework we will analyze the profound epistemological rupture that occurred due to sepsis in the field of microbiology during the nineteenth century, in addition to the gradual progress that since the sixteenth century have enabled the development of modern surgery. In this way, we will see how all these advancements motivated by sepsis had a profound impact on the development of contemporary medicine.
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Objective To discuss the effects of two different fluid resuscitation methods on early resuscitation and clinical prognosis in traumatic shock patients. Methods One hundred and twenty-six patients were treated with two different fluid resuscitation methods in traumatic shock (TS). These patients were randomly divided into 2 groups according to the strategy: the conventional resuscitation group (conventional group, 66 cases), the hypertouic saline solution resuscitation group (hypertonic saline group, 60 cases).The heart rate, blood pressure, breath, blood Na+ ,blood Cl-, the original thrombin time before and after the resuscitation and the syndrome were observed and analyzed. Results The input in the conventional group was (3000±500) mL, in the hypertonic saline group was (2000±200) mL. The difference of the input between the two groups was significant (P < 0. 05). The difference of the heart rate, blood pressure,breath, and the original thrombin time before and after half hour to one hour of the resuscitation in the two groups was not significant (P<0.05). The difference of the blood NA+, blood CL- and the original thrombin time before and after half hour to one hour of the resuscitation in the two groups was not significant (P <0. 05). The difference of the ARDS incidence, MODS incidence, cure rate and death rate from onset of the diseases to hospitalization in the two groups was significant (P <0. 05). Conclusions The fluid resuscitation strategy with hypertonic saline in early period of traumatic shock is efficient, which can work well with low fluid quantity, enhance blood pressure in short time, improve breath quality, save time for the operation of the primary injury, heighten the resuscitation rate, decrease the syndrome incidences and the death rate. The early fluid resuscitation strategy is worthy of clinical application and popularization.
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Objective To investigate the expression of CD14/CD16 by monocytes and the anti-inflammatory effects of hypertonic saline plus dextran (HSD) in adult blunt trauma patients in hemonhagic shock. Method A total of 30 adult patients were eligible for inclusion in the study if they sustained blunt trauma from March to October 2007 and had at least one recorded episode of hypotension (systolic blood pressure ≤ 90 mm Hg) with clear evidence of blood loss (external or internal including the thorax, abdomen or retroperitoneum). Patients were excluded if they refused to participate, were admitted ≥ 6 hours after injury, were pregnant, or had chronic disease. The enrolled patients were randomly divided in a double-blinded manner into an HSD group which was administered 7.5% Nad plus 6% dextran - 70, and a control group which was administered 0.9% NaCl. A single 250 ml dose of either HSD or NaO was immediately administered to the patients in each of the two groups while they were in the emergency room. The primary outcomes were to measure the changes in CD4/CD16 expression by monocytes and the levels of anti-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-lra and IL-10. Patient demographics, fluid requirements, organ dysfunction, infection and death were recorded. Results A total of 28 patients were enrolled with no significant differences in their clinical measurements. Hyperosmolarity was modest and transient. HSD altered the shock-induced monocyte redistribution pattern by reducing the drop in the "classic" CD14 ++ subset and remarkably affecting the expansion of the "pro-inflammatory" CD14+CD16+ subsets. In parallel, HSD significamly reduced pro-inflammatory TNF-α production while increasing anti-inflammatory IL-lra and IL-10 production. Conclusions This human trial demonstrates that HSD has anti-inflammatory and immunologic properties for trauma patients in hemorrhagic shock. HSD exerts profound immunomodulatory effects, promoting more balanced pro-/anti-inflammatory responses and reducing post-traumatic complications. Therefore, it could be useful in attenuating post-trauma multiorgan dysfunction (MOD).