2011-2012年度急诊病人就诊规律回顾性分析

目的:了解急诊病人在不同时间,不同科室间的就诊规律,为急诊工作的科学管理、合理安排技术力量提供依据,提高医疗服务质量。方法:应用时间序列数据季节指数分析法对本院急诊各科室就诊量按月份、时间进行流量分析。结果:2011-2012年度,我院急诊就诊总数为243021人,其中内科就诊量最多81990人,占33.74%;口腔科最少为1426人次,占1.3%。2月份急诊就诊人次最少,7月份就诊人次最多,5月、7月、8月、10月为急诊就诊高峰。24h节律,凌晨4点就诊量最少,18点最多。结论:急诊病人在不同科室、不同季节、不同时间点就诊存在不同的节律,医院可根据就诊节律合理安排技术力量,让急诊病人在最短的时间内得到迅速、高效的诊治。     

脑海绵状血管瘤257例发病周期性的临床分析

目的 探讨脑海绵状血管瘤发病的季节规律.方法 回顾性分析脑海绵状血管瘤(CM)患者257例的临床资料,按发病季节、月份和日期计算构成比;分别按发病季节和是否节气日期间发病分组,统计不同性别、年龄和临床表现的患者有无差异.结果 春季发病数最多,占30.6％,秋季最少.占20.2％;女性患者春秋季发病构成比(58.1％)明显高于男性(43.6％)(x2=5.36,P＜0.05).合并癫痫患者夏冬季发病构成比(63.3％)明显高于其他组(43.3％)(x2=8.78,P＜0.05).1、4月份发病人数最多,占12.1％,10月份最少,占4.3％.41.2％的脑CM患者在节气日期间发病,谷雨发病人数最多,占8.5％;霜降最少,占0.9.结论 脑CM具有春季高发的特点,节气日有可能诱发脑CM发病.     

急诊就诊成人患者特征分析

目的了解广州市中心城区急诊就诊成人患者特征,为急诊管理和决策提供依据。方法对广州市中心城区大型综合性医院2007年1月至2012年12月连续6年有急诊就诊登记的患者进行统计,分析和研究急诊就诊患者的人群特征。结果2007年1月至2012年12月的连续6年间,急诊就诊例次234601,各年份例次分别为36601、35987、39584、40266、38142、44021,呈上升态势,女性就诊人数超过男性,并呈快速上升趋势,连续6年的医保患者数量占年总病例数分别是11532／36601（35．5％）、13269／35987（36．9％）、17391／39584（43．9％）、19137／40266（47．5％）、17571／38142（46．1％）、20844／44021（47．4％）,进行性升高,各年龄段就诊人数有明显规律性,以20～29岁为最多,随年龄段增长而降低。结论近6年来广州市中心城区成人急诊患者有一定变化特征,即急诊总量稳步增加,女性多于男性,并有上升趋势,医疗保障人数不断增加,青壮年是主要就诊人群,随年龄增加而降低。     

日最高气温与心脑血管疾病死亡的关系探讨

目的探讨河北石家庄地区日最高气温与人群心脑血管疾病死亡的关系,找出高危因素,进行有效防治。方法收集2009年1月1日至2011年12月31日期间的心脑血管病例死亡报告卡,由河北气象台提供相应期间逐日平均气温,最低气温,平均气压,相对湿度,风速等6项气象要素,运用计算机进行各气象要素与心脑血管疾病死亡的单因素及相关因素的分析。结果气温,气压与死亡的关系显著,全年以夏季病死率最高,8月份是全年发病人数最多的月份。结论夏季日最高气温升高可能是心脑血管疾病死亡的一个危险因素,因此夏季积极治疗心脑血管病可降低病死率。     

京郊某二级中医院急诊冠心病患者特点分析

目的分析京郊二级中医院急诊冠心病患者特点。方法对2005年1～12月急诊冠心病患者就诊情况进行统计分析。结果急诊冠心病患者发病率男性高于女性;高发年龄是60～70岁;就诊高峰时间在早8～11点,晚19～22点;季节分布以秋冬季偏高,夏季偏低;统计了前5位主诉和诊断。结论通过对急诊冠心病患者情况分析,可以指导科室合理分配及培养急诊医师并发展全方位的急救制度。     

电白县134例精神分裂症首次发病与季节关系的初步分析

目的探讨精神分裂症首次发病与季节关系的可能性联系.方法以有明确首次发病时间的精神分裂症的134份病历为依据,对精神分裂首次发病与季节关系进行初步分折.结果电白县精神分裂症首次发病具有季节性差异.结论电白县精神分裂症初步发病的高峰季节是冬季,发病的高峰月份依次是冬季12月,春季3月,夏季7月.冬季是男性易感人群罹患精神分裂症高发季节夏季可能是女性易感人群罹惠精神分裂症高发季节.     

急诊病种分类及相关因素的分析研究

目的探讨基层医院急诊病种分类及相关因素.方法分析2000-2004年我院急诊就诊患者的临床资料,讨论病种分类、年龄、性别、时间、季节及相关因素.结果 5年来共有6958例急诊,以内科疾病多见,其次为外科、妇科、儿科及五官科,年龄3个月-82岁,男女比例为1.96:1,以夏季、冬季最多,19:00-21:00时为急诊病人来诊高峰,急诊疾病主要与生活条件提高,生活规律及饮食习惯改变和承受社会压力有关.结论开展急诊病种分类及相关因素分析,为基层医院加强内部管理,开展社会急需的服务项目,不断提高急救技术水平和院前救治能力提供科学依据.     

我院急诊患者流行病学分析

目的：了解天津地区综合性医院急诊患者流行病学特点。方法采用回顾性分析方法，对2013年1月1日~12月31日在天津医科大学总医院急诊医学科就诊患者的性别、年龄、就诊时间、就诊科室、急诊诊断或主诉等进行调查统计分析。结果采用信息完整的急诊患者116942例，占全年急诊患者95.96%，男女比例为0.84：1；外科性质科室中，男女比例为1.34：1；就诊患者高峰年龄组为20~29、30~39、50~59岁；8、10、12月就诊患者最多，节假、双休日日均较全年日均就诊患者数显著增多；排名前三的急诊科室为内科(49.92%)、神经内科(10.09%)、外科(7.62%)；每天以17：00~24：00就诊患者居多，占全天患者总数44.28%，高峰时段出现在20：00~22：00；报告了前40种急诊诊断，前五位依次是创伤、上呼吸道感染及气管-支气管炎、腹痛、发热、头晕或伴心慌呕吐。结论根据流行病学特点，合理分配急诊资源，在重点时段、重点科室间加强人员安排；须进一步完善急诊创伤救治系统；重视对症状学的鉴别诊断，有针对性地对急诊医生进行常见病种培训以提高救治水平。     

温州市区大气污染与儿童哮喘急性发作的相关性分析

目的分析温州市区冬春季节的大气污染物浓度变化与哮喘急性发作的关系。方法 2013年1月1日至4月30日每日获取大气污染、气象因素监测资料以及儿童哮喘门、急诊资料,并进行统计学分析。结果①温州市区P M 2.5、P M 1 0、N O2的平均浓度值均超过了年平均二级浓度限值;S O2的平均浓度值尚在年平均二级浓度限值之内,但超过年平均一级浓度限值;O3的8小时平均浓度值在二级浓度限值内;CO的24小时平均浓度值在二级浓度限值内。②以1月份哮喘就诊人次所占构成比最高,其次为4月份;哮喘急性发作率1月份最高;其余3个月接近。③儿童哮喘急性发作人次与大气中P M 2.5、P M 1 0、N O2日均浓度呈显著正相关关系,与S O2、C O日均浓度呈低度正相关,而与O3 1 h、8 h浓度无明显相关。哮喘就诊人次与大气中N O2、C O日均浓度呈低度正相关关系。④儿童哮喘急性发作密切相关的预测变量是PM2.5。结论 PM2.5对哮喘急性发作影响呈显著正相关,且对哮喘急性发作的影响比PM10、N O2更为显著,为唯一的预测变量。     

急诊患者就诊特点分布及对急诊护理人力资源分配的应对分析

目的 探讨急诊患者就诊特点规律,对急诊人力资源分配提供参考.方法 采用回顾性资料分析方法,对我院3年内急诊病人就诊人数和分布做描述性分析,3年就诊人数进行比较,2011年工作日、休息日、节假日就诊人数时间段的分布进行比较.结果 急诊患者就诊量呈逐年增高趋势,节假日、休息日就诊人数显著高于工作日(P＜0.05).结论 节假日、休息日、晚夜班急诊就诊人数较平时增多,急诊护理人力资源应合理分配.     

季节与气温变化对急性脑梗死患者血糖水平的影响

目的 探讨季节与气温变化对急性脑梗死患者血糖水平的影响。方法 回顾性分析急性脑梗死患者1 260例及同期气象资料,收集所有患者一般资料和常规血液学检查结果,分析急性脑梗死患者血糖水平的季节性变化及气温与血糖水平的相关性。结果 急性脑梗死患者冬季血压、体质量指数、基线美国国立卫生研究院卒中量表评分、总胆固醇及合并糖尿病患...     

The effect of pharmacotherapeutic counseling on readmissions and emergency department visits

Objective To evaluate the impact of pharmacotherapeutic counseling on the rates and causes of 30-day post-discharge hospital readmissions and emergency department visits. Setting The study was conducted at the Medical Clinic of University Hospital Dubrava, Zagreb, Croatia. Methods The study included elderly patients prescribed with two or more medications for the treatment of chronic diseases. The patients randomized into the intervention group received pre-discharge counseling by the clinical pharmacologist about each prescribed medication. The control group received no counseling. Main outcome measures The rates and causes of 30-day postdischarge hospital readmissions and emergency department visits. Medication compliance was also evaluated, using the pill count method. Results A total of 160 patients were randomly selected for the study. No significant difference was found in the readmission and emergency department visit rates between the intervention and control groups (p = 0.224). There were 34.9 % more compliant patients in the intervention group. Significantly more non-compliant patients in the control group were readmitted or visited emergency department because of the disease progression (p = 0.031). In the intervention group, significantly more patients were readmitted or visited emergency department because of an adverse drug reaction (p = 0.022). Conclusion Pharmacotherapeutic counseling can reduce readmission and emergency department visit rates for disease progression. Improved patient knowledge about adverse drug reactions could be the reason for increased rates of readmissions and emergency department visits due to adverse drug reactions in the intervention group.     

急诊死亡235例病因分析

目的分析急诊死亡原因,提高院前及急诊科危重患者抢救成功率。方法通过回顾性分析院前及急诊科24h内抢救无效死亡病例一般资料、最后死因等资料。结果急诊科抢救室主要以各种创伤、脑血管疾病、中毒、肿瘤为主;男性多于女性比例为1.94∶1,女性以中毒为主;男性以各种创伤和心脑血管疾病为主。儿童以意外事故为主,青少年患者以急性中毒和各种创伤及猝死为主,中老年患者以心脑血管疾病为主。各种外伤是死亡的主要原因,其次是心血管系统疾病、脑血管系统疾病;院前死亡主要以猝死、心血管疾病、呼吸疾病为主。结论应加快普及提高公民的急救知识,建立健全的基层与城市急救网络,稳定急诊专职医师,加强急救知识培训,建立并完善适合本地特点的紧急创伤救治平台,是提高急诊抢救救治水平的有效措施。     

Antivirals and antibiotics for influenza in the United States, 1995--2002

PURPOSE: To measure the rates of antiviral and antibiotic prescribing for patients diagnosed with influenza in the United States. METHODS: We performed a retrospective analysis of visits to ambulatory clinics and emergency departments in the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) with a diagnosis of influenza that occurred in seven influenza seasons between 1 October 1995 and 31 May 2002 (n=1216). RESULTS: There were an estimated 22 million visits (95%CI, 17--26 million visits) with a diagnosis of influenza to community ambulatory clinics (88% of visits), hospital ambulatory clinics (3%) and emergency departments (9%) in the United States between the 1995--1996 and the 2001--2002 influenza seasons, inclusive. The sample was 63% adults, 44% male and 84% white. Physicians prescribed antivirals in 19% of visits and antibiotics not associated with an antibiotic-appropriate diagnosis in 26% of visits. In multivariable modeling, independent predictors of antiviral prescribing were adult age (OR, 2.1; 95%CI, 1.1--4.0) and Medicare insurance (OR, 0.1 compared to private insurance; 95%CI, 0.0--0.6). Antiviral prescribing was marginally associated with influenza season (OR, 1.2 per influenza season; 95%CI, 1.0--1.4). Independent predictors of antibiotic prescribing were influenza season (OR, 0.8 per influenza season; 95%CI, 0.7--0.9), male sex (OR, 0.6; 95%CI, 0.4--0.9), adult age (OR, 2.3; 95%CI, 1.2--4.2) and emergency department visits (OR, 0.5 compared to community ambulatory visits; 95%CI, 0.3--0.8). CONCLUSIONS: Physicians prescribed antiviral medications to 19% of patients they diagnosed with influenza; the proportion that would have been clinically appropriate is unknown. In contrast, physicians prescribed apparently inappropriate antibiotics to 26% of these same patients, a rate that, encouragingly, decreased over time.     

非胰岛素依赖型糖尿病患者血清唾液酸的改变

测定20例NIDDM伴有心脑血管病变的患者、20例单纯NIDDM患者的血清唾液酸（SA）水平，并与20例正常人进行比较。结果发现所有NIDDM患者的血清SA水平均显著增高（P＜0．01），其中伴有心脑血管疾病患者的血清SA水平显著高于单纯NIDDM患者（P＜0．05），同时血清SA水平与血清胰岛素及C肽水平、收好压之间存在相关。提示血清SA水平与NIDDM患者的心脑血管疾病关系密切，可能是心脑血管并发症发生的一个危险因素。     

Effects of seasonal variations, acute hypothermia and physostigmine on cardiac acetylcholine, tissue glycogen and blood sugar concentrations in frogs

The effects of seasonal variations and the effects of acute hypothermia (8.0 degrees) and/or physostigmine (PHY) in different seasons have been studied on the tissue glycogen, cardiac acetylcholine (ACh) and blood sugar contents in frogs. Seasonal variations had no significant effect on cardiac cholinergic activity. However, cardiac ACh concentration was significantly reduced by hypothermia in all seasons. The extents of increase in cardiac ACh in PHY pretreated hypothermic frogs indicate that hypothermia depresses cardiac cholinergic acitity much more in summers than in rainy and winter seasons. The tissue glycogen contents and blood sugar concentrations were significantly lower in winter season than those in summer and rainy seasons. Hypothermia produced marked tissue glycogenolysis and hyperglycaemia during summer and rainy seasons and not during winters. In general PHY had no effect on tissue glycogen contents in any season, but it produced hyperglycaemia during rainy and winter seasons. PHY pretreatment increased cardiac, hepatic and muscle glycogen contents and produced hyperglycaemia in hypothermic winter frogs, and it increased ventricular and muscle glycogen contents during summer and hepatic glycogen during rainy seasons, there being no significant effects on blood sugar.     

Interseasonal variability in biomarkers of exposure in fish inhabiting a southwestern Australian estuary

The Swan-Canning Estuary, in southwestern Australia, undergoes distinct seasonal changes, with freshwater discharge predominant in the winter (wet) season and low flow with high salinity predominant in the dry summer season. To investigate seasonal variability in biomarkers of exposure in fish, black bream (Acanthopagrus butcheri) were collected from seven sites in the Swan-Canning Estuary in winter 2000 and in summer 2001. No interseasonal or intersite differences in serum sorbitol dehydrogenase concentration were found, indicating the measured mixed-function oxygenase (MFO) enzymes were not influenced by liver damage. The ethoxyresorufin-O-deethlyase (EROD) activity of the postspawning females was higher in summer than in winter but was significantly lower than that in males in both seasons, suggesting estradiol suppression in females. Sexual differences in ethoxycoumarin-O-deethylase (ECOD) activity were not evident in either season. Both EROD and ECOD activities and polycyclic aromatic hydrocarbons (PAH) biliary metabolites had significantly different patterns of induction between seasons. The ratio of naphthalene-type to benzo(a)pyrene-type biliary metabolites was significantly higher in summer, indicating the sources of petroleum hydrocarbons were petrogenic compared to in winter, when the source was a mixture of pyrogenic and petrogenic PAHs. There was no upstream or downstream gradient of response in any biomarker in either season, demonstrating that there were multiple sources of contaminant input into the estuary. Although winter biomarker levels were triggered by the discharge runoff from major roads and drains, summer biomarker levels appear to have been related to recreational boating use on the estuary.     

老年急性心肌梗死发病时间序列研究

【摘要】 目的 分析近3年老年急性心肌梗死(AMI)发病是否具有时间变异性。方法 回顾性分析我院2009-2012年心脏科老年AMI入院病例908例。分别对入院例次逐日进行统计,结合患者一般临床资料分析老年AMI发病是否具有年、季节、月、昼夜变异性及"星期几"效应。结果 老年AMI发病逐年增加(P<0.01)。季节发病高峰为冬季,夏季为发病低谷。其中1月发病最高,6月发病最低。在有冠心病病史、心电图表现为ST段抬高及入院时心功能分级较差的患者中,AMI发病具有季节性差异(P<0.05)。AMI发病还具有昼夜变化规律(P<0.01),其中上午发病率最高,为(82.75±14.57)例次/月。结论 研究时段内AMI发病呈逐年上升趋势,且具有季节、月、昼夜的变化规律,应据此制定相应防治措施。     

厂矿职工心脑血管疾病流行病学调查报告

目的通过对本市某厂矿〉50岁职工健康体检，了解心脑血管疾病的发病情况，对相关的危险因素积极干预防治。方法〉50岁的职工3916人，按有无心脑血管疾病危险因素分为危险与非危险因素2组。危险因素组1552人，将危险因素亚组分为高血压组680人，高脂血症组673人，高血压合并高脂血症组199人；非危险因素组2364人。逐年观察各组人群心脑血管疾病的发展情况，并以同期体检〈50岁的人群组21842人作为对照进行观察。结果〉50岁组职工心脑血管疾病发生率明显大于〈50岁组（P〈0．01），危险因素组明显大于非危险因素组（P〈0．01）。结论心脑血管疾病发病率有逐年升高的态势，并有发病年龄年轻化的趋势。