我国八个大中城市院前急救流行病学调查分析

Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the above parameter in the non-death group were 2.19 ± 1.13(min), 14.15 ± 7.14(min),11.60±6.72(min), 14.92 ±6.89(min), 41.86± 19.53(minutes) and 8.63±4.31(Km), and the above parameter in the death group were 2.10± 1.08(min), 13.68 ± 7.14(min), 25.25 ± 12.34(min), 13.75±6.48(min), 54.74 ± 25.47(min) and 7.86± 3.91(Km), and the above parameter in the non-sudden cardiac death group were2.09± 1.03(min), 13.58±6.78(min), 25.53± 12.34(min), 13.60± 6.54(min), 53.79±23.77(min) and 7.67 ± 3.86(Km), and the above parameter in the sudden cardiac death group were 2.12 ±1.02(min), 14.10±7.05(min), 24.79± 12.08(min), 13.79±6.61(min), 54. 80 ± 25. 36( min) and 7.90±3.92(Km) respectively. The scheduling time, running time, returning time and service radius in the death group were less than those of the non-death group, but the rescue time and total time of the former were more than those of the latter respectively ( P ＜ 0.05 or P ＜ 0. 001 ). The scheduling time and returning time didn' t have significant difference between the sudden cardiac death group and the non-sudden cardiac death group respectively ( P ＞ 0.05), but the running time, total time and service radius of the sudden cardiac death group were more than those of the non-sudden cardiac death group, and the rescue time of the former was less than that of the latter respectively ( P ＜ 0.05 or P ＜ 0.001 ). (2)The patients' amount in pre-hospital medical care group, the non-death group, the death group, the non-sudden cardiac death group and the sudden cardiac death group were at most in first quarter, and the least time slice of patients' amount were 4:00～ 6:00, 4:00～6:00, 4:00～ 6:00, 22:00～ 24:00, 2:00～4:00 respectively, and the most time slice of patients' amount were 20:00～ 22:00, 20:00～22:00, 8:00～ 10:00, 2:00 ～ 4:00, 8:00 ～ 10:00 respectively. (3)In 241 876 cases of pre-hospital medical care group, the patients' amount of trauma was at most, whose age grades was by far among21 ～50, and the others in sequence were nervous system, circulatory system, other group, digestive system, respiratory system and poisoning group respectively, whose age grades in nervous system, circulatory system and respiratory system was by far above 51, especially above 70. The patients' age grades in other group and digestive system had two climax age groups, which the one was 21 ～ 30, and the other was above 70. The patients' age grades in poisoning group was by far among 21 ～ 50, which the patients' amount of acute alcoholism was at the most. (4) In 12 568 cases of death group, the death amount of circulatory system, other group, respiratory system, nervous system and digestive system ranked at the lst,2nd,4th,5th 8th respectively, whose age grades was by far above 51, especially above 70,and the patients' amount of sudden cardiac death was at the most in the death amount of circulatory system. The death amount of trauma and poisoning group ranked at the 3rd, 6th respectively, whose age grades was by far among 21 ～ 50. (5)The total amount, the death amount and the sudden cardiac death amount of male patients were more than those of female patients. (6)The percentage of the death group to the pre-hospital medical care group was 5.20%, and the percentage of the sudden cardiac death group to the pre-hospital medical care group was 1.29%,and the percentage of the sudden cardiac death group to the death group was 24.87 %, and the percentage of the sudden cardiac death group to the circulatory system group was 67.33 %. Conclusions ( 1 )The trauma and the sudden cardiac death are the overriding reason of disease and the overriding reason of death in our large and medium-sized cities respectively. (2) It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular and cerebrovascular diseases, discerning the critical illness early and improving the level of pre-hospital medical care. (3)It is a strong method to decrease the total amount and the death amount of the trauma, especially in traffic accident, by strengthening safety in production, observing traffic regulation and enhancing the legal awareness.     

我国大中城市院前心脏性猝死流行病学调查分析

目的调查我国大中城市院前心脏性猝死患者流行病学情况,探讨院前心脏性猝死病例特点。方法从我国8个大中城市急救中心系统数据库中导出2008年度全部死亡数据,就其有完整记录的资料进行统计分析。结果①院前心脏性猝死的调度时间、到达时间、现场时间、返回时间、总时间、急救半径分别为（2．12±1．02）min、（14．10±7．05）min、（24．79±12．08）min、（13．79±6．61）min、（54．80±25．36）min、7．90±3．92（km）;②院前心脏性猝死的病例数以第一季度为最多,且最多时间段是8：00～10：00,最少时间段是2：00～4：00;③男性院前心脏性猝死明显多于女性,但年龄明显小于女性;④院前心脏性猝死目击者CPR为4．48％,医护人员现场CPR成功率2．26％。结论①心脏性猝死已成为我国大中城市最常见的院前死亡原因;②加强心血管病防治,提高中老年患者的常见急危重症早期识别与院前急救水平以及普及公众CPR对降低死亡有重要意义。     

泉州地区二级以上医疗机构微生物检验工作现状分析

目的了解泉州地区二级以上医疗机构微生物检验工作现状，为医学检验专业《微生物检验》课程改革提供参考。方法通过问卷调查的形式对泉州地区二级以上医疗机构的基本情况、检验人员基本情况、微生物检验设备、微生物检验项目等方面进行调研分析。结果泉州地区二级以上医院微生物检验工作总体情况良好，但不同医院之间差异较大，有待于进一步提高。结论初步了解了泉州地区二级以上医疗机构微生物检验工作的基本情况，为医学检验专业《微生物检验》课程改革提供研究基础。     

胃癌患者长链非编码 RNA 的差异表达

目的：研究胃癌患者癌组织长链非编码RNA（lncRNA）的差异表达。方法提取8例胃癌患者癌组织与癌旁对照样本中的总RNA,应用lncRNA表达谱芯片检测技术对两者之间差异表达的lncRNA进行分析。在差异表达倍数≥10的lncRNA中选择4个lncRNA（uc010lhn、uc．341、AK096257及BC048127）,利用荧光定量RT－PCR技术在细胞水平对微阵列检测结果进行验证。结果胃癌患者癌组织与癌旁对照样本间差异表达的lncRNA 共2621个,其中1215个表达上调,1406个表达下调,差异表达倍数≥10的lncRNA 22个。荧光定量RT－PCR验证结果显示,与正常胃上皮细胞系GES－1相比,4种lncRNA（uc010lhn、uc．341、AK096257及BC048127）在胃癌细胞系中的表达具有显著差异,与芯片检测结果一致。结论多种lncRNA在胃癌患者肿瘤组织中呈异常表达,其中uc010lhn及uc．341等在胃癌发生、发展过程中可能起一定的作用。     

强直性脊柱炎患者外周血Th17细胞比率及其相关细胞因子的表达

目的研究强直性脊柱炎（AS）不同疾病状态外周血Th17细胞比率及其相关细胞因子表达情况,探讨其与AS炎症活动的关系。方法41例AS患者按Bath强直性脊柱炎活动性分为活动组（n=22）和稳定组（n=19）,14例健康人作为对照。采用流式细胞术检测外周血11h17细胞比率,EMSA法检测血浆中的IL-17、IL-1β、IL-6、IL-23及肿瘤坏死因子-α（TNF-α）蛋白水平。结果活动组外周血Th17细胞比率明显高于稳定组及对照组（P〈0．05或〈0．01）。活动组血浆中IL-17平均浓度以及IL-1β、IL-6、IL-23、TNF-α等表达水平均明显高于稳定组及对照组（P均〈0．01）;IL-17、IL-1β、IL-6、IL-23、TNF-α之间呈显著相关（P〈0．05或〈0．01）。结论Th17及相关细胞因子可能与AS炎症高度活动相关。     

从自由基角度初探蝎毒及蝎毒多肽对大鼠心肌缺血的作用

目的初步探讨蝎毒(SV)及其主要成分蝎毒多肽(PSV)是否有预防大鼠心肌缺血作用以及是否对自由基造成一定作用。方法采用垂体后叶素构建心肌缺血大鼠模型,用琥珀酸脱氢酶(SDH)染色法制作心肌组织切片进行形态学观察。分光光度法检测血清及心肌组织中超氧化物歧化酶(SOD)和丙二醛(MDA)含量。结果SV组、PSV组在同等条件诱导心肌缺血情况下,其心肌细胞结构得到较好保护。自由基含量在缺血血清及缺血组织中均升高,SV和PSV能降低自由基含量,其中SOD在PSV组的缺血心肌局部甚至高于正常组。结论SV及PSV可能有保护缺血心肌的作用。     

泉州地区19F型肺炎链球菌耐药性分析及多位点序列分型研究

目的了解泉州地区临床分离株19F血清型肺炎链球菌(Streptococcus pneumoniae,SP)的耐药特征及多位点序列分型。方法 19F血清型采用多重PCR进行筛选分析,采用OP纸片法进行药敏试验测定其MIC值,采用PCR方法检测耐药基因ermB,mefE,mefA及转座子家族Tn1545转座酶基因,采用多位点序列分型(MLST)技术分析菌株序列型(ST)。结果 52株SP均表现出对利奈唑胺、替考拉宁、万古霉素的敏感;对红霉素、克林霉素、四环素、复方新诺明、青霉素G、阿莫西林、头孢噻肟、头孢吡肟、美洛培南、氯霉素、左旋氧氟沙星的耐药率分别为98.1%、98.1%、98.1%、92.3%、41.8%、38.4%、29.1%、22.6%、13.5%、9.6%、7.7%。ermB、int Tn916/Tn1545、mefE、mefA基因检出率分别为为98.1%、94.2%,75.0%、65.4%,4种耐药基因同时检出占57.7%,对红霉素、克林霉素、四环素、复方新诺明的耐药率为100%。52株SP MLST分型共分出14种STs,存在2个优势型,分别为ST271(占38.5%)和ST320(占19.2%),其中一个新的ST已被MLST数据库录入为ST10228。结论泉州地区SP耐药较为严重,且存在多重耐药,19F血清型ST271和ST320为主要流行型。     

给心脏装个“视频”

众所周知,心电图是医生获取患者心脏信息的必备检查手段,主要通过心电图机,捕捉人体心脏搏动时产生的微弱电流变化,并将其转换成可见的图形,反映心脏的活动情况。     

细菌对喹诺酮类药物耐药机制的研究进展

喹诺酮类药物是临床上最常用的抗生素之一,但是随着喹诺酮药物的广泛应用,细菌对其耐药越来越严重.细菌对喹诺酮类产生耐受的机制主要有靶位点基因的突变和细胞内药物蓄积量的减少,还有新近提出的可传递质粒所编码的Qnr蛋白的保护机制.喹诺酮药物的使用与细菌的耐药性关系密切.本文就以上几个方面作一简要综述.     

肠道黏膜M细胞与微生物相互作用机制研究进展

M细胞是黏膜免疫系统中一种特化的抗原转运细胞,能将抗原由肠腔转运到上皮下的淋巴组织,从而诱导免疫黏膜免疫应答或免疫耐受。因此M细胞被认为是启动黏膜免疫应答的＂门户＂,同时也为许多病原微生物的入侵提供突破口。研究M细胞摄取抗原的机制能为口服疫苗的设计开发提供更有效的途径。本文主要对M细胞的结构功能、M细胞摄取微生物抗原机制等方面作一简要综述。