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Objective To explore early diagnosis， surgical intervention and efficacy for blunt cardiac injury. Methods 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, pre-operative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years be-tween September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48. 8％(21/43);and steering wheel injury accounted for 71. 4％(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock;and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27. 9％(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases;relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy( EDT) with a resuscitative rate of 42. 9％(3/7). Results Overall mortality rate was 32. 6％(14/43);4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases( associated with transected aorta in 1 case);and associated injuries in 5 cases including liver trauma ( 3 cases ) , brain trauma ( 1 case ) , and cervical spinal trauma ( 1 case) . In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 ca-ses, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively;and other 2 restored spontaneously which were ensured by echocardiography. Postoperative com-plications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent tho-racotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advoca-ted. If it is necessary, EDT should be exercised decidedly.
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Objective@#To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI).@*Methods@#All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed.@*Results@#Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05).@*Conclusions@#For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.
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Objective@#To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury.@*Methods@#43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7).@*Results@#Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition.@*Conclusion@#Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly.
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Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury (BCI).Methods All BCI patients from September 2003 t9 August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group (n=305) and operative group (n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3％ of 1 903 patients with blunt thoracic injury (BTI),and the mortality rate was 10.1％.The main cause of injury was traffic accident with an incidence of 48.3％.The diagnostic methods included electrocardiogram (ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9％.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6％.The incidence of negative ECG between the two groups was not significantly different (16.7％ vs 11.6％,P＞0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P＜0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P＜0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.
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Objective To study the risk factors for perioperative heart failure in the elderly patients with femoral intertrochanteric fracture so as to provide guide information for prevention of the perioperative heart failure.Methods Included in this retrospective study were 175 elderly patients with femoral intertrochanteric fracture who had undergone closed reduction and intramedullary nail fixation in our hospital from May 2013 to August 2016.They were divided into 2 groups.In the heart failure group of 31 cases,there were 12 males and 19 females,with an age of 73.5 ± 7.8 years;in the non heart failure group of 144 cases,there were 61 males and 83 females,with an age of 69.8 ± 6.9 years.The 2 groups were compared in terms of age,early surgery,hypertension history,respiratory disease history,heart disease history,disturbance of consciousness,preoperative renal function,operation time,anesthesia method,operation time,perioperative fluid volume difference,perioperative pain score,and postoperative hemoglobin.After univariate analysis of these factors,the risk factors were determined through the multivariate regression analysis.Results The univariate analysis showed that age,heart disease history,perioperative fluid volume difference and perioperative pain score were statistically different between the 2 groups (P ＜ 0.05).By the multivariate analysis,the risk factors for perioperative heart failure were age [P =0.014,OR =1.063 (1.012,1.116)],heart disease history [P =0.008,OR =4.977 (1.526,16.230)],perioperative fluid volume difference [P =0.025,OR=2.421 (1.117,5.249)],and perioperativepain score [P=0.040,OR=2.292(1.040,5.050)].Conclusions Age,heart disease history,perioperative fluid volume difference and perioperative pain score may be the risk factors for perioperative heart failure in elderly patients with femoral intertrochanteric fracture.We should pay attention to these factors and evaluate their influences on the patient so as to take appropriate perioperative prevention and treatment measures to reduce the incidence of perioperative heart failure.
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OBJECTIVE:To provide reference for storage management of injection drugs protected from light in inpatient phar-macy of hospital. METHODS:From Jan. to Mar. 2016,the storage items of injection drugs protected from light in inpatient phar-macy of our hospital and the current storage situation were surveyed,the quality management tool PDCA circulation was adopted to improve storage situation and evaluate the effect of PDCA. RESULTS:For improper storage of injection drugs protected from light caused by employees lacking knowledge in photophobic knowledge,unfamiliar to the list of injection drugs protected from light, no packaging in returned drugs,after developing and carrying out corresponding countermeasures,including reinforcing staff train-ing,studying characteristics of the new-coming drug timely,renewal photophobic knowledge and the list of injection drugs protect-ed from light,and ameliorating working procedure,the light storage pass rate was increased from 96.5% to 100% in 310 injection drugs protected from light in inpatient pharmacy. CONCLUSIONS:Appling PDCA can effectively improve the storage management of injection drugs protected from light and provide reliable protection for the drugs'safe and effective application.
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Objective To analyze the clinical effect of vacuum sealing drainage (VSD) on skin and soft tissue injury in elderly patients.Methods A total of 75 patients with severe skin and soft tissue injury who met the inclusion criteria were enrolled in this study.They were divided into two groups based on admission dates:the observation group (n =40,receiving VSD treatment,oddnumber date admission) and the control group (n=35,receiving routine dressing changes,even number date admission).The clinical indexes including pain score,wound healing time,infection rate and complications were analyzed and compared between the two groups.Results There was a significant difference in the average length of hospitalization between the two groups (21.3 days vl 30.7 days,t=7.60,P=0.0000).The infection rate was lower in the observation group than in the control group (12.5％ or 5/40 vs.54.3％ or 19/35,x2=13.12,P=0.0003).The incidence of complications was lower in the observation group than in the control group (15.0％ or 6/40 vs.42.9％ or 15/35,x2=5.87,P=0.0154).There were no deaths in the observation group,but one patient died from acute pulmonary embolism in the control group during hospitalization.Conclusions VSD can alleviate pain,reduce the infection rate,shorten the length of hospitalization and decrease bedridden complications in elderly patients with severe skin and soft tissue injury,and has valuable applications in clinical practice.
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Objective To summarize diagnostic methods and surgical management experience of penetrating chest trauma . Methods The clinical data of 603 patients in our department during the past 10 years were analyzed retrospectively in respects of features of injury ,diagnostic methods ,surgical management and outcome ,etc .Results Location of the wounds :the wounds on the left anterior chest wall had 151 cases ,on the left posterior chest wall 134 cases ,on the right anterior chest 137 cases ,on the right posterior chest 108 cases ,on the bilateral chest 22 cases ,on the root of the neck 35 cases ,on the upper abdome 16 cases .In 453 ca‐ses examined by CT ,96 .03% of these cases were found to be abnormal .In 252 cases examined by X ray ,71 .03% of these cases were found to be abnormal .166 underwent thoracotomy ,26 underwent VATS(Video assisted Thoracoscopic Surgery ) .411 under‐went non operative management .583 were cured ,76 cases developed complications .20 were died .Conclusion Multi spiral CT is a rapidly and accurate diagnostic method to penetrating chest trauma .Incision of thoracotomy is employed according to the lethal damage and the most serious injury organ .
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Objective To investigate the effect and mechanism of tripterygium wilfordii combined with aescine in treatment of acute lung injury (ALI) following trauma.Methods A total of 120 patients with posttraumatic ALI were divided into four groups:tripterygium wilfordii + aescine group (combined group),tripterygium wilfordii group,aescine group,and control group according to random number table,with 30 patients per group.Regardless of the same conventional therapy,the patients in combined group were treated by orally or gastrically administered tripterygium wilfordii multiglycoside as well as aescine intravenously,once a day for 12 days; on the contrary,the same method but only with tripterygium wilfordii or aescine was respectively performed in tripterygium wilfordii and aescine groups.Blood gas analysis before and after treatment,length of ICU stay,fatality rate and incidence of ARDS in each group were observed.Changes in levels of inflammatory mediators (TNF-oα,IL-1,IL-6 IL-8,etc)were detected at days 4,8,and 12 after medication.Results Shorter length of ICU stay and lower ARDS incidence as well as 12-day fatality rate were detected in each treatment group as compared with control group,especially in combined group (P ＜ 0.05).Respiratory rate,PaO2 and oxygenation index (PaO2/FiO2) in each treatment group presented better amelioration than those in control group and especially better results were observed in combined group (P ＜ 0.05).Plasma levels of TNF-α,IL-1,IL-6,and IL-8 in each treatment group were lower than those in control group (P ＜ 0.05).Conclusions Tripterygium wilfordii and aescine havetherapeutic effect on posttraumatic ALI.Moreover,synergetic use of the two drugs achieves synergistic effect and better outcome.
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Objective To observe the application and the curative effects of vacuum sealing drainage (VSD) in the treatment of skin injury of trauma surgery .Methods The 50 cases with severe traumatic skin injury treated with VSD were compared with tra-ditional dressing group(control group 50 cases) to observe the curative effect of the two groups .Results Compared with control group ,VSD group improved the success rate of follow-up skin graft .Good skin graft in VSD group were obvious more than the con-trol group(P<0 .01) .Conclusion The VSD can improve the success rate of skin graft ,accelerate wound healing .At the same time , VSD can avoid the pain due to reducing the times of changing dressings .It is a good method of treating severe traumatic skin injury .
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Objective To probe into the feasibility and efficacy of damage control surgery (DCS) in treating severe pelvic fracture combined with abdominal organ injuries.Methods A retrospective analysis was done on the clinical data of 39 patients with severe pelvic fractures combined with abdominal organ injuries treated by DCS from 1995 to 2010.Results Devascularization of internal iliac arteries was performed to treat massive hemorrhage in the 39 patients with severe pelvic fractures combined with abdominal organ injuries,including ligation of bilateral internal iliac arteries in 31 palients and angioembolization of bilateral internal iliac arteries in eight.Meanwhile,early pelvic external fixators were used in 31 patients.All patients received discriminating internal fixation after resuscitation in ICU.The overall mortality rate was 21％ (8/39),with average ISS of 41.6 points and with hemorrhagic shock and combined injury for the main causes of death.Complications occurred in seven patients including combined acute respiratory distress syndrome (ARDS) in three patients,thrombosis of right common iliac artery in one,subphernic abscesses in two,and deep infection of lower extremity in one,but all the complications were cured.Conclusions Reasonable and timely use of DCS can enhance the rescue survival rate of patients with severe pelvic fraclure combined with abdominal organ injuries.
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Objective To investigate the value of diffusion-weighted imaging(DWI) in diagnosing the feminine pelvic lesions.Methods Conventional MRI and DWI with b value of 0 and 1000 s/mm2 respectively were performed in 135 feminine patients with pelvic lesions. Apparent diffusion coefficient (ADC) values of the lesions were measured. Contrast-enhancement MR imaging was performed in 16 patients.Results The average ADC values were (0.90?0.10)?10-3mm2/s in uterine malignant lesions (43 cases),(0.12?0.09)?10-3mm2/s in uterine benign lesions ( 24 cases ) , ( 0.98?0.11 )?10-3mm2/s in adnexal malignant diseases ( 34 cases ) and ( 2.25?0.12)?10-3mm2/s in adnexal benign ones(34 cases), respectively.There were significant differences between malignant and benign groups(P
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Objective To evaluate the diagnostic value of magnetic resonance urography(MRU)in patients with iatrogenic ureteral injuries.Methods MRU in 12 patients with iatrogenic ureteral injuries caused by gynecological and rectal operation were performed.Results MRU examinations were successfully done in all cases at once.The accurate rate in localized and qualitative diagnosis was all 100%.The injures of ureter in 12 cases were all located at lower segment of the ureter,of them,8 patients were purely obstruction,4 cases were obstruction with urinal leakage,all cases were accompanied by dilations of ureter and hydronephrosis.Conclusion MRU is helpful for the diagnosis of iatrogenic ureteral injury.