ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.
Objective To investigate the effects of nitric oxide precursor L-arginine on traumatic pulmonary contusion. Methods Sixty Sprague-Dawley rats were randomly divided into three groups, ie. a normal group, a model group, and a L-arginine group. The model of traumatic pulmonary contusion was established with self-made chest-impacter. Then the rats in the L-arginine group was injected intravenously with L-arginine in a dose of 250 mg/kg. All rats were sacrificed at 24 hours after these models established.Levels of TNF-α and nitric oxide ( NO2 - /NO3- ) in serum were measured by ELISA and diazo-reaction method. Lung wet/dry weight ratio, NF-κB, endothelin-1, apoptotic cell, and ICAM-1 ( intercellular adhesion molecule-1) mRNA expressions in the lung tissue were measured. Results Compared with the model group,TNF-αand lung wet/dry weight ratio decreased significantly in the L-arginine group( P lt; 0. 05) . After the L-arginine treatment, the concentration of nitric oxide, apoptotic index were significantly higher than the model group ( P lt; 0. 05) . The expressions of NF-κB, endothelin-1, and ICAM-1 mRNA in the L-arginine group were lower than those in the model group ( P lt;0. 05) . Conclusion L-arginine treatment can downregulate the expressions of NF-κB, ET-1, ICAM-1 mRNA and apoptosis obviously, and ameliorate the microcirculation of rats lung with traumatic pulmonary contusion.
摘要:目的:总结儿童眼球钝挫伤致前房积血的原因、临床表现以及最佳治疗方法。方法: 回顾分析四川大学华西医院2007年9月~2008年9月收治的眼球钝挫伤致前房积血23例的治疗:(1)半卧位休息;(2)双眼包扎或不包扎;(3)止血;(4)手术治疗。 结果: Ⅰ、Ⅱ级前房积血吸收快,出现继发性出血者常需要采取手术治疗,视功能恢复缓慢。结论: 早期积极恰当治疗,可减少继发性青光眼、角膜血染等并发症。Abstract: Objective: To summarize the reasons of children hyphema caused by blunt, clinical manifestations, as well as the best method of treatment. Methods: analysing the 23 cases history of eye hyphema from September 2007 to September 2008 in West China Hospital of Sichuan University caused by blunt. The treatments were: (1) semisupine rest; (2) eyes bandaged; (3) to use hemostatic medicine; (4) surgery. Results: Hyphema in Ⅰand Ⅱ class could be absorbed fastly.Secondary hemorrhage often need to be taken for surgical treatment, depending on the slow recovery of vision. Conclusion: Early appropriate and positive treatment can reduce secondary glaucoma, corneal complications such as blood.
Pulmonary contusion is frequent and a serious injury in the chest trauma patients in emergency department. And it is easy to induce acute respiratory distress syndrome (ARDS) and respiratory failure. Since the development of modern technology and transportation, flail chest with pulmonary contusion happens more frequently than the past. And its complications and mortality are higher. In order to understand it better and improve the effect of the therapy on flail chest with pulmonary contusion, we reviewed the relative literatures. In this article, the main contents are as followed:① The pathophysiological changes of pulmonary contusion; ② The pathophysiological changes of flail chest with pulmonary contusion; ③ Clinical manifestation of flail chest with pulmonary contusion; ④ Imaging change of flail chest with pulmonary contusion; ⑤ progress in diagnosis and treatment.