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1、创 伤 trauma,医院外科,1,Trauma： Trauma is defined as the damage caused by mechanical injurious agents, with the disturbance of tissue continuity and function.,Vessel,Skin,injurious factors,Classification,1 According to the integrity of skin：,Damaged- open wounds（开放性创伤） Intact-closed wounds (闭合性创伤),open wo
2、unds,Penetrating wound(穿入伤) Perforating wound(穿透伤) Non-penetrating wound(非穿入伤),several familiar open wounds,Abrasion(擦伤),Puncture(刺伤),several familiar open wounds,Incision or cut wound (切伤和砍伤),Laceration(撕裂伤),Closed wounds,Contusion (挫伤) Crush injury (挤压伤) Sprain (扭伤) Concussion (震荡伤) Luxation and s
3、emi-luxation (脱位和半脱位) Closed bone fracture (闭合性骨折) Closed internal injury (闭合性内伤),fracture,2 According to positions,Craniocerebral injury (颅脑伤) Maxillofacial and cervical injury (颌面颈部伤) Chest injury (胸部伤) Abdomen injury (腹部伤) Pelvis injury (骨盆部伤) Spine and spinal cord injury (脊柱脊髓伤) Upper extremity
4、injury (上肢伤) Lower extremity injury (下肢伤) Multiple injury (多发伤),epidural hematoma,Craniocerebral trauma,3 According to injurious factors,Cold weapon wounds (冷兵器伤) Firearm wounds (火器伤) Burns (烧伤) Cold injury (冷伤) Blast injury (冲击伤) Chemical injury (化学伤) Radiation injury (放射伤) Combined injury (复合伤),bu
5、rns,Cold injury,Trauma Pathology,trauma,damage of the tissue structure hemorrhage inactivation of cell local: inflammation, cellular proliferation systemic changes: blood film, body temperature, function of important organs,1 Inflammatory reaction,Local：hyperemia, edema, exudation (redness, swelling
6、, heat, pain) Benefit: 1.Proliferative cells fill the deficit, faciliting the wound healing. 2. It clears the bacteria, tissue fragment and foreign body can promote the healing procedure. Harm: Severe inflammatory reaction results in delayed healing and disturbance of circulation. Excessive exudatio
7、n causes the insufficience of blood volume.,brady-kinin,comple-ments,Histamine,interferon,TNF,PAF,Release of various inflammatory mediators and cytokines,product of damaged tissue and bacterial toxin,Pathology 2 Systemic reaction,1） body temperature： inflammatory mediators, infections heat center bo
8、dy temperature: rise or descend,Pathology 2 Systemic reaction 1）Body temperature,2）Neuroendocrine pains, stress, lose blood and water Hypothalamus -ACTH，ADH，GH Pituitary gland Synpathetic Nerves -renin，nonadrenaline，aldosterone Adrenal gland,heart rate arises, vasoconstriction, urine volumes decreas
9、e,Pathology 2 Systemic reaction 1）Body temperature reaction 2）Neuro-endocrine reaction,3）Changes of catabolism decomposition of protein and adipose increase catecholamine, corticosteroids, glucagon, TNFs, ILs increase,energy, protein,weight loss, myathenia,catabolism accentuation,（肌无力）,儿茶酚胺 皮质激素 胰高糖
10、素,Pathology 2 Systemic reaction 1）body temperature 2）neuro-endocrine reactions 3）changes of metabolism,4）changes of immune system endogenous corticosteroids decrease the functions of Neutrophils and Phagocyte Catecholamine （儿茶酚胺） PGE2 （前列腺素）,immune suppression,Pathology 1 Inflammatory reactions 2 Sy
11、stemic reactions 3 Complications of trauma tissue injury, bacteria, immune suppression: Infection blood loss, infection: Shock infection, shock, organ dammage: MODS,repair,The functions of cell in the process of wound healing,Neutrophil (中性粒细胞) Macrophage (巨噬细胞) Platelet（血小板） Lymphocyte (淋巴细胞),Infla
12、mmatory reaction stage: PDGF,TGF-,bFGF, MDGF tissue proliferation stage: IGF-1, bFGF ,TGF-, PDGF scar formation stage: TGF-, PDGF,The functions of growth factor in the process of wound healing,Participate in coagulation process Enhance the function of macrophage Chemotaxis (趋化作用),The functions of fi
13、bronectin (Fn),(纤维连接蛋白),repair,proliferation,mesenchymal tissue fill the deficit,细胞增生,细胞间质充填连接,Process of repair,1）fibrin filling,sealing the wound,（纤维蛋白充填）,Hemostasis（止血）,Process of repair,2）proliferation （细胞增生）,Fibroblast 成纤维细胞,endothelial cells 内皮细胞,neogenetic vessels 新生血管,granuloma,肉芽肿,process o
14、f repair,Collagen （胶原） Amino-polysaccharide （氨基多糖）,基质沉着,fibroblasts, endouthelial cells, epithelial cells, osteoblasts,fibrous tissue（scar）,process of repair,3）tissue plasty,Macrophages（巨噬细胞），platelet（血小板）lymphocytes，various mediators,(early period) hyperplasia synthesis,(late period) decomposition
15、modeling,harmful factors for would healing,1 infection,2 foreign bodies or excessive inactive tissue.,disturbance of circulation (shock, vessel damage, edema, bandaging ),4 lack of local braking,5 systemic factors： 1) dystrophy营养不良：protein，vitamin, trace element 2) the use of corticosteroids，chemotherapy, radiation, etc. 3) immunocompromise：DM，tumor，cirrhosis，AIDS, etc.,Types of wound healing,primary healing：（一期愈合） based on original cells, with a wel
