目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
Objective To retrospectively analyze and classify 23 open fractures that resulted in severe infection, in order to provide evidence that can be used in future disaster scenarios. Methods Based on medical records of 23 cases of open fracture and subsequent bacterial infection, we analyzed the clinical diagnosis, treatment, laboratory tests, bacterial smear of wound secretion, and the bacterial culture of the wound secretion. We then analyzed which antimicrobial agents were used and how they were applied, and the subsequent effect on controlling the serious infection.? Results All cases were related to seismic injury and belonged to class VI open fracture. Eight cases were male and 15 were female. All cases had similar symptoms such as chills, fever, large scale muscle necrosis, and severe infection. A direct smear of the wound showed that the number of cases with one bacterial infection was 6 (26.09%), the number that had double bacterial infections was 12 (52.18%), and the number with multiple bacterial infections was 5 (21.74%).There were 18 strains of 11 types of bacteria recovered from wound samples. Conclusion Early treatment with the joint application of multiple antibacterial agents, early debridement, and adequate drainage all helped to control the infection and avoid nosocomial infection. Employing these strategies in the future will control infection in disaster situations.
Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan-Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.
ObjectiveTo explore the innovative application and effect of lead-type close medical consortium under the epidemic situation of coronavirus disease 2019 (COVID-19).MethodsDuring the epidemic of COVID-19, Jintang First People’s Hospital implemented a series of innovative countermeasures under the guidance of West China Hospital of Sichuan University, the leading hospital of a lead-type close medical consortium. To verify the implementation effect of the countermeasures, the patient satisfaction questionnaire and medical personnel satisfaction questionnaire were administered in confirmed or suspected COVID-19 patients and anti-epidemic healthcare workers. The relevant health economic indicators were extracted through the hospital information system for descriptive analysis.ResultsA total of 16 patients were included, including 10 confirmed patients and 6 suspected patients. The median score of patient satisfaction was 66. All patients were cured and discharged. A total of 56 healthcare workers were included, including 18 doctors and 38 nurses, with a median satisfaction score of 81. The average length of hospital stay of patients was 11.00 d, the average hospitalization cost was 5 117.35 yuan; the average drug cost was 1 099.95 yuan, accounted for 21.49%; the average material cost was 38.63 yuan, accounted for 0.75%.ConclusionsThe innovative application of the lead-type close medical consortium in the treatment of patients with COVID-19 plays an important role in the prevention and control of epidemic, and has achieved remarkable results in patients treatment, patients satisfaction, and hospital management. It is worthy of being widely popularized.
Objective To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.
Objective To review the application and research progress of artificial intelligence (AI) technology in trauma treatment. MethodsThe recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked. Results The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients’ situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment. ConclusionThere is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.
目的 探讨重症急性胰腺炎(SAP)早期治疗模式。方法 分析我院ICU建成前、后收治的SAP病例资料，对比ICU组和非ICU组的住院时间、后期并发症、死亡率、死亡原因等。结果 ICU组抢救成功率明显提高（92.1% vs 54.8%），P＜0.05。结论 以 ICU为中心的综合治疗模式，能提高SAP抢救成功率。
ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P＜0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P＜0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P＜0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.
ObjectiveTo explore fibrinogen (Fbg) variety in the patients wounded in Lushan and Wenchuan earthquake. MethodsAs the research subjects, 276 Lushan earthquake victims (from April 20th to 24th, 2013) and 503 Wenchuan earthquake victims (from May 13th to 17th, 2008) were divided into five groups according to the admission date, and then the Fbg variety in those earthquake victims were analyzed. We carried out pairwise comparison among these groups in the Lushan earthquake and Wenchuan earthquake respectively on the Fbg variety. Ninety-one fracture patients in the Lushsan earthquake and 130 fracture patients in the Wenchuan earthquake were divided into two groups according to clinical diagnosis:multiple fracture and single fracture, and then we evaluated the Fbg values in patients with different degrees of disability. ResultsThe whole Fbg level[(2.70±1.15) g/L] in Lushan earthquake was below the level[(4.47±1.94) g/L] in Wenchuan earthquake, and the difference was statistically significant (P<0.01). The Fbg level in the patients whose admission date was within 48 hours was significantly different with that in patients whose admission date was more than 48 hours (P<0.01). The Fbg level in Lushan earthquake was below the level in Wenchuan earthquake, not only in the multiple fracture group but also in the single fracture group[in Lushan earthquake, the former was (2.21±0.76) g/L, and the latter was (1.98±0.85) g/L; in Wenchuan earthquake, the former was (3.35±1.48) g/L, and the latter was (3.11±1.05) g/L], and the difference was statistically significant (P<0.01). ConclusionBlood coagulation, especially Fbg level, has different degrees of changes in acute stress caused by emergency and in different treatment times, and it is better to take preventive measures.