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Objective:To investigate the predictive value of estimated renal perfusion pressure (eRPP) for acute kidney injury (AKI) in severe multiple trauma patients.Methods:Severe multiple trauma patients were collected based on the inclusion criteria and exclusion criteria from the Trauma Center, the Third Xiangya Hospital, Central South University. Subsequently, patients were divided into the AKI group and non-AKI group according to the occurrence of AKI during 72 h admission to hospital. Further clinical information, ISS score, SOFA score, APACHE Ⅱ score, mean arterial pressure (MAP), central venous pressure (CVP) and intra-abdominal pressure (IAP) were collected, and eRPP were calculated. Additionally, the differences of parameters in the AKI group and non-AKI group were analyzed and logistic regression analysis was performed to identify the independent predicted risk factors for AKI. Finally, ROC curve was conducted to identify specificity, sensibility and best cut-off point.Results:A total of 173 severe multiple trauma patients were finally analyzed. Compared with the non-AKI group, the serum albumin [(32.21±5.20)g/L vs. (34.83±4.20)g/L, P =0.001] and 24 h urine output [(711.90±241.38)mL vs. (1 101.21±509.86)mL, P =0.001] were significantly lower and serum lactate [(2.80±0.96)mmol/L vs. (1.89±0.63)mmol/L, P<0.001], ISS score [(29.05±5.91) vs. (22.17±4.02), P <0.001], APACHEⅡ score [(38.84±21.47) vs. (31.45±18.24), P <0.001] and SOFA score [(5.26±2.08) vs. (3.14±1.34), P <0.001], in-hospital mortality (9.52% vs. 2.29%, P=0.038), and ICU stay [(8.43±6.46)d vs. (6.42±3.78) d, P =0.01) were significantly higher in the AKI group. Moreover, 6, 12 and 24 h of CVP and eRPP after admission were associated with the incidence of AKI. Logistic regression analysis showed that 24 h urine output, CVP and eRPP were the independent predictive factors (P <0.05) and 24 h of eRPP after admission applied a better predictive value of the incidence in AKI. Conclusions:24 h of eRPP might be the most suitable independent predictive factor for AKI in severe multiple trauma patients.
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With the traffic accident,sudden disaster and safety accidents occur year after year,the injured patients often complicated with multiple injuries,how to maximize the treatment of the injury to improve the survival rate,is an important problem faced by orthopedic surgeons.In recent years,damage control orthopaedics (DCO)technology has been gradually developed,DCO aims to control the patients'primary injury,to prevent further deterioration of the disease,compared with the traditional treatment,it can effectively reduce the second strike and complications,is conducive to the recovery of patients.In this paper,the development of DCO concept,the theoretical basis of DCO,the adaptation of DCO,the implementation steps of DCO and the best time,the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed.
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With the traffic accident, sudden disaster and safety accidents occur year after year, the injured patients often complicated with multiple injuries, how to maximize the treatment of the injury to improve the survival rate, is an important problem faced by orthopedic surgeons.In recent years, damage control orthopaedics (DCO) technology has been gradually developed, DCO aims to control the patients' primary injury, to prevent further deterioration of the disease, compared with the traditional treatment, it can effectively reduce the second strike and complications, is conducive to the recovery of patients.In this paper, the development of DCO concept, the theoretical basis of DCO, the adaptation of DCO, the implementation steps of DCO and the best time, the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed.
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Trauma is an important cause of death in the world, and emergency treatment for severe trauma is a worldwide problem. With the integration of more artificial intelligence into the medical industry, the information platform of intelligent hospital should be established with the help of 5G era, so that patients can enjoy timely, convenient, safe and high-quality diagnosis and treatment services, and solve the problems of low medical work efficiency and lagging internal management mechanism of the hospital. At present, there are few reports on the combined application of serious trauma emergency system and 5G in China. The potential application of 5G in severe trauma treatment system was introduced in this paper.
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Trauma is an important cause of death in the world,and emergency treatment for severe trauma is a worldwide problem.With the integration of more artificial intelligence into the medical industry,the information platform of intelligent hospital should be established with the help of 5G era,so that patients can enjoy timely,convenient,safe and high-quality diagnosis and treatment services,and solve the problems of low medical work efficiency and lagging internal management mechanism of the hospital.At present,there are few reports on the combined application of serious trauma emergency system and 5G in China.The potential application of 5G in severe trauma treatment system was introduced in this paper.
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Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.
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Objective To investigate thyroid hormone nuclear receptor expression in peripheral blood mononuclear cells (PBMCs) and its relation with injury severity in patients with severe multiple trauma.Methods Twenty-eight patients with severe muhiple trauma and another 26 healthy subjects as control were enrolled in the study.At 2 days after injury,the levels of free triiodothyronine (FT3),free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in peripheral venous blood were determined by using immunoradiometry,and the expressions of mRNA of the thyroid nuclear receptors (TRα and TRβ) in PBMCs were measured by using real-time RT-PCR.Results FT3 concentration in peripheral venous blood was significantly decreased in patients with severe multiple trauma versus healthy subjects.Concurrently,the expressions of TR mRNA (TRα and TRβ) were significantly decreased in PBMCs of patients with severe multiple trauma compared with healthy subjects (TRα mRNA:3.86 ±0.54 vs.5.24 ± 1.17,P ＜0.05;TRβ mRNA:9.86±2.27 vs.13.57 ±2.45,P ＜0.05).Pearson correlation analysis showed that FT3 concentration and the expression of TRβ mRNA correlated negatively with injury severity score (ISS) in patients with severe multiple trauma (r=-0.445,-0.496,P=0.018,0.007).Conclusions These data provide the evidence of a lowered activity of the thyroid signaling pathway in PBMC and a significantly negative correlation between FT3 concentration and the expression of TRβ mRNA in respect of injury severity in patients with severe multiple trauma.Additional investigations are needed to further determine the roles of the thyroid signaling pathway in adverse outcomes in the wake of severe multiple trauma.
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Objective To observe the influence of intensive insulin therapy on inflammatory fac-tors and prognosis in severe multiple trauma patients.Methods A total of 53 cases of severe multiple trauma were randomly divided into the treatment group(n =27)and the control group(n =26).Besides basic treatment,patients in the treatment group received additional intensive insulin therapy by micro-pump.The level of blood glucose in the control group was controlled under 11.1 mmol/L.Levels of TNF-α,IL-1β,IL-6,and CRP were tested before and after treatment.Multiple organ dysfunction syndrome,noso-comial infection rate,and mortality rate were also observed.Results The levels of TNF-α,IL-1β,IL-6, and CRP in the treatment group were significantly lower than those of the control group(P <0.05 or P <0.01).The incidence of multiple organ dysfunction syndrome,nosocomial infection,and mortality rate in the treatment group was lower(P <0.05).Conclusion Intensive insulin therapy can effectively decrease the expressions of inflammatory factors in patients with severe multiple trauma,improve the prognosis,re-duce the incidence of nosocomial infection and mortality.
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This study examined the effects of ω-3 polyunsaturated fatty acid (ω-3PUFA) on the expression of toll-like receptor 2 (TLR2),toll-like receptor 4 (TLR4) and some related inflammatory factors in peripheral blood mononuclear cells (PBMCs) of patients with early-stage severe multiple trauma.Thirty-two patients who were admitted to the Department of Traumatic Surgery,Tongji Hospital (Wuhan,China) between May 2010 and November 2010,and diagnosed as having severe multiple trauma with a injury severity score (ISS) no less than 16,were enrolled in the study and divided into two groups at random (n=16 in each):ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days.Peripheral blood from these patients was collected within 2 h of admission (day 0),and 1,3,5 and 7days after the nutritional support.PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively,the levels of NF-κB by quantum dots-based immunofluorescence assay,the levels of TNF-α,IL-2,IL-6 and COX-2 by ELISA,respectively.The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support (both P＜0.05).The levels of TNF-α,IL-2,IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day (P＜0.05 for all).It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2,TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma,which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.
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In order to observe the nutrition state in the severe multiple trauma patients undergoing adjuvant recombinant human growth hormone (rhGH) nutritional support therapy, 45 patients with severe multiple traumas (ISS＞25) were randomly divided into 3 groups. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two rhGH-treated groups in which rhGH was 0.2 and 0.4 U/(kg·d) respectively, and the resting group served as control one. The levels of nitrogen balance, prealbumin and safety variables (blood sugar, Na+, TT3 and TT4) were observed and compared among the three groups. The levels of nitrogen balance on the postoperative day (POD) 3 and 5 in the rhGH-treated groups were - 1.28±3.19, 5.45±2.00 and -0.18±2.55, 6.11±1.60, respectively,which were significantly higher than those in the control group (-5.17±1.68 and -1.08±3.31, P＜0.01). The values of prealbumin on the POD 3 and 5 in the rhGH-treated groups were 180.19±27.15, 194.44±50.82 and 194.94±29.65, 194.11±16.17, respectively, which were significantly higher than those in the control group (117.42±19.10 and 135.63±28.31, P＜0.01). There was no significant difference between the rhGH 0.2 U/(kg·d) group and rhGH 0.4 U/(kg·d) group in both of the levels of nitrogen balance and prealbumin. It is concluded that the nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple trauma. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 and 0.4 U/(kg·d).
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16 and the distribution of severe trauma more than 2 anatomic parts.They were randomly divided into two groups:intensive insulin treatment group(n=31)and control group(n=31).Intensive insulin treatment group received insulin with insulin pump in order to maintain blood glucose levels at 4.0-6.1 mol/L,while the control group received routine insulin treatment in order to mmaintain blood glucose levels at 10.0- 11.0 mol/L.Plasma levels of TNF-?,IL-1,IL-6, CRP,APACHEⅡscores and cure rate were analyzed before and after the treatment.Data was expressed as mean?standard deviation.Two- tailed T test and ANOVA were used for comparison in SPSS 10.0,and changes were considered as statistically significant if P value was less than 0.05.Results After the intensive insulin treatment, patient's hemodynamic parameter apparently improved,APACHEⅡscores descended,and the levels of TNF-?, Ib-1,IL-6,CRP all declined,in comparison with control group,there were significant differences. Intensive insulin treatment might improve patient's general condition and decrease complications and mortality of severe multiple trauma.
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In order to evaluate the post-traumatic changes of serum levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF_?) and their relationship to the occurance of multiple system organ failure (MSOF), 80 adult patients with severe multiple trauma(SMT), injury severity score(ISS) 32?14. served as the tested subjects. of which 50 cases received operations and the other did not. Thirty adult patient, scheduled for elective abdominal surgery, were randomly chosen as trauma control, and 20 healthy blood donors acted as normal control. The venous blood samples were taken on that day of injury, 3, 10 and 20 days post-traumatically, and immediately before dis charge. to measure serum concentrations of IL-6 by immunocytochemistry method and TNF_? by enzymo-immunoassay, respectively. The diagnosis of post-traumatic MSOF was made according to Baue's criteria. As compared with normal control levels, the concentrations of IL-6 and TFN_?, increased significantly in patients with SMT(P0.05). In comparison correspondingly with those of trauma control, the levels of IL-6 and TFN_? were elevated markedly (P