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胸腹部器官Ⅲ度以上创伤104例报告

CLINICAL STUDY ON SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN DYSFUNCTION SYNDROME IN ELDERLY PATIENTS WITH SURGICAL ABDOMINAL EMERGENCY

To evaluate the process from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies for elderly patients, we retrospectively studied the clinical data of SIRS and MODS in 292 elderly patients with surgical abdominal emergency. Results: On admission, the morbidity rate of SIRS was 41.1%. Afterwards the morbidity rate of MODS was 14.2%, and the mortality rate of the elderly patients with SIRS was 11.7%. After 48 hours of therapy, MODS was developed in 40.5% of the cases also with SIRS. Of all the 292 elderly patients, 19 cases (6.5%) developed MODS and 16 patients (84.2%) died. Conclusion: The outcome of the patients with surgical abdominal emergency may be improved if SIRS is early diagnosed, the cause of SIRS after 48 hours therapy is well defined and the body inflammatory response is properly regulated.

Surgical First Aid of 200 Cases of Closed Abdominal Injury 〖STBZ〗〖WTBX〗WANG Huihong.

【摘要】 目的 探讨腹部闭合性损伤的外科急救方法。方法 2003年1月—2009年1月收治200例腹部闭合性损伤患者,根据病史、体征、辅助检查等做出诊断后,在确保重要器官血流供应的基础上进行外科手术治疗。结果 治愈187例,治愈率93.5％；死亡13例,9例患者死于多脏器受损引起的出血性休克,2例脾破裂患者因失血过多术中死亡,2例患者因合并颅脑损伤形成脑疝死亡。结论 对于腹部闭合性损伤患者,应快速准确地根据病史、体征、辅助检查等做出诊断,进行积极外科急救治疗。有效控制出血,保证重要器官血液供应,是外科急救能否成功的关键。

Nutritional Support for Functional Delayed Gastric Emptying after Abdominal Operation

【摘要】目的 探讨腹部手术后功能性胃排空障碍的营养支持。方法 对我院1997年1月至2004年2月收治的27例腹部手术后胃排空障碍患者的临床资料进行回顾性分析。结果 单纯肠内营养支持8例（29.6%），肠内、肠外联合营养支持10例（37.0%），单纯肠外营养支持9例（33.3%），分别于术后平均15、20及23 d恢复胃动力。结论 肠内营养在功能性胃排空障碍的治疗中具有重要作用。

Analyzing and Nursing of the Psychological Problems of Patients with Abdominal Injury during the Earthquake

目的:分析汶川8.0级大地震致腹部外伤的患者的心理问题并探索其护理对策。方法:以汶川8.0级大地震致腹部外伤的19名患者为暴露组,普通患者20名和医务人员19名作为对照组。由3名医护人员运用汉密顿抑郁量表进行调查和分析。结果:地震伤员在睡眠质量、精神焦虑、抑郁情绪等3个方面与普通患者及医务人员比较有明显异常。结论:地震致腹部外伤患者的心理影响明显大于普通患者及医务人员,应进行及时有效的心理干预护理,以控制和减缓其心理问题。

Treatment Experience about The Skin-Sparing Mastectomy and Immediate Breast Reconstruction of 10 Cases

Objective　To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods　The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results　There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions　Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.

The Role of Somatostatin in Gastrointestinal Function after Operation for Treatment of Abdominal Injury

ObjectiveTo investigate the role of somatostatin in gastrointestinal function after operation for treatment of abdominal injury patients. MethodsSixty patients with abdominal trauma were divided into somatostatin in treatment group (n=30) and the conventional treatment control group (n=30). The amount of gastrointestinal decompression drainage, bowel sounds recovery time, exhaust time, defecation time, and the levels of serum C reactive protein, TNF-α, IL-6, and IL-8 after operation in two groups were observed. ResultsSomatostatin treatment group recovery time of bowel sounds, exhaust time, and defecation time were earlier than the control group, hospitalization time shortened, and the amount of gastrointestinal decompression drainage reduced (P < 0.05), The levels of serum C reactive protein, TNF-α, IL-6 and IL-8 of somatostatin treatment group were lower than those in control group (P < 0.05), and the magnitude of decline above index in the somatostatin treatment group were greater than that in the control group (P < 0.05). ConclusionSomatostatin can promote the recovery of gastrointestinal function in patients after operation in abdominal injury.

Abdominal Reoperation after Liver Transplantation (Report of 7 Cases)

【摘要】目的探讨肝移植术后再次腹部手术的围手术期处理。方法对7例肝移植术后再次腹部手术患者的资料进行回顾性分析。结果5例择期手术患者围手术期平稳，痊愈出院。2例急诊手术患者中1例术后因并发上消化道应激穿孔、出血和切口感染自动出院。结论肝移植术后再次腹部择期手术的风险较急诊手术者低，与非肝移植行类似手术者相仿。

超声诊断妇科急腹症

【摘要】 目的 总结经腹部B超在妇科急腹症诊断中的应用。方法 回顾分析2007年1月—2009年3月115例妇科急腹症患者的腹部B超检查资料,并将超声结果与最后临床诊断结果进行对比。结果 经腹部超声诊断妇科急腹症的总误诊率7.83%,总符合率为92.17%。结论 腹部超声对妇科急腹症的诊断准确性高,对于超声声像图特征不明显者,应结合患者的病史及实验室检查,可提高诊断准确性。

Analysis on Diagnosis and Treatment about Laparoscopy for Abdominal Trauma and Gastrointestinal Injury

目的探讨腹腔镜在腹部外伤并胃肠道损伤中的诊治作用。 方法对我院2005年1月至2010年6月期间60例行腹腔镜手术治疗的腹部外伤并胃肠道损伤患者的临床资料，以及腹腔镜手术入路及术中处理情况进行回顾性分析。 结果60例患者均经腹腔镜手术证实为胃肠道损伤，根据损伤的具体情况，行完全腹腔镜手术20例、腹腔镜下辅助手术40例，其中行胃肠穿孔修补术45例,肠段切除术15例。 所有患者均顺利完成手术，无术后胃肠道瘘和腹腔出血情况，有2例患者术后出现切口感染，经换药后治愈。 结论 腹腔镜在腹部外伤并胃肠道损伤方面的诊断价值确切，治疗效果满意，避免了不必要的剖腹手术，且创伤小，是一种安全、合理的手术方式。