加强对专业人员进行急救知识和技能培训

目的探讨如何加强急救医疗队伍建设，提高急救专业技术人员的紧急救援和医疗救治能力的方法和措施。方法总结对四川省、成都市急救专业人员进行现代急救知识和技能规范化培训的经验。结果成都市急救指挥中心近8个月，集中举办罔家级继教项目《高级生命支持及急救技术培训班》（提高班）3期，举办区、县《急救医学培训班》（普及班）6期，采取授课与操作相结合，培训急救专业人员1285人，合格率98．9％。结论规范化、分层次集中培训提高了急救专业人员的急救医疗水平，提高了紧急救援队伍的综合急救能力。     

特殊人群的急救培训现状和存在的问题及对策

随着社会的发展,我国现有的急救医疗体系提供的服务已不能够满足社会的需要,全民参与急救体系建设的时代已经到来."急救要从现场开始"的观念已逐渐被人们接受.对病情紧急患者,最宝贵的抢救时机是在现场进行急救.国内专家呼吁全民普及急救知识特别是心肺复苏的技术和知识,认为应在特殊人群中率先普及心肺复苏、创伤救护技术等知识.国内外实践经验表明,对涉及急救工作的有关人员,如警察、消防员、飞机乘务员、导游、游泳场馆救生员、机动车驾驶员及教练、矿山抢险人员等特殊人群进行急救培训,能在现场急救中发挥重要的作用.同时,通过培训的特殊人群可发挥急救作用,既弥补了现时院前急救体制的不完善,又弥补了医疗卫生机构对院前急救多样化不适应之处,缩短了无治疗期,减少了医疗纠纷,扩充了急救资源,提高了急救水平[1].     

重大灾害事件的紧急医疗救援

目的报告河南省5次重大突发事件和紧急救援的组织管理。方法重大灾害事件发生后，迅速报告上级主管部门和紧急救援中心，公安、消防和医疗急救人员共同参加现场急救，使通讯和道路通畅，维持现场秩序，保证现场急救和顺利转运伤员到医院。河南省突发公共卫生事件应急医疗救治专家迅速赶赴现场和救治伤员的医院，指导急诊手术和重症监护治疗。结果5次重大突发事件现场共死亡259例，181例伤员送入院治疗，其中危重伤员26例。仅2例死于多器官衰竭，其余179例康复出院。结论重大突发事件紧急救援需要消防、警察、医疗急救等多系统的协调合作，急诊医学专家指导大批伤员的分类急救和重症监护治疗，可提高救治成功率。     

医学研究应重视非医疗因素的影响

背景： “首都紧急医学救援（五分钟）科技工程”是由北京市科委和北京市卫生局共同主持，市发改委、市财政局等8家单位参与、实施的北京市重大项目。“五分钟”是“紧急救援法定时间”。于要提出适合北京实际情况的紧急医学救援法定时间，该项目主要针对重大创伤、心脑血管疾病等对救援时间要求高的突发性疾病。北京大学人民医院胡大一教授主持的是心血管急救部分，并在该项目组组织了课题论证会，邀请了北京大学、首都医科大学、上海同济大学医学院、中国协和医科大学和解放军总医院等单位的专家，共同研讨了关于心血管急救研究的策略和方向。会后，胡大一教授组织编写了研讨会的部分内容，希望能对其他领域的研究提供借鉴和帮助。     

突发事件紧急医学救援工作的几点思考

灾害医学是研究在各种自然灾难和人为事故中所造成的灾害性损伤条件下实施紧急医学救治、疾病预防和卫生保障的一门科学［1］。自2003年SARS之后,灾害医学在中国得到了空前重视和迅速发展。到2008年汶川大地震时,初步建立了伤员集中、检伤分类、现场救治、后方转运的救治模式,形成了通讯保障、卫生防疫、心理救援、军民协作等策略,这标志着中国灾害紧急医学救援体系初步建立;但也暴露出相关系统研究的具体成果较少、专业化培训规模小、紧急医学救援人才储备不足、应急指挥和决策系统不完善、全民急救知识普及教育不够等问题［2］。随着中国经济、社会快速发展,人口、资源的流动性将大大提高,传染病暴发、恐怖袭击、安全事故等风险也随之增加,中国的灾害紧急医学救援工作面临着前所未有的形式和严峻挑战。     

发生灾害要立即通知“120”，医院不得拒收伤员

公安部、卫生部日前发出通知，要求做好灭火救援现场紧急救护工作，建立火灾害事故信息通报和联合救护机制，着力提高火灾及其他灾害事故信息传递、现场急救和人员转运等方面的综合反应能力。     

澳大利亚John Murtagh全科病案研究（二十五）——在超市里晕倒的病人

译者按:全科医生诊所往往最接近意外或急救发生的场所.在争分夺秒的紧急情况下,全科医生需要发挥其急救和快速判断及施救的能力,在专业急救人员和急救车赶到前,做出快速判断并给患者做恰当的处置.Murtagh教授在本案例中,以低血糖休克为例,说明在急救现场全科医生应该怎样做.同时也提示我们,在全科医学培训中增加社区急救内容培训的必要性.     

山西晋城2·25重大车祸现场应急救援体会

通过分析山西晋城2·25重大车祸现场紧急救援情况，笔者总结了本次救援的经验和不足，在重大车祸现场救援时，需要平时多方位急救技能培训、临场迅速反应和有力指挥，以及多部门多警种密切配合。另外，急救资源整合及院前、院内有机结合是本次救援中需提高的地方。     

对特殊人群院前急救知识培训的探讨

目的通过对城市特殊人群进行院前急救知识培训,使更多的现场第一目击者掌握院前急救知识和技能;提高院前急救成功率.方法对城市中的特殊人群(110消防武警、110公安巡警、122交通警察)分批进行院前急救培训,采用边讲理论,边练习的授课方式,使受训人员掌握心肺复苏、创伤急救的基本急救技能.结果培训614人,参加考试604人平均成绩92.7分.调查表反馈,全体学员均认为在工作中需要急救知识培训课程设置合理.98%学员认为培训时间合理.49.6%对学习心肺复苏与创伤急救感兴趣.结论通过培训的人员可发挥作用弥补因现时院前急救不完善及医疗卫生单位,对院前急救多样化不适应而造成的急救反应时间过长的现象,提高院前急救成功率,降低死亡率.     

一普二专三开放：灾害救援医学教学体系的构建与实施

21世纪灾难频发，造成大量的人员伤亡和财产损失，救援医学人才匮乏，相关的教育是关键。为培养具备较强综合能力和素养的救援医学人才，我校通过探索，构建了“一普二专三开放”三位一体的教学体系：对全校新生开设急救常识课程；对高年级临床医学生开设《基础灾害救援医学》专业课程；三支学生志愿者服务队对社会开放式急救培训。以“构建灾害救援知识、能力和职业素养结合的教学体系”，“开展多形式的灾害救援仿真情景实践教学”，“灾害救援医学校内教学与服务社会相结合”为特色，经过五年的实践，医学生灾害救援的能力和素质明显提升。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…