院外气管插管在急危重症患者抢救中的应用

院外急救是急诊的重要组成部分,对于危急重症患者的院外急救,开放气道是必要的选择,也是急诊抢救的基础和保障,是提高心肺复苏成功率的重要环节[1],笔者对山东省荣成市第二人民医院2011年1月~2012年1月收治的58例需行气管插管的急危重患者资料进行回顾性分析,以探讨院外气管插管在该类患者抢救中的作用和效果,为临床提供借鉴。     

喉罩在院外急救困难插管中的应用

喉罩是介于气管插管和面罩之间的通气工具,为人工气道的建立提供了一种行之有效且简便的补充手段,亦可用于协助气管内插管和心肺复苏中作为紧急通气道使用。随着喉罩产品的推陈出新,喉罩的优越性渐趋明显,喉罩使用率逐步提高。合肥急救中心于2011年引进插管型喉罩,作为气管插管的补充,应用于院外急救中需要建立紧急通气道,但又难以在短时间内成功进行气管插管或不能行气管插管的患者,本文就喉罩在院外急救中的应用价值进行探讨。     

不同人工气道在院外救护车内的应用

目的 探讨院外急救车上心肺复苏(CPR)建立人工气道通气的最佳方法和对复苏成功率的影响.方法 对院外急救车上发生心跳呼吸骤停患者318例,根据当时CPR时对患者随机建立人工气道的3种不同方法,将其分为3组,进行回顾性分析,A组68例,常规行气管导管插管;B组140例,盲插喉罩通气;C组110例,食管气管联合导管通气.结果 B组建立人工通气需(26±11.3)s,显著短于A组和C组[分别为(146±14.7)s和(81±16.5),均P＜0.05].A组建立人工通气所需时间显著长于C组(P＜0.05).盲插喉罩通气时间最短,其次是食管气管联合导管插管术,气管插管术最慢.B组一次插管成功率为100％,显著高于A组(60.3％,P＜0.05),与C组的差异无显著性(98.2％,P＞0.05).B组与C组之间差异无统计学意义(P＞0.05).A、B、C组三组复苏成功率分别为26.5％,25.7％和27.3％,相互间的差异无无统计学意义(均P＞0.05).结论院外急救车上最好早期应用盲插喉罩或食管气管联合导管.     

影响院外心跳呼吸停止复苏成功的因素:771例分析

目的 探讨院外心跳呼吸停止的相关因素与院外急救的关系.方法 对2005年1月至2006年12月两年间合肥市急救中心接处的771例院外心跳呼吸停止病案进行回顾,分析院外急救中死因、急救反应时间、目击者救护、专业救护与预后的关系.结果 院外心跳呼吸停止的病因中,猝死495例,基础疾病衰竭106例,意外伤害170例;平均救护车急救反应时间11 min;目击者救护12例;复苏有效(成功)16例;复苏有效(成功)组急救反应时间6.5 min.结论 目击者参与救护、缩短急救反应时间、提高专业救护能力是提高院外复苏成功率的三大要素.     

真空夹板在院外急救骨折患者中的应用

院外急救是急救医学的首要环节和重要基础,也是整个医疗卫生体系的重要组成部分[1,2].随着社会发展,交通的发达,各种交通事故及意外伤害事故频繁发生.多发性创伤所占比例较高,江西省宜春市紧急救援中心接诊患者中创伤类占44.7%.此类患者发病急,病情重,且多伴有骨折,甚至多发性骨折.正确使用真空夹板固定院外急救患者骨折部位,能有效降低骨折患者在院外急救途中的再损伤率和死亡率,提高院外急救抢救成功率并广泛应用于120急救、消防、矿山、体育等系统.     

喉罩在危重患者抢救中的应用

目的探讨喉罩在危重患者抢救中应用的可行性。方法心肺复苏及呼吸衰竭的患者50例，男32例，女18例，年龄63．2（20-86）岁。应用喉罩建立紧急通气道，记录插入成功率、操作时间、通气效果以及胃肠胀气等并发症。结果喉罩插入操作时间平均32s。49例成功（98％），1例失败，及时给予气管插管。SpO2均恢复至90％以上，血压和心率等生命体征也基本恢复至治疗前水平，昏迷程度有所减轻。3例胃肠胀气。结论在急救情况下，喉罩可替代气管插管用于建立紧急通气道。     

气管插管和口咽通气管在院外急救中应用比较

放置气管插管和口咽通气管是院外急救人员必须具备的保证呼吸道通畅的急救技能之一，在很多情况下是拯救患者生命的惟一手段。我中心在加强培训和应用该技能的同时对两者在院外急救中应用进行了比较，现报告如下。     

急诊科护士实施气管插管的临床意义

目的探讨急诊科护士实施急救性气管插管的可行性。方法通过对全体急诊护士进行规范化培训,并对培训前后60例心肺复苏患者资料进行回顾性分析,通过对麻醉科医师（对照组）和急诊科护士（治疗组）的开始实施气管插管所需时间、完成捅管时间、插管成功率及复苏成功率进行比较。结果治疗组从决策到实施插管所需时间为（90±10）s（1～2min）,显著短于对照组[（9±3）min,（6～12）min,P〈0．05]。治疗组心肺复苏成功率为53．3％（16／30）,显著高于对照组（13．3％,4／30,P〈0．01）,而2组在完成插管时间、插管成功率比较差异无统计学意义（均P〉0．05）。结论通过对急诊护士规范化培训,熟练掌握气管插管术,由急诊护士在第一时间完成急救性气管插管是切实可行和非常必要的。     

便携式超声在院外急救困难静脉穿刺的应用研究

目的研究便携式超声在院外急救困难静脉穿刺中的应用研究。方法将2017年12月-2018年11月郴州市第一人民医院中心医院院外急救科接诊的135例严重创伤失血性休克患者,采用随机数字法分为超声引导组和常规对照组,超声引导组将超声引导技术应用于静脉穿刺过粒,包含有操作前静脉血管评估,操作时实施引导,操作后进行确认评估。常规对照组则采用常规触摸或者触摸不到依据解剖学血管走向进行言穿。对照两组巧一次性穿刺成功率、穿刺时间、并发症发生率进行比较。结果超声引导组一次性穿刺成功率为88.06%,穿刺时间及并发症发生率小于常规对照组。结论在院外急救中使用便携式超声引导静脉穿刺可以提高穿刺成功率。     

高血压脑出血患者的院外救治分析

高血压脑出血（hypertensive cerebral hemorrhage,HCH）是院外急救危重急症之一,发病急,病情变化快,致死致残率高。正确的院外急救可以降低患者入院前的危险性、减少并发症的发生、缩短发病至入院接受进一步治疗之间的时间与距离,提高抢救成功率,减少致残率。囚此,如何提高HCH的院外急救成功率尤显重要。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.