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Objective@#To explore the influences of ulinastatin on acute lung injury and time phase changes of coagulation parameters in rats with severe burn-blast combined injuries.@*Methods@#One hundred and ninety-two Sprague-Dawley rats were divided into pure burn-blast combined injury group, ulinastatin+ burn-blast combined injury group, and sham injury group according to the random number table, with 64 rats in each group. Two groups of rats with combined burn-blast injuries were inflicted with moderate blast injuries with the newly self-made explosive device. Then the rats were inflicted with 25% total body surface area full-thickness scald (hereinafter referred to as burn) on the back by immersing in 94 ℃ hot water for 12 s. Rats in sham injury group were sham injured on the back by immersing in 37 ℃ warm water for 12 s. Immediately after injury, rats in the three groups were intraperitoneally injected with Ringer′s lactate solution (40 mL/kg), meanwhile rats in ulinastatin+ burn-blast combined injury group were intraperitoneally injected with ulinastatin (4×104U/kg), once every 12 hours, until post injury hour (PIH) 72. Before injury, at PIH 3, 6, 12, 24, 48, 72, and on post injury day (PID) 7, 8 rats in each group were selected to harvest abdominal aortic blood samples to detect plasma levels of activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, D-dimer, antithrombin Ⅲ (AT-Ⅲ), and α2-antiplasmin (α2-AP). At PIH 24, three rats in each group which were used in detection of coagulation parameters were sacrificed to observe lung injury. At PIH 72, three rats in each group were sacrificed for histopathological observation of lung. Data were processed with analysis of variance of factorial design and least-significant difference test.@*Results@#(1) Compared with those of rats in sham injury group, APTT of rats in pure burn-blast combined injury group significantly prolonged at PIH 72 and on PID 7 (P<0.05 or P<0.01). PT significantly prolonged at PIH 3 and 72 and significantly shortened at PIH 6 (P<0.05 or P<0.01) . Fibrinogen level significantly increased from PIH 12 to PID 7 (P<0.01). AT-Ⅲ level significantly decreased at PIH 6 and 12 (P<0.01), and α2-AP level significantly decreased at PIH 6 and significantly increased from PIH 24 to 72 (P<0.01). Compared with those of rats in pure burn-blast combined injury group, APTT of rats in ulinastatin+ burn-blast combined injury group significantly prolonged at PIH 3 and 6 (P<0.01) while PT significantly shortened at PIH 3, 12, and 72 (P<0.05 or P<0.01). Fibrinogen level significantly decreased at PIH 6 and 12 and significantly increased at PIH 72 (P<0.05 or P<0.01). AT-Ⅲ level significantly increased at PIH 3, 12, 48, and 72 (P<0.05 or P<0.01), and α2-AP level significantly decreased from PIH 12 to 72 (P<0.05 or P<0.01). D-dimer level of rats in sham injury group, pure burn-blast combined injury group, and ulinastatin+ burn-blast combined injury group were respectively (0.084±0.013), (0.115±0.015), (0.158±0.022), (0.099±0.011), (0.099±0.012), (0.089±0.011), (0.124±0.014), and (0.116±0.018) μg/mL, (0.064±0.033), (0.114±0.016), (0.135±0.009), (0.060±0.008), (0.104±0.010), (0.124±0.020), (0.180±0.036), and (0.201±0.032) μg/mL, (0.074±0.013), (0.084±0.035), (0.101±0.050), (0.091±0.046), (0.096±0.034), (0.044±0.019), (0.106±0.049), and (0.118±0.047) μg/mL. Compared with that of rats in sham injury group, D-dimer level significantly decreased at PIH 6 and 12 and significantly increased from PIH 48 to PID 7 (P<0.05 or P<0.01). Compared with that of rats in pure burn-blast combined injury group, D-dimer level of rats in ulinastatin+ burn-blast combined injury group significantly decreased at PIH 3, 48, and 72, and on PID 7 (P<0.05 or P<0.01). (2) At PIH 24, there was a large amount of light red effusion in the thoracic cavity, and both lung lobes were hyperemic and edematous with a small amount of blood clots in the left and middle lobe of rats in pure burn-blast combined injury group. There was a small amount of yellowish effusion in the thoracic cavity of rats in ulinastatin+ burn-blast combined injury group, and the degree of hyperemic and edematous of bilateral lobes was lighter compared with rats in pure burn-blast combined injury group with no clot in the left lobe. No congestion, edema, or bleeding was observed in lungs of rats in sham injury group. (3) At PIH 72, disorganized alveolar structure, collapsed alveolar cavity, edematous and thickening pulmonary interstitium, infiltration of a large amount of inflammatory cells, obvious rupture of alveolar septum, and hyaline thrombus were observed in lungs of rats in pure burn-blast combined injury group. Significantly improved alveolar structure, less collapsed alveolar cavity, improved edematous pulmonary interstitium, less infiltration of inflammatory cells, rupture of alveolar septum, and no thrombus were observed in lungs of rats in ulinastatin+ burn-blast combined injury group. The lung tissue had a well-filled alveolar cavity with no interstitial edema or infiltration of inflammatory cells and no thrombosis in lungs of rats in sham injury group.@*Conclusions@#Ulinastatin has positive therapeutic effects on acute lung injury in rats with severe burn-blast combined injuries through its good regulating effects on coagulation and fibrinolytic disorders caused by burn-blast combined injuries.
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Objective@#To investigate the situations of on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou, so as to provide more data support for emergency medical rescues of the similar incidents of massive casualty.@*Methods@#Two medical workers with a certain clinical experience were sent to Hangzhou 120 emergency medical centers to collect data of the on-site rescue on 21st July, 2017, including ambulance call-outs, on-site command and traffic conditions, and on-site triage and evacuation of the victims. They were then sent to the hospitals receiving the victims to investigate the situations of these victims including the general information (such as gender, age, admitted hospitals, and number of admission, discharge, and transferring in the first two weeks after the accident) and injury assessment [such as injury position and type, injury severity evaluation by New Injury Severity Scoring (NISS), and burn severity evaluation for victims with burns].@*Results@#(1) A total of 15 ambulances reached the accident site for rescue. The traffic and transportation were jammed and interrupted after this accident. On-site triage and distribution were disorderly conducted. (2) Clinical data of 53 victims were collected, including 24 males and 29 females, with the age of 8 to 70 (34±14) years old. They were sent into 6 hospitals in Hangzhou. Two victims died on the day of accident. Up to two weeks after this accident, 28 (52.8%) victims were discharged from the hospitals and received follow-up in outpatient department. Five victims with severe injuries were transferred to the other hospitals. (3) Based on the results of NISS, the injury severities were mild in 29 (54.7%) cases, moderate in 9 (17.0%) cases, serious in 3 (5.7%) cases, and severe in 12 (22.6%) cases. Those 2 dead victims were classified into the severe category due to the highest NISS score of 75. For all of the victims, skin and soft tissue defects were most common. Six (11.3%) victims were combined with burns. According to the classification of burn severity, there were one case of mild, one case of serious, and 4 cases of severe.@*Conclusions@#The gas explosion accident in Hangzhou caused massive casualties with complex injuries. The local emergency medical rescue responded quickly, but during the rescue process, lots of aspects should be further improved.
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In order to ameliorate the prognosis of patients in burn disaster, national emergency medical rescue expert teams are usually dispatched to incident areas. This article discusses the major work and challenges of the medical rescue expert teams using example of rescuing gas explosion accident in Hangzhou in last few days and author′s personal experience of previous mission. The foremost mission of medical rescue expert teams is to provide feasible strategic advice for burn disaster rescue and pivotal critical care support. The medical rescue expert teams always begin their work in hospitals lack of experience in disaster rescue. According to the characteristics of"7·21"Hangzhou gas explosion accident, the medical rescue expert teams focus on reassessment of the severity and hidden injuries of all patients, referral of patients according to the homeostasis status in patients with different severity, developing medical safety strategies, medical-related public safety strategies, and nosocomial infection control measure for rescue work. Furthermore, the medical rescue expert teams join the treatment for some critically ill patients and sudden emergency cases. The main challenges of medical rescue experts faced are accumulation and improvement of personal medical skill and powerful psychological endurance. Psychological counseling can play beneficial role in rescue group. In addition, establishing coordinated relationship among national emergency medical rescue expert teams, local administration, and local medical group shall be beneficial to disaster rescue.
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Objective A dog model of blast-burn combined injuries followed by immersion in seawater was reproduced in dog to study hemodynamic responses and their mechanism. Methods The dogs which were exposed to blast injuries produced by primer explosion and 10% second degree burn were randomly divided into seawater immersion group and blast-burn only group. The dogs in immersion group were immersed in seawater under anesthesia for 4 hours. The hemodynamics of the dogs was monitored, and blood samples were collected to assay malondialdehyde (MDA), and cultured for bacteria. After the above procedures were completed, the pathological changes in the dogs′ hearts and lungs were observed. The dogs in blast-burn group underwent the same protocol in immersion group except immersion. Results The body temperature (T), cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) in dogs in the immersion group were remarkably decreased, while the mean pulmonary artery pressure (MPAAP), systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) were markedly increased compared with those in blast-burn group. These obvious hemo dynamic disorders occurred during 3h to 6h after the dogs leaving seawater. Plasma MDA level was negatively correlated with CI. The interval between positive blood calture for intestinal bacteria and injury was shorter in immersion group than that of blast-burn group. The gross and histopathological changes in dogs′ hearts and lungs in immersion group injuries were more severe in degree than in blast-burn group. Conclusions Seawater immersion markedly aggravates the hemodynamic disorders in dogs having had blast-burn combined injury. The changes became obvious during 3h to 6h after leaving seawater. The aggravating effect might be related with declination of body temperature, inflammatory response and lipid peroxidation.
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This experiment was taken to study the changes of cell mediated immunity (CMT) after burn—blast combined injuries in rats and the regulatory effects of indomethacin and PGE_1 on CMT. Mitogen stimulated blastogenic transformation (MSBT) and interleukin—2 (IL—2) were measured in 54 rats before injury and on 1, 3, 5, 7, 14 days after injury. The results showed that MSBT increased significantly on days 3. 5 and 7 but decreased significantly on day 1. IL—2 increased significantly after injury and did not return to normal until day 14. MSBT and IL—2 production were significantly depressed by PGE_1 but on the other hand much enhanced by indomethacin. PGE_1 and indomethacin had no effect on MSBT and IL—2 production in the control group. These results indicate: 1. moderate burn—blast combined injuries can stimulate CMI in rats: 2. PGE_1 can significantly depress IL—2 production and MSBT in rats after injury: 3. Indomethacin can enhance IL—2 production in rats after injury and 4. PGE_1 and indomethacin have no regulatory effect on IL—2 production and MSBT in normal rats.
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Objective To review the clinical features and early management of combined thorcoabdominal injury(CTI),to decrease the mortality rate.Methods A retrospective study was carried out in 63 cases of CTI treated surgically from May 1990 to May 2007.There were 34 cases with blunt injuries and 29 cases with penetrating injuries.Forty-seven patients had rapture of left diaphragm,9 cases had rupthure of right diaphragm,7 cases had rupture of both diaphragms,24 cases were combined with traumatic diaphragmatic hernia,63 cases were combined with hemopneumothorax,and 60 cases were combined with shock.Forty-one cases were diagnosed correctly before surgery.Sixty-three cases were treated by surgery,among them,surgery was performed through left thoracotomy in 18 cases,through a right thoracotomy in 2 cases,through bilateral thoracotomy in 5 cases,through thoraco-abdominal incision in 2 cases,and through the abdominal route in 32 cases.Results Fifty-six cases were cured,and 7 cases(11.1 %) died.The main cause of death was hemorrhagic shock.Conclusions CTI has high mortality rate,and the most frequent cause of mortality is hemorrhagic shock.The operative approach is based on the individual injury condition.Early diagnosis and timely surgical intervention is the key to improving the cure rate and reducing mortality in severe CTI.
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How to use intravenous fluid therapy safely in patients with combined burn-blast injuries is an unsolved problem. Therefore, this experimental study was carried out in 64 dogs with combined injuries of 40% second degree burns (inflicted with nalpam) and moderate or severe blast injury (inflicted with TNT charge explosion) . Intravenous infusion was administered as early as 6-8 hours after injury. The amount was 0.5 ml colloid and 1-1.5 ml crystal solution/kg of body weight/one percent of body surface burns in the first 24 hours after injury, and a half of this amount was given in the second 24 hours. The transfusion of the fluid was finished within 3-5 hours. Another amount 30% of the total amount of the fluid intravenously infused was added as drinking water.It was found that there was no significant difference between the infused animals and the controls so far as the pulmonary pathological changes (including pulmonary edema) were concerned. It is believed that a reasonable amount of intravenous fluid can be safely given to patients with combined burn-blast injuries provided that the changes of the urinary output and the physical signs of the chest are carefully monitored.
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Objective To explore effective methods of organization and early treatment of mass casualties of burn-blast combined injury. Methods Early clinical data of a batch of 16 patients with burn-blast combined injury and experience of organization for early care were summarized and analyzed. Results The plan for emergency care of mass casualties was implemented in time and well organized, as a result all the wounded survived the shock stage. 10 wounded servicemen were safely transported to other hospitals. Cardiac and respiratory arrest occurred in 1 case during transportation by ambulance, but was successfully resuscitated. Conclusions Timely deployment of plan for emergency treatment, with the organization of a task force including the director of the hospital and clinical specialists are pivotal in the success of taking care of mass casualties. Correct understanding of the clinical characteristics of burn-blast combined injury, effective fluid resuscitation in early stage of injury, and measures to prevent multiple organ dysfunction syndrome were essential in the treatment.
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Objective To approach the clinical features of batched severe burn accompanied by blast injury in lungs, and to sum up both experiences and lessons drawn from the treatment on those cases. Methods 16 cases of severe burn accompanied by blast injury in lungs were inductively analyzed on their clinical features and the experiences and lessons drawn from the treatment were summed up. Results 14 cases got full recovery, and the 2 remainders died of multiple organ failure. Conclusion An overall treatment plan, evacuation in time and individual therapy are necessary for the batched treatment of severe burn accompanied by blast injury in lungs, and an integrated therapy may get a satisfied result.