全球突发性传染病状况及变化趋势分析

在人类发展的历史上,突发性传染病一直是造成人类的主要灾难之一,其防治已成为全球公共卫生工作中的重点.了解过去一个多世纪的传染病发生、导致的死亡人数和对人们生活的影响的总体基本状况,以及在世界各地区的分布状况和变化趋势,为应对突发性传染病提供一定的参考依据.     

A review of the contemporary evidence on rescue cervical cerclage

Background

Rescue cervical cerclage (RCC) is essentially a salvage procedure to prolong pregnancy in women with advanced cervical changes and prolapsed membranes in the second trimester. However, its effectiveness and safety remain controversial.

Objectives

To provide a comprehensive review of the contemporary evidence on RCC and evaluate which treatment modalities can be offered to pregnant women based on the best available evidence.

Search strategy

A PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords.

Selection criteria

Clinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels.

Data collection and analysis

Abstracts of 141 articles were screened and 40 articles were selected.

Main results

Evidence from retrospective and nonrandomized prospective trials shows a benefit of RCC. It may prolong pregnancy by an average of 4–5 weeks, with a 2-fold reduction in the chance of preterm birth before 34 weeks. A higher chance of failure is expected if cervical dilatation exceeds 4 cm or if membranes are bulging into the vagina.

Conclusions

The decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.     

突发公共卫生事件医疗资源调配系统设计

设计突发公共卫生事件医疗资源调配系统,介绍系统设计的总体思想、架构、数据库管理平台、软件开发平台、结构、流程等,阐述系统的功能。该系统科学可行,可减轻突发公共卫生事件对公众健康和生命安全所造成的危害。     

急性颅内血肿患者手术室抢救的临床路径

目的 制定急性颅内血肿患者手术室抢救的临床路径并评价其实施效果.方法 对46例急性颅内血肿患者的手术室急救护理进行回顾性分析,借鉴循证医学的方法,运用统筹学等相关理论,设计临床路径并实施于抢救护理中.在切皮前时间及术前物品器械准备时间方面,与以往常规抢救护理进行比较.结果 依照制定的临床路径进行抢救护理,可缩短切皮前时间和术前物品器械准备时间(均P＜0.01).结论 该临床路径符合手术室急救护理特点,对急性颅内血肿患者的手术室抢救具有重要意义.     

874例院外猝死临床分析与急救干预

目的　分析探讨院外猝死及现场复苏成败的原因,以进一步提高现场复苏成功率,强化院外猝死的急救干预。方法　收集1999年1～12月经本中心院外急救的874例猝死病历,参照Utstein模式进行资料报告方法统计,进行回顾性研究。结果　猝死前有心血管病史者占70.44%;猝死高发年龄为60～84岁,占64.48%,且男性多于女性;发病地点以家庭为主,占93.8%;先由目击者进行心肺复苏(CPR)的24例中16例复苏有效,有效率66.67%,而后再由医生进行CPR的815例中43例复苏有效,有效率仅为5.28%,二者差别有显著意义(P＜0.01);呼叫～到达现场平均间期在复苏有效组与无效组中分别为8.16分钟和9.90分钟;经除颤、气管插管后复苏有效率分别为12.59%和28.22%,面未用除颤、气管插管的有效率仅为5.89%和1.92%,二者差别有显著意义(P＜0.01);现场复苏有效58例(6.91%),复苏成功1例(0.12%)。院外猝死率在12个月中的高峰期为冬季。在平均一昼夜中的高峰点为早晨7点。结论　降低院外猝死发生率的急救干预①要识别、防治猝死的高危因素;②在人群中普及以CPR为主的初级救护知识;③努力缩短急救反应时间即呼叫～到达现场间期;④要针对不同季节和时间,及时调整急救力量。     

云南突发事件的特点：2007年云南19次突发事件的回顾性分析

目的分析云南省影响较大的突发事件的特点。方法统计和分析2007年云南省卫生厅共处置的19次在云南省内影响较大的突发事件的资料。结果19次影响较大的突发事件中,报告发病4311例,死亡100例,其中公共卫生事件9次（47．37％）,事故灾难6次（31．58％）,自然灾害3次（15．79％）,社会安全事件1次（5．26％）。结论2007年云南省影响较大的突发事件以公共卫生事件为主,事故灾难、自然灾害的危害性也很大。     

Emergent treatment of patients with traumatic aorta ruptures

Objective ： To discuss our experience on the diagnosis and treatment of thoracic aorta rupture （TAR） that is one of the main common causes of death in the victims under blunt chest trauma. Methods： Between July 2001 and March 2006, 9 patients （6 men and 3 women, aged from 20 to 54 years ） suffering from acute traumatic aorta rupture after motor vehicle accidents received emergent surgical treatments in our hospital. Based on our experience in the rescue of the first TAR patient we introduced a practical procedure on the diagnosis and treatment of TAR in our department. All the other patients generally followed this procedure. Eight patients received contrast material enhanced helical computerized tomography scan before the operation. The leakage of coustrast medium from the aorta isthmus was found, and diagnosis of TAR was confirmed. Seven patients underwent immediate operation within 14 hours after accidents. One patient was treated on the 5th day of the accident because of delayed diagnosis of aortic rupture. All patients received general anesthesia with double lumen endotracheal tube and normothermic femoro-femoral partial cardiopulmonary bypass, with beating heart and aortic clamping. One patient received simple repair, and others received partial replacement of thoracic aorta with artificial vascular graft. Results： Seven TAR patients were successfully salvaged. Three patients combined brain injury as well as extremitiy hemiplegia before operation. After treatments one was fully and two partially recovered without paraplegia. Conclusions： Proper practical protocol is emphasized for the surgical repair of TAR because it will reduce the mortality of severe blunt chest injury.     

急诊胃镜对肝硬化非食管胃底静脉曲张破裂出血的诊疗价值

目的 探讨急诊胃镜对肝硬化非食管胃底静脉曲张破裂出血(non-esophageal variceal bleeding, NEVB)的诊疗价值.方法 回顾2003年1月～2008年1月我院肝硬化上消化道出血患者采取急诊胃镜检查130例,快速尿素酶试验和14C呼气试验(14C-UBT)检测幽门螺杆菌(Helicobacter pylori,H.pylori)感染情况,分析总结其中45例非食管胃底静脉曲张破裂出血临床诊治情况.结果 127例得到了确诊,确诊率为97.7%,其中非食管胃底静脉曲张破裂出血45例,占34.6%,以门脉高压性胃病(portal hypertensive gastropathy,PHG)和肝源性溃疡(hepatogenic ulcer, HU)居多.内镜下止血治疗14例,肝硬化并食管胃底静脉破裂出血者(EVB)H.pylori阳性率(38.8%)低于非食管胃底静脉破裂出血者(42.2%),但两者之间差异无统计学意义(P＞0.05),根除H.pylori者再次出血率低.结论 对肝硬化合并上消化道出血患者,最好行急诊胃镜检查,其诊断率高;非食管胃底静脉曲张破裂出血给予内镜下止血及内科治疗,效果确切,同时根除H.pylori有助于预防再次出血.     

46例孕产妇死亡原因分析

目的:了解射洪县孕产妇死亡原因及影响因素。方法:对县妇幼保健院收集我县1996年-2008年度孕产妇死亡病例进行回顾分析。结果:1996年-2008年活产婴儿数87571人,孕产妇死亡46例,死亡率52.53/10万,死亡原因首位是产科出血27例(58.7%),妊娠期高血压病4例(8.7%),羊水栓塞1例(2.1%),合并内科疾病14例(30.4%);死亡地点在家及个体诊所14例(30.4%)、乡镇卫生院13例(28.3%)、县城医疗机构19例(41.2%)。结论:加强孕产妇保健管理,取缔非法接生,提高基层产科人员和医疗机构处理妊娠合并症与并发症的急救能力,是降低孕产妇死亡的关键。