创伤与战伤Trauma And War Ijury 外科学总论课件.pptVIP

Risk factors Traffic Accident Natural disaster Explosion 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 First aid 3. Functional change of vital organ Heart: Catecholamine increases heart rate. Anoxia, acidosis→ the injuries of cardiac muscle. Lungs: The ventilation-perfusion imbalance→ ARDS. Kidneys: Renal failure, oliguria (400 ml/d), anuria (100 ml/d) . Brain: Edema, The encephalic pressure increases. Gastrointestine: the intestinal mucosa barrier was damaged →shift of bacteria and toxin → MODS. Liver: The endotoxicemia→ metabolic disturbance and acidosis aggravated. Chapter 3 Repair of injured tissue Trauma directly stimulates local tissue and triggers a cascade of tissue repair process which includes: A. Inflammation. B. Proliferation and differentiation of many types of cell—granulation formation. C. Wounds healing and car formation. The concept of inflammation Inflammation can be defined as a localized protective tissue response elicited by injury or destruction of tissues, which serves to destroy, dilute or wall off both the injurious agent and the injured tissues. The inflammation is often characterized by injured tissue showing redness, swelling, heat, pain and loss of function. New Tissue Formation (granulation) Following the inflammation -- proliferation and migration of cells at the wound site. This dense population of macrophages, fibroblasts and endothelial cells, etc., embedded in a loose matrix. Granulation formation – fill the gap of injured tissue before their coverage by epidermal cells. Matrix Formation and Remodeling Remodeling of the immature tissue matrix commences simultaneously with granulation tissue formation. For clarity, however, it is normally regarded as forming the third and fi