创伤与 及战伤Trauma And War Injury 外科学总论课件.ppt

Dr. Zhendong Liu The Third Xiangya Hospital;Risk factors ;Traffic Accident;Industrial injury;;DEFINITION;Chapter 1 Classification of the Trauma;1. For the integrity of skin;2). The blunt injury : Contusion （挫伤） Crush injury（挤压伤） Sprain（扭伤） Concussion （震荡伤） Luxation and semiluxation （关节脱位/半脱位） Closed bone fracture （闭合性骨折） Closed internal injury （闭合性内脏伤）;2. For injured place and organ;3. Wound causing factors ;Opened injury;Opened fracture;;;Chapter 2 Pathophysiology of trauma; Trauma can trigger a cascade of pathological response which includes inflammatory/immune reaction, neuroendocrine response and functional change of vital organ.;1.The inflammatory/immune reaction ; ;Schematic representation of the interactions between the stress and the immune system. LC/NE: locus ceruleus/norepinephrine-sympathetic system, SPGN: sympathetic postgaglionic neurons, CRH: corticotropin-releasing hormone, AVP: arginine vasopressin, ACTH: corticotrophin, PAF: platelet activating factor, NE/E: norepinephrine/epinephrine,: Th1: T-helper lymphocyte 1, Th2: T-helper lymphocyte 2. Stimulation is represented by solid green lines and inhibition by dashed red lines. ;1. Sympathetic / adrenocortex system 2. Hypothalamus / pituitary system 3. Renin-angiotension system;The purpose of the physical reaction is to maintain the circulation of the blood and tissue perfusion ;;2.SNS - Hormonal: Adrenal Cortex Anterior pituitary releases adrenocorticotropic hormone (ACTH). Stimulates adrenal Cx to release glucorticoids. Blood sugar increases to meet increased metabolic needs. ; 3.SNS - Hormonal: Antidiuretic Hormone Osmoreceptors in hypothalamus stimulated ADH released by Posterior pituitary gland Vasopressor effect to increase BP Acts on renal tubules to retain water;4.SNS - Hormonal: Renin-angiotension system Decrease renal perfusion Releases renin angiotension I angiotension II potent vasoconstriction releases aldosterone adrenal