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Influence of Intensive Insulin Therapy on Vascular Endothelial Growth Factor in Patients with severe trauma

Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第1期33卷 107-110页

作者：赵晓东秦宇红马俊勋党伟王曼张宪刘红升张建波姚咏明张连阳苏琴 Emergency Department the First Affiliated Hospital of PLA General Hospital Institute of Field Surgery Research Daping HospitalThird Military Medical University

The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication were investigated. Sixty-four cases of severe trauma （injury severity score 〉20） with stress hyperglycemia （blood glucose 〉9 mmol/L） were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient grada- tion one-step process were used to determine plasma VEGF, endothelin-1 （ET-1）, and the number of circulating endothelial cells （CECs） at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF （ng/L）, 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P〈0.05, 0.01, 0.05, 0.05 respectively; for ET-1 （ng/L）, 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P〈0.05, 0.01, 0.01, 0.01 respectively; for CRP （mg/L）, 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P〈0.05; for CECs （/0.9 μL）, 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P〈0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.

关键词： intensive insulin therapy severe trauma vascular endothelial growth factor endothelin-1 endothelial cell

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Evaluation of the Whole Body Scanner in the Management of severe traumas at Armentieres Hospital Centre (France): Scanographic and Clinical Correlation about 180 Cases

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Open Journal of Radiology 2016年第3期6卷 220-228页

作者： Sessi Miralda Kiki Hermione Patricia Yekpe Ahouansou Djivèdé Akanni Chakib Aiouaz Olivier Biaou Rabiou Cisse Radiology Department of Armentieres Hospital Centre Armentieres France Radiology Department of the National Hospital University Centre Hubert Koutoukou MAGA Cotonou Benin Radiology Department of the Hospital University Centre Yalgado OUEDRAOGO Ouagadougou Burkina-Faso

Goal: This study aims to evaluate the contribution of the whole body scanner in the management of severe traumas. Patient and Method: It is a retrospective analytical study, carried out at the Armentieres Hospital Centre (France) over a period of 14 months. It analyzes computed tomography reports and emergency department results of severe trauma patients immediately stabled at the entrance or stabilized after benefiting from a full body scanner according to Vittel criteria. Results: One hundred eighty patients were included in the study with an average age of 32.71 years old. One hundred and twelve patients (62.2%) had at least one clinical sign and only 48 patients presented a lesion on the computed tomography (26.7%). Sixty-two patients (34.4%) showed neither clinical signs nor damage in scan. The radio-clinical correlation was bad at spinal and abdominal level, mediocre at brain and chest level, but it was medium in the pelvis. The average radiation dose per patient was 3319.21 mGy⋅cm. Conclusion: The whole body computed tomography or scanning allows fast images acquisition compatible with emergency situation and with a satisfactory diagnostic reliability, but still remains an irradiating exam. The results of this study lead to reflect on the use of Vittel criteria that could be improved to reduce the number of normal tests carried out.

关键词： severe trauma Whole Body Computed Tomography or Scanner Vittel Criteria Radio-Clinical Correlation

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Incidence investigation and analysis of hepatic stress injury after trauma

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胃肠病学和肝病学杂志 2012年第7期21卷 661-663页

作者： WANG Quanchu ZHANG Yafei CHENG Zhengxiang Department of Infectious Diseases 153th Hospital of PLAZhengzhou 450042China

Objective To investigate the etiology and pathogenesis of hepatic stress injury after *** 4 677 patients with severe trauma in 153th Hospital of PLA from Jan.2004 to Jul.2005 were enrolled in this study to investigate the incidence of hepatic stress injury,and furthermore,in combination with medical information,the possible pathogenesis was *** The main manifestation of hepatic stress injury was the elevated ALT or AST levels(387 cases,8.3%).The incidence of hepatic stress injury after hand injury,burn injury,head injury,bone injury,abdominal injury,and thoracic injury were 16.6%,6.9%,5.6%,5.0%,3.8% and 2.0%,respectively,and among which,the incidence of hepatic stress injury after hand injury was statistically highest(Ptrauma was 8.3%.Intestinal endotoxemia might be one of the beginning components of hepatic stress injury after trauma.

关键词： severe trauma Hepatic stress injury Pathogenesis

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trauma care construction under the guidance of county-level trauma centers

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Chinese Journal of traumatology 2018年第5期21卷 256-260页

作者： Pei-Yang Hu Xin-Yi Chen Xiong-Huan Chen Yi-Min Chen trauma Center Tiantai People's Hospital of Zhejiang Province Taizhou 317200 Zhejiang Province China

severe trauma has the characteristics of complicated condition, multiple organs involved, limitq auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to prima hospitals to receive treatments. But the traditional mode of separate discipline management can easi lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mc tality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospit~ （usually the top general hospital within the administrative region of a county）, can establish a sc entific and comprehensive trauma care system, the success rate of trauma rescue in this region can ] greatly improved. On March 1st, 2013, Tiantai People＇s Hospital of Zhejiang Province, China set up trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedur~ and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patier （injury severity score 〉16） have been treated in this trauma center. The rescue success rate reach~ 95~ and the delayed and]or missed diagnosis rate was less than 5%. Totally 86 severe cases of peK fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospil emergency rescue response time is less than 3 min, and the time from definite diagnosis to surge is within 35 min.

关键词： severe trauma Integrated emergency management system County-level hospital

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