目的 分析2021年重庆市院前急救创伤患者的流行病学特征、救治结局及其影响因素,为预防创伤发生及提高院前创伤救治水平提供依据.方法 回顾性分析2021年1月1日—2021年12月31日重庆市120调度指挥中心数据库中院前急救创伤患者的数据,分析院前急救创伤患者的流行病学特征,运用卡方检验和二元Logistic回归模型探讨院前急救创伤患者结局的影响因素.结果 2021年重庆市院前急救创伤患者66560例,以男性为主,占59.86％;高发年龄段为41～65岁,占39.27％;平均年龄为(48.8±21.2)岁.道路交通伤是65岁以下人群的首要致伤原因(52.95％),摔跌伤是65岁以上人群首要致伤原因(51.82％).院前急救创伤患者的病死率为1.22％,主要致死原因为:高处坠落伤(37.04％)、道路交通伤(28.40％)和自杀(12.96％).高处坠落伤(OR=17.537,95％CI:14.598～21.068)、自杀(OR=176.745,95％CI:126.816～246.331)、凌晨时间段受伤(OR=1.672,95％CI:1.280～2.185)和0～6岁组(OR=9.894,95％CI:7.430～13.174)以及>65岁组(OR=2.676,95％CI:2.117～3.383)的创伤患者更易发生院前死亡.结论 重庆市院前急救创伤患者以青壮年男性为主,道路交通伤、摔跌伤是院前急救创伤患者的主要致伤原因,高处坠落伤、道路交通伤和自杀是病死率最高的致伤原因,0～6岁儿童和>65岁以上老年人是易发生死亡的敏感人群.因此,应针对不同致伤原因和不同人群制定有针对性的预防措施、合理调配院前资源、提高救治能力,预防创伤发生,减少创伤导致的死亡.

脾脏作为腹腔实质性器官,血供丰富,质地松脆,脾破裂病情发展快,如不及时救治易发展成失血性休克,严重威胁患者生命安全[1]. 但开腹脾切除治疗创伤性脾破裂具有创伤大、并发症多、恢复缓慢等劣势;完全腹腔镜下脾切除也存在暴露困难、技术要求高、手术时间长、出血多等缺点. 免"蓝蝶"手辅助腹腔镜脾切除术在治疗创伤性脾破裂时,视野暴露好、手术时间短、并发症低等,同时具备节省手术时间、患者费用低的优势,易于在基层医院推广[2]. 现将重庆奉节县人民医院采用免"蓝蝶"手辅助腹腔镜脾切除术治疗创伤性脾破裂16例患者,报告如下.

Objective To determine the effects of fluorouracil and mitomycin on the autophagy,aging,and apoptosis in cholangiocarcinoma cell line QBC939,and investigate the relationship of autophagy,aging,and apoptosis,and the underlying possible mechanisms.Methods Fluorouracil(25 to 200 μg / mL),mitomycin(0.25 to 2.0 μg / mL) and their corresponding final concentration of the mixed solution were respectively used to treat QBC939 cells for 0,24 and 48 h,respectively.Cell counting kit-8(CCK-8) assay was employed to measure cell viability and determine the combined chemotherapy drug concentration by detecting of cell proliferation.Cell apoptosis was detected by flow cytometry with Annexin V-FITC staining,aging by SA-β-Gal staining,and autophagy by flow cytometry with monodansylcadaverin(MDC) staining.Above detections on proliferation,aging,apoptosis and autophagy were carried out again by the same methods after the apoptosis and autophagy were blocked by caspase inhibitor Z-VAD-FMK and 3-methyl adenine(3-MA) respectively.Results QBC939 proliferation was significantly inhibited when combination of fluorouracil and mitomycin(with final concentrations of 100 and 1.0 μg / mL respectively) for 24 h,though widespread cell death was not observed.There was significant differences among groups(F = 26.929,P < 0.05),and compared with the control group,the autophagy,aging and apoptosis were changed significantly(P < 0.01).After the treatment of autophagy inhibitor,the level of autophagy was reduced,cell proliferation was inhibited,the amount of senescent cells was decreased,and apoptosis was significantly increased.On the other hand,after the treatment of apoptosis inhibitor,cell apoptosis was suppressed,proliferation was enhanced,cell aging was significantly increased,but no significant change was found in autophagy.Conclusion Combination treatment of fluorouracil and mitomycin significantly not only reduces cell proliferation but also induces apoptosis in cholangiocarcinoma cells.These changes were related with autophagy in cholangiocarcinoma cells after chemotherapy.Autophagy might be a mechanism for QBC939 cells to avoid adverse environment.

Objective To investigate the perfusion-weighted MR imaging(PWI)and diffusion-weighed MR imaging(DWI)features of acute cerebral ischemic as well as its histopathology.Methods Seventy Wistar rats were divided into 7 groups randomly,including control group(A)and occluded and reperfusion groups.The occluded groups were studied after the right middle cerebral artery of the rats unilaterally occluded(MCAO)at an interval of 30 min(B),60 min(C),after that,the reperfusion operated at an interval of 30 min(B1,C1),60 min(B2,C2),respectively(n=10 for each group).Then all rats were imaged with MRI.The relative areas of the abnormal signal(rSD、rSP),the relative apparent diffusion coefficient(rADC),the relative mean transit time(rMTT)were calculated.The cerebral ischemic tissue were examined with histology.Results There was no changes of the signal intensity on T1WI and T2WI in all groups.In group A,DWI and PWI showed no change in the signal intensity,too.Hyper-intensity was found in the cerebral ischemic areas of groups B,C,B1,B2,C1 and C2.The size of the hyper-intensity signal(rSD)in DWI along with the extension of occlusion time(B and C).Meanwhile,it reduced along with the time of reperfusion(B1,B2 and C2).On PWI,significant hypo-perfusion of right basal ganglia was shown in groups B and C.Otherwise,significant hyper-perfusion of right basal ganglia was shown in groups B1 and C2.There was no change of signal ingroup B2,slightly hypo-perfusion of right basal ganglia was shown in group C1.Tissues which hyper-intensity mismatch region between on DWI and MTT/DWI all shown slight swelling of cel organ in neurons,indicating the existence of ischemic penumbra zone.The vasogenic brain edema was observed in groups B1 and C1.No histopathological change was found in groups B2 and C2.Conclusion The results imply that the intracelluar brain edema is one of the important pathological characteristics of the ischemic penumbra.The hyper-intensity signal on DWI in the hyperacute stroke includes the ischemic penumbra.Vasogenic brain edema is exhibited in the early stage of reperfusion.The more early of reperfusion,the better of recovery of the shape of neurons.