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.
In vivo and in vitro tracer studies, e. g., fundus fluorescein angiography, fluorescein and lanthanum tracer procedures were carried out on mild and severe blunt ocular trauma in rabbits to investigate pathological changes of the blood retinal barrier. Noo difusion of the tracers was found in the retinal after mild blunt trauma. However, severe disorganization of the retinal pigment epithelial cells and breakdown of the outer blood retinal barrier with permeation of tracers in the interphotoreceptor space were evident after severe blunt trauma. These results suggest that contusional retinal edema is mainly due to disruption of cells in the outer retinal layer barrier may, in part, play a role in pathogenesis of the retinal edema. （Chin J Ocul Fundus Dis,1992,8:130-132）
Tweenty-seven cases (27 eyes) of retinal detachment and change of anterior chamber angle induced by contusional eye injuried were reported ,in which there were 23 eyes with obviously visible recession of the chamber angle, and 10 eyes with adherent lesions in the chamber angle, The position of retinal holes and detachment of retina as well as changes of anterior chamber angle in majority of cases located at the sites of trauma or the quadr ants opposite to them. The proportions of retinal detachment due to dialysis of ora sen'am or round retinal holes were found to be high in this series of cases,and the round holes were found in injured eyes with relatively long courses of ocalar trauma. Owing to the close interrelationship between rbegmatogenous retinal detachment and the anterior chamber angle lesions after the eontusional ocular injuries,it was suggested that the chamber angle changes might be used as one of the important referential indicators in diagnosis of traumatic retinal detachment induced by blunt ocular injuries. （Chin J Ocul Fundus Dis,1993,9:74-76）
目的 探讨胸外伤开胸探查的手术指征及救治策略。 方法 回顾性分析我院自 2006 年 1 月至 2014 年 12 月经开胸探查救治 51 例胸外伤患者的临床资料，其中男 43 例、女 8 例，年龄 24（17～75）岁。 结果 全组损伤严重度评分（ISS）平均 19.4 分。闭合性损伤 16 例，开放性损伤 35 例，治愈 45 例（88.24%），死亡 6 例（11.76%）。死亡原因为心脏破裂、失血性休克、感染性休克、多器官功能障碍综合征（MODS）、弥散性血管内凝血（DIC）。 结论 及时就医、快速诊断、准确把握手术指征、多科室联合诊治是救治胸外伤的关键。
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.