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Traumatic aortic rupture: Recent outcome with regard to neurologic deficit

ANNALS OF THORACIC SURGERY 1999年第4期67卷 959-964页

作者： Attar, S Cardarelli, MG Downing, SW Rodriguez, A Wallace, DC West, RS McLaughlin, JS Maryland Inst Emergency Med Serv Syst Dept Surg Div Thorac & Cardiovasc Surg Baltimore MD 21201 USA

Background. Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia. Methods. The charts of 263 patients with traumatic aortic rupture from vehicular accidents treated between 1971 and 1998 were reviewed. Patients were grouped according to four periods: group 1, 1971 to 1975, (n = 31);group 2, 1976 to 1985, (n = 83);group 3, 1986 to 1994, (n = 82);and group 4, 1994 to 1998 (n = 67). Seventy-one patients died of exsanguination before definitive care. One hundred-ninety two patients had surgical repair with the following techniques: clamp and sew, 6 in group 1, 22 in group 2, 54 in group 3, none in group 4;shunt, 23 in group 1, 39 in group 2, 2 in group 3;cardiopulmonary bypass, 2 in group 1, 1 in group 3. Forty-three patients had partial bypass with the centrifugal pump and heparin-coated circuits in group 4. Results. Operative mortality was 6 of 31 (19%) in group 1, 22 of 61 (36%) in group 2, 15 of 57 (26%) in group 3, and 7 of 43 (16%) in group 4. There was one case of paraplegia in group 1 (4%), ten in group 2 (18%), 11 in group 3 (26%), and none in group 4. This difference of paraplegia between the groups was significant (p < 0.002). Significant factors for paraplegia were intraoperative hypotension (p < 0.000002), cross-clamp time longer than 30 minutes (p < 0.008), pump versus no pump (p < 0.008), and younger age group (28 +/- 11 versus 39 +/- 17 years) (p < 0.03). Conclusions. There were no statistically significant improvements in mortality rate over the four periods, although, the mortality rate was lowest in the last period when partial bypass with the centrifugal pump was used exclusively. Further, the use of the centrifugal pump with heparin-coated circuits, with femoral vein cannulation into the right atrium and distal aortic perfusion, reduced paraplegia significantly. (Ann Thorac Surg 1999;67:959-65) (C) 1999 by The Society of Thoracic Surgeons.

关键词：事故交通主动脉胸/损伤主动脉破裂/并发症主动脉破裂/病因学主动脉破裂/死亡率主动脉破裂/外科学心肺转流术体外循环出血/死亡率截瘫/病因学创伤非贯通性人类

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MATERNAL DEATHS IN CALIFORNIA FROM 1967 TO 1971 - DEMONSTRATION OF NEED FOR MORTALITY REVIEW

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1976年第3期125卷 393-401页

作者： COPPES, JB MESSER, RH UNIV NEW MEXICO DEPT OBSTET & GYNECOLALBUQUERQUENM 87131

An evaluation of maternal mortality statistics in California from 1967–1971 has been performed. There has been a fall in the maternal mortality rate following the institution of a therapeutic abortion act. However, analysis of the data reveals that there was an increase in the deaths due to hemorrhage and sepsis. At this same time the maternal mortality study committee was discontinued. It is strongly felt that the data demonstrate the need for a continuing review of maternal deaths. A proposal is made to redesign the maternal mortality study committee so that it can fully meet the needs of the medical profession and the patient.

关键词：流产合法流产治疗性加利福尼亚出血/死亡率产妇死亡率医学审核先兆子痫/死亡率女(雌)性人类妊娠

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Reduction in the need for hospitalization for recurrent ischemic events and bleeding with clopidogrel instead of aspirin

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AMERICAN HEART JOURNAL 2000年第1期140卷 67-73页

作者： Bhatt, DL Hirsch, AT Ringleb, PA Hacke, W Topol, EJ Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA Univ Minnesota Sch Med Vasc Med Program Minneapolis MN 55455 USA Heidelberg Univ Sch Med Dept Neurol Heidelberg Germany

Background Repeat hospitalizations of patients with atherosclerosis represent a considerable burden on the health care system. We sought to determine whether clopidogrel compared with aspirin decreases the need for rehospitalization for ischemia and bleeding. Methods and Results The Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial was a randomized, blinded, multicenter, trial of 19,185 patients with atherosclerotic disease manifested as recent ischemic stroke or myocardial infarction or symptomatic peripheral arterial disease. Without any double-counting of events, the number of rehospitalizations for ischemic events (defined as angina, transient ischemic attack, or limb ischemia) or bleeding events was determined for the entire cohort. There was a significant reduction in the total number of rehospitalizations for ischemic events or bleeding with clopidogrel use compared with aspirin (1502 vs 1673;P = .010) over an average of 1.6 years of treatment. This reduction in rehospitalization was consistent across individual outcomes of angina, transient ischemic attack, limb ischemia, and bleeding. Compared with aspirin, clopidogrel also resulted in a 7.9% relative risk reduction in a combined end point of vascular death, stroke, myocardial infarction, or rehospitalization for ischemic events or bleeding (15.1% to 13.7% at 1 year;P = .011). Adjusting for baseline prognostic variables, clopidogrel therapy was an independent predictor for reduction of vascular death, stroke, myocardial infarction, or rehospitalization for ischemic events or bleeding (P = .009). Conclusions Treatment with clopidogrel results in a significant decrease in the need for rehospitalization for ischemic events or bleeding compared with aspirin. This meaningful end point tracks well with other, more traditional measures of outcome and has incremental value beyond such end points.

关键词：阿司匹林/投药和剂量脑缺血/药物疗法脑缺血/病因学脑缺血/死亡率死亡原因置信区间双盲法出血/药物疗法出血/死亡率住院/统计学和数值数据发病率缺血/药物疗法缺血/病因学缺血/死亡率多元分析心肌梗死/并发症心肌梗死/药物疗法心肌梗死/死亡率外周血管疾病/并发症外周血管疾病/药物疗法外周血管疾病/死亡率血小板聚集抑制剂/投药和剂量概率预后比例危险度模型复发/预防和控制危险性评估存活率分析噻氯匹定/投药和剂量噻氯匹定/类似物和衍生物女(雌)性人类男(雄)性中年人

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Acute lung injury in leptospirosis: Clinical and laboratory features, outcome, and factors associated with mortality

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CLINICAL INFECTIOUS DISEASES 1999年第6期29卷 1561-1563页

作者： Marotto, PCF Nascimento, CMR Eluf-Neto, J Marotto, MS Andrade, L Sztajnbok, J Seguro, AC Univ Sao Paulo Fac Med Inst Infectol Emilio Ribas Intens Care Unit BR-01246903 Sao Paulo Brazil Univ Sao Paulo Fac Med Dept Prevent Med BR-01246903 Sao Paulo Brazil Univ Sao Paulo Fac Med Lab Invest Med BR-01246903 Sao Paulo Brazil

Forty-two consecutive patients with leptospirosis and acute lung injury who were mechanically ventilated were analyzed in a prospective cohort study. Nineteen patients (45%) survived, and 23 (55%) died. Multivariate analysis revealed that 3 variables were independently associated with mortality: hemodynamic disturbance (odds ratio [OR], 6.0;95% confidence interval [CI], 0.9-38.8;P=.047), serum creatinine level >265.2 mu mol/L (OR, 10.6;95% CI, 0.9-123.7;P = .026), and serum potassium level >4.0 mmol/L (OR, 19.9;95% CI, 1.2-342.8;P=.009). These observations can be used to identify factors associated with mortality early in the course of severe respiratory failure in leptospirosis.

关键词：急性病队列研究肌酸酐/血液随访研究出血/病因学出血/死亡率出血/治疗钩端螺旋体属/分离和提纯钩端螺旋体病/并发症钩端螺旋体病/微生物学肺/病理学肺疾病/血液肺疾病/病因学肺疾病/治疗多元分析钾/血液前瞻性研究呼吸人工存活率分析存活率青少年成年人女(雌)性人类男(雄)性中年人

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DEATH DURING OPERATION

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BRITISH JOURNAL OF ANAESTHESIA 1975年第3期47卷 408-411页

作者： WHITBY, JD NEWCASTLE GEN HOSP DEPT ANAESTHESIAWESTGATE RDNEWCASTLE TYNEENGLAND

Although deaths that take place during the course of an operation are now commonly called "Death under the Anaesthetic", they did occur before the advent of anaesthesia and in 1824 Dupuytren listed seven possible causes. Thirty-three reported cases are mentioned and compared with Dupuytren's list. Air embolism was the commonest cause. The last major survey in 1956 suggested that anaesthesia was entirely responsible for about 60% of cases and surgery for 10%.

关键词：麻醉/死亡率栓塞空气/死亡率恐惧普通外科学/历史出血/死亡率疼痛外科手术/死亡率历史 19世纪人类男(雄)性

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Is antenatal care effective in reducing maternal morbidity and mortality?

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HEALTH POLICY AND PLANNING 1996年第1期11卷 1-15页

作者： McDonagh, M SAVE CHILDREN FUND LONDON ENGLAND

Women in developing countries are dying from simple preventable conditions but what impact can the procedures collectively called antenatal care have in reducing maternal mortality and morbidity? More importantly what is antenatal care? This review found that questions have been raised about the impact of antenatal care (specifically on maternal mortality) since its inception in developed countries, and that although the questions continue to be asked there is very little research trying to find answers. Many antenatal procedures are essentially screening tests yet it was found that there were very few results showing sensitivity and specificity, and that they rarely complied with the established criteria for the effectiveness of a screening test. The acknowledged gold standard measurement of effectiveness is the randomized controlled trial, yet the only results available referred to nutritional supplementation. This service of flawed methodology has been exported to developing countries and is being promoted by WHO and other agencies. This paper argues that there is insufficient evidence to reach a firm decision about the effectiveness of antenatal care, yet there is sufficient evidence to cast doubt on the possible effect of antenatal care. Research is urgently required in order to identify those procedures which aught to be included in the antenatal process. In the final analysis the greatest impact will be achieved by developing a domiciliary midwifery service supported by appropriate local efficient obstetric services. That this domiciliary service should provide care for women in pregnancy is not disputed but the specific nature of this care needs considerable clarification.

关键词：细菌感染/流行病学细菌感染/死亡率发展中国家卫生服务研究出血/流行病学出血/死亡率高血压/流行病学高血压/死亡率产妇卫生保健服务/标准年患病率死亡率妊娠并发症心血管/流行病学妊娠并发症心血管/死亡率妊娠并发症感染性/流行病学妊娠并发症感染性/死亡率产前保健/标准危险因素世界卫生组织女(雌)性人类妊娠

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动脉瘤性蛛网膜下隙出血患者的护理进展

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中国实用护理杂志 2008年第29期24卷 75-76页

作者：缪建平徐玲丽浙江大学医学院附属第二医院神经外科

动脉瘤性蛛网膜下隙出血(aneurysmal subarachnoid hemorrhage, aSAH)是神经外科的危重急症之一。aSAH占自发性蛛网膜下隙出血的85%左右,10.0%～12.5%的患者就诊前死亡,约50%的患者死于出血后的第1个月内,存活者中约30%有中、重度残疾... 详细信息

动脉瘤性蛛网膜下隙出血(aneurysmal subarachnoid hemorrhage, aSAH)是神经外科的危重急症之一。aSAH占自发性蛛网膜下隙出血的85%左右,10.0%～12.5%的患者就诊前死亡,约50%的患者死于出血后的第1个月内,存活者中约30%有中、重度残疾。有机会获得治疗的患者又将在治疗过程中面临着动脉瘤再次破裂出血、急性颅内高压、脑血管痉挛、脑积水、电解质紊乱等并发症,本文综合国内外相关文献,将aSAH的护理研究进展进行总结,现报道如下。

关键词：残疾人出血/死亡率存活率动脉瘤护理研究急性病神经外科(学) 蛛网膜下腔人类

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The injured colon: Therapeutic considerations

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The American Journal of Surgery 1975年第2期129卷 187-191页

作者： Kirkpatrick, John R. Rajpal, Swarn G. Detroit Michigan U.S.A.

A prospective randomized study was carried out at the Detroit General Hospital over a two year period to evaluate methods of management in 165 patients with colonic injuries. Results of the study show that primary closure is a safe and reiable method of management when rigid criteria are incorporated in an ongoing protocol. Moreover, the technic of exteriorization is a safe adjunct to management and is recommended in any patient with a colonic injury above 18 cm in which one suture line is required and in which the additional operating time of twenty minutes will not compromise the management of secondary injuries. Patients not fulfilling these criteria should have primary colostomy. These principles make it possible to reduce the need for primary colostomy to approximately 50 per cent in a large ongoing group of patients with colonic injury.

关键词：腹部损伤/并发症腹部损伤/死亡率腹部损伤/外科学脓肿/病因学动静脉瘘/病因学中枢神经系统/损伤结肠/损伤结肠造口术心脏停搏/死亡率出血/死亡率肠梗阻/病因学方法胰腺瘘/病因学消化性溃疡穿孔/病因学气胸/病因学前瞻性研究呼吸功能不全/病因学外科伤口裂开时间因素伤口感染/死亡率创伤枪击/并发症创伤枪击/死亡率创伤枪击/外科学青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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气管套管致大出血死亡一例报告

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中华结核和呼吸杂志 1989年第3期12卷 170页

作者：薛中杰陕西韩城矿务局总医院

张××,男,19岁。住院号28688。患者自1985年11月28日突然发热、头及腰背疼痛,继而由下肢瘫痪向上漫延到躯体及上肢,并排尿困难,呼吸费力。12月3日在当地医院行脑脊液化验:外观清亮,压力1.48 kPa（145mmH2O）,白细胞5个,蛋白（+... 详细信息

张××,男,19岁。住院号28688。患者自1985年11月28日突然发热、头及腰背疼痛,继而由下肢瘫痪向上漫延到躯体及上肢,并排尿困难,呼吸费力。12月3日在当地医院行脑脊液化验:外观清亮,压力1.48 kPa（145mmH2O）,白细胞5个,蛋白（++）,氯

关键词：病例报告插管法气管内/副作用出血/病因学出血/死亡率人类

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Clinical challenges of platelet glycoprotein IIb/IIIa receptor inhibitor therapy: Bleeding, reversal, thrombocytopenia, and retreatment

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AMERICAN HEART JOURNAL 2000年第2期139卷 S38-S45页

作者： Tcheng, JE Duke Clin Res Inst Durham NC USA

Randomized clinical trials of glycoprotein IIb/IIIa integrin inhibition during percutaneous coronary intervention and as adjunctive treatment of acute coronary syndromes have shown impressive clinical efficacy in reducing the morbidity and mortality rates of cardiovascular disease. Three agents are currently available in the United States: abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat). Pharmacodynamic studies show that abciximab is a high-affinity agent with a low dissociation constant;eptifibatide and tirofiban are high-specificity agents with higher dissociation constants and concentration-dependent antiplatelet effects. This article first reviews the relevant pharmacokinetic and pharmacodynamic properties of each of the agents. These principles ore then applied to a discussion of the 4 primary clinical issues concerning their use: prevention of untoward bleeding, algorithms for acute reversal, recognition and treatment of thrombocytopenia, and the issue of readministration.

关键词：出血/化学诱导出血/死亡率出血/预防和控制心肌缺血/血液心肌缺血/药物疗法血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂复发危险因素存活率血小板减少/化学诱导血小板减少/死亡率血小板减少/预防和控制酪氨酸/类似物和衍生物人类

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