ICU中心肺复苏结果的五年回顾

目的：了解ICU中心肺复苏病人的复苏成功率,存活率以及基础疾病与复苏成功率之间的关系。方法：对1995年－1999年在我院急救科ICU中经历过心肺复苏（CPR）的病人病史进行回顾性研究。结果：5年中共有153例病人经历过CPR,平均年龄59岁,39例（25．5％）CPR成功,但最终仅有10例（6．5％）存活出院,CPR后存活者与未存活者在年龄和CPR持续时间上有一定差别,在性别和基础疾病上无明显差异,CPR前的基础疾病分别为心脑血管疾病44例（28．8）,感染性疾病26例（17．0％）,胃肠道疾病18例（11．8％）,呼吸系统疾病14例（9．2％）。恶性肿瘤14例（9．2％）等。结论：年龄是影响ICU中心腹复苏成功与否的一项重要因素,心脑血管疾病和感染性疾病是ICU中心跳呼吸停止的主要基础疾病。     

影响心肺复苏预后的相关因素分析

目的探讨影响心肺复苏预后的相关因素，为治疗提供依据。方法回顾分析我院急诊重症监护室2001—01～2005—05心肺复苏患者48例，按复苏成功与否分为复苏失败组（A组）、复苏成功组（B组）和存活出院组（C组）。分析患者年龄、合并疾病、骤停时间、抢救时间、存活时间、Glasgow评分和APACHEⅡ评分。结果与A组比较，B组和C组年龄、骤停时间、抢救时间差异具有显著性（P〈0．05），但两组间差异不明显；与A组和B组比较，C组存活时间、Glasgow评分和APACHEⅡ评分相差非常显著（P〈0．01）。三组患者均合并多种疾病，而以合并心脑血管疾病和呼吸系统疾病为首位。结论年龄是复苏成功的重要因素，合并心脑血管和呼吸系统疾病是心脏骤停高危因素，骤停时间是复苏成功的关键，脑复苏成功是存活出院的最重要因素，APACHEH评分能评估心肺复苏的预后。     

院前心搏骤停患者心肺复苏后自主循环恢复与存活出院的相关影响因素研究

目的:以院前心搏骤停患者为病例对象,观察影响其心肺复苏(CPR)后自主循环恢复与存活出院的相关因素。方法:回顾性分析我院2018-01—2018-12期间行院前CPR的105例心搏骤停患者临床资料,对其进行跟踪随访,观察CPR后自主循环恢复与存活患者的病情特点,用Logistic回归方程计算,分析其相关影响因素。结果:本研究所选105例心搏骤停行CPR患者中,最终死亡78例(74.29%);自主循环恢复出院组与死亡组在基础疾病、心律类型、气管插管、心搏骤停原因、心脏停博耗时、群众性的CPR、院前CPR抢救时间、心肺复苏进行次数、肾上腺素注入剂量、入院至电除颤开始时间等一般资料上出现较大差异,数据对比差异有统计学意义(P0.05);将上述差异有统计学意义的资料代入Logistic回归方程进行计算,发现基础疾病、心律类型、气管插管、心搏骤停原因、心搏骤停耗时、群众性的CPR、院前CPR抢救时间、心肺复苏进行次数、肾上腺素注入剂量、入院至电除颤开始时间是影响心搏骤停患者CPR后自主循环恢复与否的相关因素。结论:影响院前心搏骤停患者心肺复苏后自主循环恢复与存活出院的因素很多,其中复苏前心律,尤其是室颤/室速、急救反应时间和复苏时间长短是影响患者存活的重要因素,而群众CPR与低剂量肾上腺素可能会提高院前CPR出院成功率。     

脑复苏中能量代谢与细胞凋亡

现代心肺复苏(CPR)技术始于20世纪50年代末60年代初,经过50多年的发展,CPR技术水平日臻完善.然而,CPR尤其是脑复苏的现状仍不能令人满意.在CPR后存活的患者中,80%都经历了不同时间的昏迷,其中40%的患者进入了持续植物状态,仅1%～8%的院外心搏骤停患者能够无神经损害出院[1].     

脑复苏中能量代谢与细胞凋亡

现代心肺复苏(CPR)技术始于20世纪50年代末60年代初,经过50多年的发展,CPR技术水平日臻完善.然而,CPR尤其是脑复苏的现状仍不能令人满意.在CPR后存活的患者中,80%都经历了不同时间的昏迷,其中40%的患者进入了持续植物状态,仅1%～8%的院外心搏骤停患者能够无神经损害出院[1].     

急诊重症监护病房心肺复苏成功相关因素分析

目的:探讨急诊重症监护病房(ICU)心肺复苏(CPR)成功相关因素分析。方法:对我院256例接受CPR的患者的临床资料及合并症与心肺复苏成功率进行相关性分析。结果:在急诊ICU心肺复苏成功率46%。年龄、性别及复苏前心脏电生理状况对CPR的成功率无明显影响,合并有呼吸衰竭、肾功能衰竭、弥散性血管内凝血、脑疝的CPR成功率下降。气管插管所需的时间越短,复苏成功率越高。结论:在急诊ICU内CPR的成功与患者原发病及合并症有关;与气管插管时间呈负相关。     

65例心肺复苏病例临床分析

目的：探讨进一步提高急诊心肺复苏（CPR）水平的方法。方法：回顾性分析心跳呼吸骤停患者65例的临床资料。结果：有效共计15例,显效3例,CPR成功率23％。存活出院率为5％。结论：患者年龄、病因、心律失常类型、采取措施、CPR持续时间、成功的电击除颤、建立通畅呼吸道和有效呼吸及血管活性药物的应用、均影响复苏的成功率。     

儿童重症监护病房心肺复苏的回顾性分析

目的分析在儿童重症监护病房(PICU)心肺复苏(CPR)的有效性及影响CPR存活率的因素。方法回顾性分析PICU发生呼吸心跳骤停而行CPR的临床情况,评价其与CPR存活率的关系。不包括仅用辅助正压通气或复苏药物而未施行胸外按压的病例。结果1998年4月至2004年8月间北京儿童医院PICU共258例患儿施行CPR,131例(50.8%)初步复苏成功,36例(14.0%)治愈出院。性别和年龄对存活率的影响差异无显著性。原发病及其合并症对存活率有显著影响。入PICU24h内及24h后行CPR其存活率分别为23.1%和17.4%;CPR时间≤5min,5～15min及≥5min的存活率分别为53.7%,23.5%和2.1%,差异均有显著性。CPR次数增多存活率下降。结论PICU行CPR后患儿的存活率较低。原发病及其合并症、复苏时间、复苏次数及入住ICU至心肺复苏时间是影响存活率的重要因素。     

急诊心肺复苏4年间变化趋势的单中心研究

目的：分析急诊心搏骤停（CA）患者实施心肺复苏（CPR）成功与否的相关因素,以提高CPR的能力及常见急诊疾病的防治策略。方法回顾性分析2010年1月至2013年12月兰州军区乌鲁木齐总医院急诊科CPR患者的临床资料,对病例数量、疾病种类、CPR有关时程及成功率等数据进行统计分析。结果4年共救治急诊CPR患者340例,CPR患者的数量呈逐年上升趋势,2010、2011、2012、2013年分别为90、75、83、92例;其中心血管系统疾病稳居首位（共108例）,其余依次为病因不详、严重创伤、各类急性中毒、神经系统疾病、呼吸系统疾病、消化系统疾病、恶性肿瘤晚期。340例患者中复苏成功74例,成功率为21.76%;其中以药物中毒、农药中毒后CPR复苏成功率最高,分别为58.33%、50.00%,最低的是恶性肿瘤晚期（10.00%）和各种严重创伤（交通事故18.75%、高空坠落5.00%、其他14.29%）。从整体上来看,CA至CPR开始时间逐年缩短（字2＝23.858,P＝0.021）,且CA患者在CA发生5 min内进行CPR的比例逐年提高,至2013年高达57.6%;2010、2011、2012、2013年CPR成功率逐年提高,分别为14.44%、12.00%、26.51%和32.61%。4年中有217例CA患者除颤,其中单次除颤83例,多次除颤134例,成功率分别为34.94％、19.40％（字2＝6.539,P＝0.011）。结论CPR成功与否与患者的基础疾病、CA至CPR开始时间及除颤次数有关。应加强社区群众、高危作业人员的急救知识及CPR技术的普及,让群众参与自救、互救,可有效提高CPR成功率。加强急救中心建设,引进先进的CPR设备,建设高效的CPR团队,加强人员业务及技能培训,是提高CPR成功率的关键。     

1例心源性猝死病人的成功救治及护理

2008年1月12日我院经过125min持续心肺复苏（CPR）成功救治了1例急性心肌梗死致心搏、呼吸骤停病人,并完全康复出院。现报告如下。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.