Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

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.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

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.

Treatment efficacy of damage control strategy in elderly patients with multiple injuries combined with thoracic trauma / 中华创伤杂志

Objective To investigate the efficacy of damage control strategy in treating elderly patients with multiple injuries combined with thoracic trauma and evaluate its efficacy.Methods A retrospective case-control study was performed to analyze the data of 877 elderly patients with multiple injuries combined with thoracic trauma admitted from January 2005 to December 2016.There were 574 males and 303 females,aged 65-94 years (mean,70.8 years).The patients were divided into damage control group (n =406) and non-damage control group (n =471),according to the application of damage control strategy.The injury severity score (ISS) of the damage control group and the non-damage control group were (14.4 ± 8.5) points and (13.7 ± 9.4) points,respectively.The emergency operation rate within 24 hours,the blood loss during emergency operation,the thoracic and abdominal surgery,vascular interventional embolization,thoracic fracture and limb pelvic fracture operation within 72 hours,as well as ICU treatment rate,treatment time,complications,and prognosis were compared between the two groups.Results Fifty-one cases (12.6％) in the damage control group and 93 cases (19.7％) in the non-damage control group underwent emergency operation within 24 hours (P ＜ 0.01).The blood loss during emergency operation were (465.2 ± 329.6) ml in the damage control group and (574.4 ± 437.3) ml in the non-damage control group (P ＜ 0.01).Operation time of the two groups were (108.7 ± 57.1)minutes and(123.5 ± 86.4) minutes,respectively(P ＜ 0.01).In the damage control group and the nondamage control group respectively,there were 25 cases (6.2％) and 48 cases (10.2％) of laparotomy (P ＜ 0.05),23 cases (5.7％) and six cases (1.3％) of vascular interventional embolization (P ＜0.01),41 cases (10.1％) and 29 cases (6.2％) of internal fixation for thoracic fracture (P ＜ 0.05),zero and 232 cases (49.3％) of internal fixation for fracture of limbs and pelvis (P ＜0.01),92 cases (22.7％) and 53 cases (11.3 ％) of external fixation for extremity and pelvic fractures (P ＜ 0.01).A total of 271 cases (66.7％)in the damage control group and 256 cases (54.4％)in the non damage control group were admitted to ICU (P ＜ 0.01),and the ICU treatment time was (8.1 ± 6.5) days and (10.5 ±7.4)days,respectively (P ＜ 0.01).The top three complications for the two groups were atelectasis and pulmonary infection,arrhythmia and heart failure,respiratory failure and acute respiratory distress syndrome (ARDS).In the damage control group and the non-damage control group respectively,the incidence of atelectasis and pulmonary infection were 65％ and 64.5％ (P ＞ 0.05),the incidence of arrhythmia and heart failure were 53.4％ and 60.5％ (P ＜ 0.05),and the incidence of respiratory failure and ARDS were 17.7％ and 23.8％ (P ＜ 0.05).A total of 29 cases died in the damage control group (7.1％) and 53 cases died in the non damage control group (11.3 ％) (P ＜ 0.05).Conclusions Damage control strategy should be applied to treating elderly patients with multiple injuries combined with chest injury.By simplifying or reducing emergency surgery,active ICU treatment,and focusing on the fixation of chest fractures,damage control strategy can effectively reduce complications and improve survival rate.

Application of vacuum sealing drainage in elderly patients with severe skin and soft tissue injury / 中华老年医学杂志

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.

Value of AIS-ISS for evaluation of trauma in the elderly / 中华创伤杂志

Objective To investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.

Analysis of the diagnosis and management of penetrating chest trauma in 603 cases / 重庆医学

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 .

Synergetic use of tripterygium wilfordii and aescine for treatment of posttraumatic acute lung injury / 中华创伤杂志

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.

Vacuum sealing drainage in the application of trauma surgery / 重庆医学

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 .

Damage control surgery for treatment of flail chest combined with multiple trauma / 中华创伤杂志

Objective To investigate clinical effect of damage control surgery (DCS) in treatment of patients with flail chest combined with severe multiple injuries.Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments:DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs ; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib.Complications,mortality,and main parameters before and after operation in each group were analyzed and compared.Results Complications including pulmonary infection (32 cases),atelectasis (38 cases),and acute lung injury (ALI)/ARDS (39 cases) were found.Twenty-two cases died,including 13 deaths from ARDS,two from tension pneumothorax,one from massive hemoptysis,three from cardiac shock,two from craniocerebral injury,and one from liver trauma and thus the overall death rate occupied 11.8％.Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P ＜ 0.01),but the change of OI was inappreciable in Group B.Mortality,complication rate,cases treated with mechanical ventilation,tracheotomy or fiberoptic bronchoscopy,and average length of ICU and hospital stay were the lowest in the DCS Group,followed by a relatively higher result in Group B and a much higher result in Group A (P ＜ 0.01).Conclusion DCS decreases mortality and complications dramatically when appolied to treat flail chest combined with severe multiple trauma.

Role of fibrobronchoscopy in diagnosis and treatment of severe chest trauma / 中华创伤杂志

Objective To explore the role of fibrobronchoscopy in diagnosis and treatment of se- vere chest trauma. Methods A retrospective analysis was done on 114 patients with severe chest trau- ma who were diagnosed and treated by fibrobronchoscope from January 1999 to July 2007. We finished 289 times of fihrohronchoscopies including 181 times through nasal cavity, 32 through tracheal, 52 through oral cavity and 56 through traeheostomy tube. SaO2 and arterial blood gas were monitored continu- ously before and after operation, and respirator support or oxygen was administered simultaneously. Re- suits Definite diagnosis was achieved in all patients, of whom were 102 patients treated with lavement. SaO2 was significantly increased in all patients after bronchial lavement (P <0.01) and Pao2 was signifi- candy ameliorated two hours after bronchial lavement (P < 0.05). Conclusions Fibrobronchoscopy can identify diagnosis of bronchial injury and remove foreign body, secretion, blood and phlegm for pa- tients with severe chest trauma. Meanwhile, fibrohronchoscopy can relieve obstructive atelectasis and ob- structive pneumonia, improve respiratory function and hence increase survival rate.