广州市中心城区院前急救死亡病例的流行病学特征研究

目的:探讨广州市中心城区院前急救死亡病例的流行病学特点。方法:对广州市中心城区1996年1月至2004年12月的院前急救死亡病例进行统计分析。结果:广州市的院前急救病例逐年上升,但死亡病例所占比例呈下降趋势。死亡人数最多的集中在70岁以上的年龄段。院前急救死亡的常见病因是猝死(65.68%)、创伤(9.74%)、脑血管意外(8.79%)、心血管急症(7.34%)、呼吸系统急症(6.32%)、中毒(1.61%)、消化道出血(0.52%)等。因创伤死亡的病例呈上升趋势,但2004年有所下降。脑血管意外所致的死亡则呈下降趋势。结论:应加强对猝死、心血管急症及创伤院前急救的研究,进一步提高院前急救水平。     

福州市2010年中心城区社区人群的院前急救分析及策略

目的 回顾性调查分析福州市中心城区所属社区人群院前急救的流行病学特点,探讨有效提高本地区院前急救能力及常见急诊疾病的防治策略.方法 回顾性分析2010年福州市中心城区院前急救患者的疾病类型、年龄、性别、月份分布、呼叫反应时间及转归等.结果 福州市中心城区2010年院前急救病例总计2130例.在2130例院前急救中,创伤类占院前急救比例最多,以31 ～40岁青壮年阶段为主;其次是心脑血管疾病,以50岁(尤其是70岁)以上的中老年患者明显居多,约占该年龄段的50.57％.男性院前急救的数量明显高于女性,男女比例为1.57∶1.院前死亡190例,主要死因是创伤(69例,占36.32％),其次为心脑血管疾病,以50岁以上年龄段明显居多(53例,约占该年龄段81.54％).院前猝死患者中,从发病至120现场抢救期间,目击者无一例行心肺复苏.院前急救与院前死亡患者均以冬春季节为最多.院前急救患者的呼叫反应时间、现场时间分别为(10.0±6.1) min、(11.8±5.9) min;院前死亡患者的呼叫反应时间、现场时间分别为(11.2±6.2) min、(29.0±21.1)min.结论 (1)加强社区人群的卫生健康宣传力度,提高社区高危人群自身的防病意识,尤其针对心脑血管疾病的预防,可有效减少院前急症、甚至猝死的发生.(2)重视社区人群院前急救常识及心肺复苏技术的普及,对于提高院前急救水平、减少死亡有着重要意义.(3)加强急诊网络建设、严格遵循“就近原则”、院前120同相关部门紧密联合处理突发事件,可有效提高急诊医疗服务体系的效率.     

高血压急症的院前急救

院前急救是面对突发急症、意外创伤等，需要急救人员作出快速反应，设置急救方案，快速出诊，独立实施现场急救。lop年12月，我院成立院前急救中心，面向贵阳三县一市开展院前急救工作。现将我院对高血压急症的急救情况作一报告。1急救资料IWe年12月一lop年11月，我院院前急救中心现场急救病人l（kl人次，其中急救脑血管病411例，占院前急救部例数的38．of％，高血压急救病例94例，占急性脑血管病例总数的22．86％，男性53例，女性41例，男女比例为1．3：1，年龄对一叨岁，cd岁以上74例，占78．刀％。血压为舒张压15．3－17．3kPa以上，收…     

加强院前急救是完善急诊医疗体系的当务之急

院前急救是急诊医疗体系最首要的环节。近年来，我国大城市院前急救有明显改善。但中小城市仍相当薄弱，与当今社会发展很不相适应。因此，进一步加强中小城市院前急救是完善急诊医疗体系的当务之急。现将我院1995～1997年735例院前急救病例资料分析如下。1临床资料1．1一般资料男426人，女309人，1995～1997年各年院前急救人数分别为72人，270人和393人。有年龄资料的709例，其中：60岁以上362人占49．3％。占前六位病种为：脑血管疾病146人占19．9％；创伤113人占15．4％；心血管疾病108人占14．7％；消化道急症75人占10．2％；呼吸道急症…     

2036例院前急救患者的流行病学研究

目的 了解综合性医院院前急救患者的流行病学特点。方法回顾性分析2009年我院的院前急救患者的资料,对患者性别、就诊时间、疾病分类、转归等进行调查分析。结果2009年内院前急救患者2036例,男女比1．73：1;10～12月份为急救高峰月份;每天7：00—9：00,19：00—21：00为急救高峰时间;疾病分类中创伤占67．63％、严重创伤占8．74％、多发伤占3．49％、非多发伤占5．26％、非严重创伤占58．89％、内科疾病占23．62％、理化因素疾病5．45％、其他妇儿疾病占3．29％。多发伤是主要死因。结论分析本地区院前急救流行病学特点,有助于制定相应措施,合理配置院前急救资源,提高急危重患者院前急救成功率。可为提高院前急救质量与管理水平提供科学依据。     

上海市1991-1995年院前急救病种分析

对上海市医疗救护中心1991～1995年院前急救救治的467674例病例进行分析。本组男268300例（57．37％），女性199374例（42．63％），男女之比1．346：1。其中60岁以上占49．16％，危重病人占20．12％。院前急救病种前5位依次为：外伤、脑血管病、心脏病、急性腹痛、呼吸道急诊。院前死亡死因前5位（除恶性肿瘤外）依次为：心脏病、呼吸道急诊、自杀与中毒、脑血管病、创伤。本文还探讨了院前急救病种的月份布分特点。指出：院前急救培训应以心脏病、脑血管病、呼吸系统疾病、损伤和中毒的现场急救作为培训重点，救护车装备及药械配备也应适应这些病种的需要，并适应季节性流行疾病疾病谱变化。     

院前急救患者流行病学研究

目的分析院前急救患者性别、年龄、病种、出诊时间、地点等资料的流行病学特点,合理安排院前急救班次,使有限的护士人力资源发挥最大效益.方法分别对我院2002年1月～2003年12月紧急出诊出车抢救的全部院前急救患者的病历资料进行统计分析和研究.结果与2002年比较:1)2003年院前急救患者年龄0～15岁组和81～92岁组明显减少(P＜0.05);16～35岁、51～65岁患者的比例明显增加(P＜0.05);2)2003年病种构成前4位依次为心血管系统、神经系统、颅脑创伤、多发伤.3)出诊时间:2003年在00:00～06:00时段患者数明显减少(P＜0.05),而在12:00～15:00和18:00～24:00患者比例明显增加(P＜0.05).4)出诊地点:2003年乡镇医院及公共场所比例增加(P＜0.05),家庭的急诊患者减少(P＞0.05).结论随着院前急救病例的流行病学变化,应及时调整院前急救护理人员班次,使在院前急救高峰期有足够的护理人员参与院前急救.     

院前急救患者流行病学研究

目的分析院前急救患者性别、年龄、病种、出诊时间、地点等资料的流行病学特点,合理安排院前急救班次,使有限的护士人力资源发挥最大效益。方法分别对我院2002年1月～2003年12月紧急出诊出车抢救的全部院前急救患者的病历资料进行统计分析和研究。结果与2002年比较:1)2003年院前急救患者年龄0～15岁组和81～92岁组明显减少(P<0.05);16～35岁、51～65岁患者的比例明显增加(P<0.05);2)2003年病种构成前4位依次为心血管系统、神经系统、颅脑创伤、多发伤。3)出诊时间:2003年在00∶00～06∶00时段患者数明显减少(P<0.05),而在12∶00～15∶00和18∶00～24∶00患者比例明显增加(P<0.05)。4)出诊地点:2003年乡镇医院及公共场所比例增加(P<0.05),家庭的急诊患者减少(P>0.05)。结论随着院前急救病例的流行病学变化,应及时调整院前急救护理人员班次,使在院前急救高峰期有足够的护理人员参与院前急救。     

老年人慢性硬膜下血肿的特点

慢性硬膜下血肿（CSDH）是颅脑损伤常见的继发性损害，占颅脑外伤1％，占颅内血肿10％，好发于老年人[1，2]。我们曾收治经CT及手术证实CSDH108例，其中60岁以上占32例。现就老年CSDH的某些临床特点，分析如下。1临床资料1．1一般资料：本组108例患者中男104例（96．3％），女4例（3．7％）。年龄5．5个月～84岁，以60岁以上最多32例（29．6％）。76例有明确外伤史（70．4％）。车祸或硬物致伤15例，轻微头部损伤93例。1．2临床表现。头痛79例（73．1％），其平均年龄30．57岁。智能精神障碍32例（29．6％），平均年龄67．88岁。肢体…     

烟台市区近10年胃癌的临床内镜特征及流行病学研究

目的 了解烟台市区胃癌发病率及临床内镜特征及流行病学研究。方法 对我院10年间经胃镜、病理检查及外科手术诊断为胃癌的临床资料进行统计分析。结果 （1）本组10年间共检出胃癌2192例，检出率7．29％；（2）胃癌患者男女之比为2．82：1，男性明显高于女性；（3）胃癌患者平均检出年龄60．24岁，以50-70年龄多发，占57．11％；（4）早期胃癌检出率19．29％．结论 （1）本组胃癌检出率7．29％。胃癌检出人数有逐年增加趋势。胃癌男性多于女性；（2）胃癌的好发部位为胃窦，以隆起型为主；（3）胃癌高发病年龄在50-70岁．并发症以出血、梗阻居多；（4）胃癌早期无明显临床症状；胃镜下缺乏特征性改变．提高早期胃癌检出率关键在于普及内镜普查及内镜医生认真仔细的检查及多点多部位活检．早期胃癌检出率17．02％，内镜下以Ⅲ型为主，占早期胃癌82.31％。     

上海市头部外伤患者急诊流行病学特征

目的 了解我国上海市头部外伤急诊患者的就诊时间分布和流行趋势.方法 采用前瞻性资料收集的方法 ,对2004年1月至2004年12月在参加调查的上海市12家医院急诊首诊的头部外伤病例进行调查,并填写统一的调查表,内容包括年龄、受伤时间、致伤原因等.运用STSS 11.5统计学软件包对数据进行描述性分析和:检验.结果 本研究共收回调查表19 532份,去除重复病例和缺项较多的调查表后,共得到有效调查表18076份(占92.55%).病例男女性别比为2.11:1.女性患者年龄>性(t=10.575,P<0.01).20～29岁年龄组为最高发患者群,占24.7%.本市常住病例占所有统计病例的34.2%.12、1、3月份和8月份头部创伤急诊患者明显多于其他月份;而19:00-21:130,16:00-19:00和10:00-12:00为就诊高峰时段.5.1%患者的致伤原因与工作相关.就致伤原因而言,儿童组(<14岁)和老年组(>60岁)以坠落伤为首要致伤原因(分别占66.9%和48.4%);青少年组(15～34岁)以暴力击打伤最为常见(占3_4.2%);中青年组(35～59岁)以交通伤占第一位(占37.7%).受伤情况以头皮损伤(占40.2%)最为多见.85.8%的患者在就诊时接受了CT检查.71.1%的患者在急诊后自行离院,0.5%的患者死亡.结论 上海市头部外伤急诊患者在年龄、就诊时间、致伤原因等方面有一定的规律性,掌握头部外伤急诊患者的流行趋势将有助于医院合理安排急诊医疗资源.     

Pan-Asian Trauma Outcomes Study (PATOS): Rationale and Methodology of an International and Multicenter Trauma Registry

Background: Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers. Trauma registries have been developed in mostly developed countries and measure care quality, process, and outcomes. In general, existing registries tend to focus on inhospital care rather than prehospital care. Methods: The Pan-Asia Trauma Outcomes Study (PATOS) was proposed in 2013 and initiated in November, 2015 in order to establish a collaborative standardized study to measure the capabilities, processes and outcomes of trauma care throughout Asia. The PATOS is an international, multicenter, and observational research network to collect trauma cases transported by emergency medical services (EMS) providers. Data are collected from the participating hospital emergency departments in various countries in Asia which receive trauma patients from EMS. Data variables collected include 1) injury epidemiologic factors, 2) EMS factors, 3) emergency department care factors, 4) hospital care factors, and 5) trauma system factors. The authors expect to achieve a sample size of 67,230 cases over the next 2 years of data collection to analyze the association between potential risks and outcomes of trauma. Conclusion: The PATOS network is expected to provide comparison of the trauma EMS systems and to benchmark best practice with participating communities.     

浙江省8家医院创伤患者死亡危险因素分析

目的 探讨导致创伤患者死亡的危险因素以及改进创伤急救的措施.方法 整理2009年全年浙江省8所医院急诊室首诊的创伤患者的病例资料,结合创伤急救的各个环节,挑选可能导致患者死亡的相关因素,通过单因素和多因素Logistic回归分析方法,得到导致创伤患者死亡的独立危险因素.结果 2009年浙江省8所医院共有3 659名患者纳入了本次研究,其中死亡226人,病死率为6.18%.单因素分析结果提示,年龄、创伤机制、ISS评分、GCS评分、专业现场急救、转送途中气管插管、转送途中清创止血、入院时低血压、昏迷、急诊室胸腔闭式引流、急诊手术、ICU内中心静脉压监测和ICU内机械通气的患者死亡相关.多因素Logistic回归分析提示,GCS评分、ISS评分、机械通气、入院时低血压、年龄是患者死亡的独立危险因素,有效的专业现场急救是保护因素.结论 患者的伤情严重程度和年龄是影响患者结局的重要因素.加强院前急救,早期稳定患者伤情以及合理使用ICU内监护设施有助于进一步降低创伤救治的病死率.

Abstract：

Objective To explore risk factors in the mortality of casualties and to find a way to improve trauma emergency service. Method The possible factors likely related to the mortality of casualties were taken into account based on each stage of trauma emergency so as to find the independent risk factors by using univariate and multivariate analyses. Results A total of 3 659 casualties were enrolled in this study.Of them, 226 casualties died and the mortality rate was 6.18%. Following factors were related to mortality after univariate analysis: age, cause of trauma, injury severity score, Glasgow come scale come on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU and mechanical ventilation in ICU. After multivariate analysis, six factors were independently related to the mortality of casualties as follows: Glasgow coma scale, injury severity score, mechanical ventilation, blood pressure at admission, age and professional emergency treatment on the scene. Conclusions It has a great significance to investigate the risk factors of mortality for casualties. Severity of trauma and age were independently associated with the outcomes of trauma. Besides, improving prehospital care and stabilizing the trauma patients in early phase can further decrease the mortality.     

Assessment of the quality improvement of prehospital emergency care in Sweden.

The optimal competence level of personnel involved in prehospital emergency care is a matter for discussion. In Sweden a national quality improvement process has been initiated including strict regulation of the authorization of ambulance personnel to administer drugs and increased involvement of registered nurses. The aim of the present study was to assess from a national survey the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. A questionnaire, detailing organizational, staffing, competence and functional aspects, was sent to all medical directors of prehospital EMS. The response frequency was 87.5%. Variations in the local organization of the prehospital care were observed. Only a limited number (20%) of the districts organized the ambulance services according to the competence level of the personnel. It was found that the competence level of the personnel involved in prehospital emergency care had improved considerably compared with the situation 5 years ago. A majority of the ambulancemen had increased their competence level by completing nurse assistant training and more registered nurses had been employed. The changes in the competence level and organization of the ambulance services and prehospital emergency care were considered to have had moderate (38.5%) or great (51.9%) impact on the quality of the services during the past 5 years. The effect was reported by 53.2% of the directors to be objectively verified from review of ambulance records, regular proficiency tests, patient survival data (cardiopulmonary resuscitation), and analyses of computer-based records. It is concluded that the present study clearly shows that quality improvement process initiated by the Swedish authorities has resulted in a considerable improvement of prehospital emergency care in Sweden during the past few years.     

2004-2006郑州市创伤流行病学分析

目的研究最近3年郑州市创伤流行病学现状和不同创伤急救模式对创伤救治的效果。方法统计2004年1月至2006年12月郑州市紧急救援中心的急诊流行病学资料和急救车出诊情况，比较自主型模式急救站和通道型模式急救站的创伤救治效果。结果郑州市紧急救援中心2004年、2005年和2006年派出的创伤出诊例次分别占当年急诊出诊总例次的45．3％、44．7％和45．8％。26家急救站中自主型模式1个，以内科为主的半自主型模式8个，通道型模式17个。严重多发伤在自主型模式急救站进行确定性手术治疗，明显缩短了受伤到手术的时间和降低死亡率。结论创伤是急诊出车原因的第一位。布局合理的急救站为急诊患者提供了快捷的院前急救，迅速转运严重创伤患者到自主型模式急救站可提高抢救成功率。     

Effects of early prehospital life support to war injured: the battle of Jalalabad, Afghanistan

OBJECTIVE: To study the effects of early, advanced prehospital life support on the survival rate of war casualties during the battle of Jalalabad, Afghanistan from 1989-1992. METHOD: The outcomes of simple trauma care administered from 1989-1990 were compared to the outcomes of advanced trauma care administered from 1991-1992 in the combat zone. The outcomes were measured by the number of deaths at admission to the referral surgical hospitals in Pakistan. RESULTS: A total of 3,890 war casualties were treated in the combat zone by paramedics, and were evacuated through light, forward, field clinics to surgical hospitals in Pakistan. Advanced trauma care that was administered in the combat zone reduced the prehospital mortality rate from 26.1% to 13.6% (95% CI for difference = 9.7-15.4%). CONCLUSION: In scenarios with protracted evacuation, early and advanced trauma care should be included in the chain of survival. Local paramedics can provide such trauma care with a minimum of resources.     

Field Triage in Disasters

In man-made andnatural disasters, prehospital providers andtheir emergency medical services systems may find it necessary to shift their triage methodology from a daily operational framework of treating the most severely injured patient first andproviding the highest level of care for each patient to the concept of providing the greatest good for the greatest number of casualties. In a scenario where there are an overwhelming number of casualties, this shift will be necessary, both to identify critically injured patients who can benefit from immediate, life-saving interventions andto preserve prehospital andhospital resources. This report examines triage issues as they apply to mass casualty events.     

专职化院前急救对心肺复苏成功率的影响

目的探讨专职化院前急救对心肺复苏成功率的影响。方法135例院前心肺复苏患者的资料,按非专职化院前急救与专职化院前急救两种情况进行分组,从医务人员状况、出车时间、到达现场时间、院前应用高级生命支持技术(ACLS)技术及抢救成功率等方面进行对比研究。结果专职化院前急救心肺复苏成功率达26.8%,较非专职化成功率3.7%有显著的提高(P<0.05),且出车时间、到达现场时间、车载设备的配备、现场应用高级生命支持技术等均有明显的改善。结论专职化院前急救可提高院前心肺复苏的成功率。     

Lack of change in trauma care in England and Wales since 1994

Abstract: To demonstrate trends in trauma care in England and Wales from 1989 to 2000.

Study population: Database of the Trauma Audit and Research Network that includes hospital patients admitted for three days or more, those who died, were transferred or admitted to an intensive care or high dependency area.

Method: To demonstrate trends in outcome, severity adjusted odds of death per year of admission to hospital were calculated for all hospitals (n=99) and 20 hospitals who had participated since 1989 (adjustments are for Injury Severity Score, age, and Revised Trauma Score). The grade of doctor initially seeing the injured patient in accident and emergency and median prehospital times per year of admission were calculated to demonstrate trends in the process of care. Trend analyses were carried out using simple linear regression (odds ratio versus year).

Results: The analysis shows a significant reduction in the severity adjusted odds of death of 3% per year over the 1989–2000 time period (p=0.001). During the period 1989–1994 the odds of death declined most steeply (on average 6% per year p=0.004). Between 1994 to 2000 no significant change occurred (p=0.35). This pattern was mirrored by the 20 permanent members where the odds of death also declined more steeply over the 1989–1994 period. The percentage of severely injured patients (ISS >15) seen by a consultant increased from 29 to 40 from 1989–1994 but has remained static subsequently. Median prehospital times for severely injured patients have not changed significantly since 1994 (51 to 45 minutes).

Conclusion: Most of the case fatality reduction for trauma patients reaching hospital over the 1989–2000 time period occurred before 1995 when there was most marked change in the initial care of severely injured patients.