The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potentia...The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potential for large volume shifts and hypotension may pose a risk in patients with traumatic brain injury. An alternative therapy to hemodialysis is continuous renal replacement therapy, which has slower clearance rates than hemodialysis, but has decreased adverse effects in cases of traumatic brain injury. However, there are few published reports of clearance rates of salicylates using continuous renal replacement therapy. We report a case of multisystem trauma with concomitant intentional salicylate overdose in which continuous renal replacement therapy was employed. The salicylate clearance rate that was obtained in this case was 7.5 mL/minute using continuous veno-venous hemodiafiltration, a form of continuous renal replacement therapy.展开更多
目的评估在严重创伤急救中应用综合创伤一体化急救模式的临床效果。方法回顾性分析2022年5月-2024年5月在广东省中西医结合医院急诊科就诊的104例严重创伤患者,按照实施综合创伤一体化急救模式的时间节点,将患者分为实施前组和实施后组...目的评估在严重创伤急救中应用综合创伤一体化急救模式的临床效果。方法回顾性分析2022年5月-2024年5月在广东省中西医结合医院急诊科就诊的104例严重创伤患者,按照实施综合创伤一体化急救模式的时间节点,将患者分为实施前组和实施后组,每组各52例。实施前组采用常规治疗模式,实施后组采用综合创伤一体化急救模式。分别比较综合创伤一体化急救模式实施前后患者在抢救成功率、抢救时间、各种并发症的发生率、血清炎症因子的表达等方面的差异。结果综合创伤一体化急救模式实施后患者抢救成功率高于实施前(χ^(2)=15.145,P<0.05),抢救时间(t=3.879,P<0.05)、辅助检查时间(t=2.252,P<0.05)和急诊接诊到手术时间(t=2.807,P<0.05)均缩短,总并发症发生率(χ^(2)=15.592,P<0.05),包括感染(χ^(2)=4.300,P=0.038)、失血性休克(χ^(2)=6.190,P=0.013)、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)(χ^(2)=0.153,P=0.696)发生率均低于综合创伤一体化急救模式实施前。该模式实施后,患者各种炎症因子如C反应蛋白(C-reactire protein,CRP)、降钙素原(procalcitonin,PCT)的水平在治疗后明显下降(P<0.05)。结论综合创伤一体化急救模式在严重创伤的急救中疗效显著,能够提高患者的抢救成功率,节约抢救时间,降低并发症的发生率,值得在临床急救中推广应用。展开更多
文摘The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potential for large volume shifts and hypotension may pose a risk in patients with traumatic brain injury. An alternative therapy to hemodialysis is continuous renal replacement therapy, which has slower clearance rates than hemodialysis, but has decreased adverse effects in cases of traumatic brain injury. However, there are few published reports of clearance rates of salicylates using continuous renal replacement therapy. We report a case of multisystem trauma with concomitant intentional salicylate overdose in which continuous renal replacement therapy was employed. The salicylate clearance rate that was obtained in this case was 7.5 mL/minute using continuous veno-venous hemodiafiltration, a form of continuous renal replacement therapy.
文摘目的评估在严重创伤急救中应用综合创伤一体化急救模式的临床效果。方法回顾性分析2022年5月-2024年5月在广东省中西医结合医院急诊科就诊的104例严重创伤患者,按照实施综合创伤一体化急救模式的时间节点,将患者分为实施前组和实施后组,每组各52例。实施前组采用常规治疗模式,实施后组采用综合创伤一体化急救模式。分别比较综合创伤一体化急救模式实施前后患者在抢救成功率、抢救时间、各种并发症的发生率、血清炎症因子的表达等方面的差异。结果综合创伤一体化急救模式实施后患者抢救成功率高于实施前(χ^(2)=15.145,P<0.05),抢救时间(t=3.879,P<0.05)、辅助检查时间(t=2.252,P<0.05)和急诊接诊到手术时间(t=2.807,P<0.05)均缩短,总并发症发生率(χ^(2)=15.592,P<0.05),包括感染(χ^(2)=4.300,P=0.038)、失血性休克(χ^(2)=6.190,P=0.013)、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)(χ^(2)=0.153,P=0.696)发生率均低于综合创伤一体化急救模式实施前。该模式实施后,患者各种炎症因子如C反应蛋白(C-reactire protein,CRP)、降钙素原(procalcitonin,PCT)的水平在治疗后明显下降(P<0.05)。结论综合创伤一体化急救模式在严重创伤的急救中疗效显著,能够提高患者的抢救成功率,节约抢救时间,降低并发症的发生率,值得在临床急救中推广应用。
