In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

Background Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in trauma patients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival. Methods All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. Results A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9. Conclusions Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.

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.

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.

Objective To summarize treatment methods for severe liver trauma associated with trauma-in-duced coagulopathy .Methods The clinical data of 32 sustained severe liver trauma patients associated with trau-ma-induced coagulopathy were collected from Feb .2010 to Apr.2016 in Chongqing Emergency Medical Center . There were 23 males and 9 females with an average age of 37.4(15-84) years.Seventeen cases (56.3%) were in-jured from road traffic accidents ,10 were from high falling/falling,3 were from crushing and 2 were from other causes . The methods of damage control resuscitation and treatment results were analyzed retrospectively .Results All the 32 cases had multiple injuries .The rapid assessment of the severity of injury was done in admission according to the principle of"CRASH PLAN",while the establishment of venous access and coagulation function ,cross matching and other tests were performed ,and the cases were resuscitated according to the principle of damage control resuscitation (DCR).Preoperative coagulation dysfunction occurred in 19 cases.Massive blood transfusion was achieved in 22 cases by fresh frozen plasma(FFP),packed red blood cells(PRBC) in the ratio of 6-10u, respectively and 10u of cryoprecitation.Liver trauma was grade Ⅳ in 20 cases,and was grade Ⅴin 12 cases.Damage control surgery in-cluding debridement hepatectomy was performed in 22 cases and improved peri-hepatic packing was performed in 13 cases.The operative time was 30min-1.5h.In this group,24 cases were survived ,and the overall mortality rate was 25%(8/32).Six (18.8%,6/32)cases died of liver injury with or without complications .Besides associated inju-ries inside and outside the abdomen , exsanguination due to liver trauma and coagulopathy was the main cause of death.Conclusion Trauma-induced coagulopathy would easily develop in patients with liver trauma of grade Ⅳand gradeⅤ.DCR is the main protocol in treating such patients .Improved perihepatic packing and debridement hepatectomy are the main damage control measures in treating severe liver trauma associated with trauma -induced coagulopathy .

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.

Objective To explore the measures for prevention and treatment of intra-abdominal infection in liver trauma.Methods The clinical data of 314 patients with liver trauma between Jan.2006 and Dec.2015 was analyzed.There were 221 males and 93 females,with age ranging from 15 to 76 years( average,38 years) .Totally 129 cases received non-operative treatment,and 185 cases received operative treatment.Results Fifty-four cases occurred peritoneal infection,all of whom were from the operation group,with the infection rate of 29.2%.Of the 185 cases in the operation group,there were 73 cases of isolated hepatic injury( according to American Association for the Surgery of Trauma, 68 cases of gradeⅢto gradeⅤwith 14 cases developing peritoneal infection,and 5 ca-ses of gradeⅠ-Ⅱwithout peritoneal infection).A total of 112 cases were associated with other organ injuries (33 out of 67 cases of gradeⅢto gradeⅤdeveloped peritoneal infection,and 7 cases of 45 cases of gradeⅠ-Ⅱdeveloped peritoneal infection.Of 54 patients with peritoneal infections,49 cases were cured(90.7%).Conclusion The inci-dence of intra-abdominal infection is high in the patients with severe hepatic injury or associated with multi-organ inju-ry in the abdomen.Reasonable surgical procedures based on classification of liver trauma,adequate drainage and com-bined application of preventive techniques can effectively decrease the incidence and mortality of intra-abdominal in-fections in liver trauma.

>文献报道胸部穿透伤锐器刺伤病死率为30%,枪弹伤病死率为52% [1] 。我们收集2002年1月至2012年12月我院收治的612例胸部穿透伤患者的临床资料,总结救治经验如下。资料与方法1.一般资料:男性538例,女性74例;年龄15～72岁,平均32.6岁。刀刺伤585例,枪弹伤19例,钢筋贯通伤4例,食管异物穿透伤3例,牛角伤1例。受伤至入院时间0.5～52.0 h,平均2.9 h。穿透伤入口部位:左前胸壁

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 .

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.

Objective To observe the therapeutic value of aescine in traumatic acute lung injury .Meth-ods Eighty patients with traumatic acute lung injury were randomly divided into aescine group (n=40) and con-trol group (n=40).Both groups was given routine treatment ,while the patients of the aescine group were given aescine (20mg,intravenous drip,once per 24 hours,for 12 days).The efficacy in both groups was assessed ,and their serum cytokines including tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6 (IL-6)and in-terleukin-8(IL-8) were measured on the day before treatment and on the third day ,the sixth day,the ninth day and the twelfth day after treatment.Results There was no difference in TNF-α,IL-1,IL-6 and IL-8 levels between the two groups before treatment,which reduced more significantly on the sixth day after treatment in the aescine group than those in the routine group(P<0.05).There were significantly differences in the respiratory rate (RR),arteri-al partial pressure of oxygen (PaO2 ),arterial partial pressure of carbon dioxide (PaCO2 ) and PaO2/FiO2 after treat-ment between the two groups (P<0.05).Conclusion Aescine significantly inhibits the production of inflammato-ry cytokines,relieves acute pulmonary edema.Early administration of aescine can play an important role in the treatment of acute lung injury.

Objective To investigate the trauma mechanism,injury characteristics,early diagnosis and treatment of the drivers with steering wheel injuries.Methods The clinical data of 122 patients who suffered from steering wheel injuries in our hospital from Jan.2007 to Dec.2011 were analyzed retrospectively.Results Among these 122 patients,there were 27 patients with cranial or cervical trauma,64 patients with chest trauma,56 patients with abdomen trauma,41 patients with extremities,pelvic or spine fracture.There were 81 patients with poly-trauma.Totally 115 patients were survived.The survival rate was 94.3%(115/122) and the mortality was 5.7%(7/122).The main cause of death was the injuries with cranial trauma.Conclution Steering wheel injuries in drivers usually were severe and accompanied with high poly-trauma rate.Mostly severe thoracoabdominal trauma need surgical treatment.Blunt cardiac injuries and pancreaticoduodenal injuries are easy to be miss-diagnosed and mis-diagnosed,so doctors should pay more attention to these conditions.

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 traditional 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 control 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.

OBJECTIVE:To investigate the diagnostic and therapeutic effect of bronchofiberscopy in the management of severe thoracic trauma.METHODS:A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal incision (282), nasal cavity (149) and oral cavity (57). Intensive SaO2 monitoring as well as blood gas analysis were performed pre-, intra- and postoperatively. Simultaneously oxygen therapy or ventilatory support was given. Sputum culture was done intraoperatively.RESULTS:Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was positive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery (both P less than 0.05). Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death.CONCLUSION:Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and sputum crust in the airway, manage obstructive atelectasis and pneumonia, and significantly improve respiratory function and treatment outcome.

分析41例创伤性十二指肠损伤的临床资料,术前及术中确诊37例,误诊和漏诊4例.行十二指肠Ⅰ期修补21例;十二指肠端端吻合加胃造瘘、空肠造瘘十二指肠内引流3例;带蒂空肠袢修补胃造瘘、逆顺向空肠造瘘3例;修补加十二指肠憩室化4例;十二指肠空肠 Roux-en-Y吻合5例;腹膜后多孔引流1例;十二指肠Ⅰ期修补,胃造瘘、逆顺向空肠造瘘,胆总管引流1例;胰十二指肠切除1例,应用损害控制手术2例.治愈32例(78%),死亡9例(22%).认为早期诊断和恰当术式是提高十二指肠损伤救治成功率的关键.

现代创伤以高能量、多发伤发生率高为其特点,胸部创伤在多发伤中所占的比例接近50％[1].但胸部创伤中创伤性乳糜胸少见,且常合并其他损伤,致乳糜胸易被掩盖而不易诊断,导致治疗延误.收集重庆市急救医疗中心2004年1月至2011年8月治疗的创伤性乳糜胸17例,现将诊治体会总结如下.

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.

Objective To evaluate the application condition and effect of external fixation in treating severe multiple injuries.Methods The clinical data of 47 multiple injury cases in our unit from Jan.2007 to Jun.2009 were studied retrospectively.This group included 16 cases of pelvic fractures and 35 limbs fractures;closed fractures in 18 cases,open fractures in 29 cases.Results Of these patients,44 cases survived and 3 cases died of critical brain injury and hemorrhagic shock.Totally 18 cases received re-operation of internal fixation.External fixation was applied as definitive technique for fixation of bone fracture,resulting in fracture healing in 26 cases.Conclusion The early external fixation for severe multiple injury patients can be widely used for the relatively short operation time,simple manipulation and less complications.

严重创伤患者往往因严重失血,导致大量凝血因子丢失,加之低体温、代谢性酸中毒、电解质紊乱,容易出现凝血功能障碍甚至消耗性凝血病.而消耗性凝血病、低体温和酸中毒是严重创伤患者的主要生命威胁,通常称作"致死三联

探讨肝动脉断血术在肝外伤治疗中的方法和效果。肝动脉断血术对难以控制出血的肝外伤,是一种安全、有效的止血手段。