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.
Objective To find out about the characteristics and prognosis of retinal detachment due to ocular contusion.Methods The clinical data of 36 patients(36 eyes)with retinal detachment due to ocular contusion were retrospectively analyzed.Results There were 3 eyes(8．3％)with huge retinal hole(≥90°)，4 eyes(11．1％)oral tear of ora serrata retinae，4 eyes(11．1％)with macular hole，3 eyes(8.3％)with tractive retinal detachment，and 22 eyes(61．2％)with retinal hole(lt;90°)at other positions(including temporal peripheral hole in 9，nasal peripheral hole in 5，and posterior polar hole in 8).Proliferative vitreoretinopathy(PVR)was found in a11 patients withConclusions Retinal detachment due to ocular contusion often go with PVR．The interval from contusion to retinal detachment varies from days to months.Visual prognosis can be good when retinal detachment is diagnosed and treated in time． (Chin J Ocul Fundus Dis，2004，20：1-66)
Abstract： As the most common blunt thoracic injury, lung contusion may develop into acute lung injury, adult respiratory distress syndrome or ventilation associated pneumonia, which can cause a high mortality. However, the pathogenesis and pathophysiology of lung contusion is not well understood yet. Stress is laid by many researchers on inflammatory response in the pathogenesis of lung contusion. We review the potential role of inflammatory response in the pathogenesis and pathophysiological changes of lung contusion. Emphasis is put on studies of inflammatory cells, mediators, receptors, surfactant dysfunction, and the potential role of epithelial cell or neutrophil apoptosis. The animal models are essential to the study of lung contusion and the studies examining secondary injuries exacerbating lung contusion are also noted.
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.
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.
ObjectiveTo explore the correlation between the degree of bone marrow edema (BME) and the content change of tumor necrosis factor α (TNF-α) and matrix metalloproteinase 3 (MMP-3) and the knee pain symptoms in patients with bone contusion around the knee joint. MethodsThirty patients (30 knees) of bone contusion around the knee joint were chosen as the trial group between October 2009 and April 2012. According to visual analogue scale (VAS), 30 patients were divided into mild group (10 cases), moderate group (10 cases), and severe group (10 cases); according to MRI morphological changes, the patients were divided into type I group (12 cases), type Ⅱ group (11 cases), and type Ⅲ group (7 cases). Ten patients (10 knees) with soft tissue injury of the knee were chosen as control group. No significant difference was found (P>0.05) in gender, age, causes, side, and admission time after injury between 2 groups. The serum contents of MMP-3 and TNF-α were detected and statistically analysed between different degrees of pain groups and between different degrees of BME groups. Correlation was analysed between BME and inflammatory factor changes and VAS score. ResultsThe MMP-3 and TNF-α contents in trial group[(29.580±6.870) μg/L and (23.750±7.096) ng/L] were significantly higher than those in control group[(8.219±1.355) μg/L and (6.485±1.168) ng/L](t=9.686, P=0.000; t=7.596, P=0.000). The MMP-3 and TNF-α contents in patients with different degrees of pain and BME were significantly higher than those in patients of control group (P<0.05), and significant difference was found between patients with different degrees of pain (P<0.05), but no significant difference between patients with different degrees of BME (P>0.05). Multiple linear regression analysis showed that TNF-α content was significantly correlated with VAS score (P=0.000). ConclusionKnee pain symptoms are not related to the degree of BME in patients with bone contusion around the knee joint. Inflammatory factor TNF-α content is the main influence factor of knee joint pain symptoms.