Objective To testify the efficacy of revised trauma score （RTS） in evaluating the severity of trunk injury，analyze its inadequacy and make modifications to improve its specificity and accuracy in evaluating trunk injury. Methods Medical records of 278 patients undergoing emergency surgery for the treatment of trunk injury in West China Hospital of Sichuan University between January 2006 and June 2012 were retrospectively analyzed. There were 231 males and 47 females in the age of 1-75 （33.7±14.1） years. RTS was calculated for each patient. Hemoglobin （Hb） concentrations in these patients acquired at the emergency room were included to reflect the severity of blood loss. The correlations between RTS and patient response to treatment as well as RTS and prognosis were analyzed. Patient response to treatment and prognosis were compared between the normal RTS group and the abnormal RTS group. Univariate analysis was performed followed by multivariate analysis for the variables which may impact prognosis. Modified RTS was established by regression analysis. Results RTS was significantly correlated with patient response to treatment as well as prognosis. RTS was significantly correlated with the time duration between the onset of injury and the beginning of operation （r =0.249，P＜0.001）， thoracic and abdominal blood loss volume （r = -0.255，P＜0.001），fluid resuscitation volume （r = -0.244，P＜0.001） as well as length of ICU stay （r = -0.202，P=0.001）. Mortalities in patients with different RTS were statistically different （P=0.004）. In the patient group with normal RTS the mortality was 5.1%，which indicates the inadequacy of RTS in evaluating trunk injury. Univariate analysis revealed that both emergency room Hb and RTS were correlated with patients’ prognosis. After putting these two factors into the regression analysis，a new formula to calculate modified RTS is established：Logit （P death）=6.450-0.769×RTS-0.029×Emergency room Hb. Conclusion Modified RTS is more specific in evaluating trunk injury and maintains the advantages of simplicity and rapidness.
目的 观察和评价采用偏心型封堵器导管介入治疗干下型室间隔缺损的近期疗效和安全性。 方法 2011年8月－12月，6例经无主动脉瓣脱垂的干下型室间隔缺损（直径≤7 mm）患者（年龄＞3岁）在杂交手术室接受介入治疗。造影评估后，建立动静脉轨道，在保留导丝的情况下置入合适型号的国产偏心型室间隔缺损封堵器，并于术后定期随访复查。 结果 6例患者缺损直径4～7 mm（平均5.3 mm），其中5例成功地接受了导管介入封堵治疗，置入封堵器直径5～9 mm（平均6.4 mm）。仅1例因封堵器置入后出现主动脉瓣受压影响关闭，即改由外科微创经胸封堵成功。所有患者在随访期内，无栓塞、残余分流、瓣膜功能障碍、房室传导阻滞、死亡等并发症。 结论 无主动脉瓣脱垂的干下型室间隔缺损患者接受导管介入封堵治疗是安全、可行的，且短期随访结果良好。