无国界医生在救援中备灾的重要性

无国界医生致力于应对天灾和战祸所引起的人道医疗危机。灾后实时爆发的人道医疗危机包括急性的外科创伤问题和基础医疗系统的破坏导致疫症发生。本文介绍了无国界医生的救援经验以及专业的备灾体系。     

成批硫化氢中毒抢救的组织与管理

目的 :探讨成批硫化氢中毒患者抢救时的组织与管理。方法 :由护理部及监护室护士长统筹安排 ,将 15位患者分成由 7个监护小组组成的 7个监护小单元实施程序化抢救 ,并统一调配抢救物资、器械。结果 :14例患者抢救成功治愈 ,1例患者心肺复苏成功后死于多脏器功能衰竭。结论 :有效、合理的护理组织与管理 ,能够争取抢救时间 ,提高成批硫化氢中毒患者的抢救成功率。     

体外膜肺氧合技术在ECPR手段救治心脏骤停患者中的应用效果

目的探讨体外膜肺氧合技术(ECMO)在体外心肺复苏(ECPR)手段救治心脏骤停患者中的应用效果。方法回顾性分析2017年1月至2020年1月我院收治的15例心脏骤停患者的临床资料,均在ECPR治疗中应用ECMO,分析治疗效果。结果15例患者的存活出院率为53.33%(8/15);15例患者ECPR时间(85.69±10.84)min,体外膜肺氧合治疗时间(92.04±15.26)h,重症监护病房住院时间(7.55±1.15)d;存活组ECMO复苏后48 h的平均动脉压高于死亡组(P<0.05)。结论心脏骤停患者ECPR救治中应用体外膜肺氧合技术效果理想。     

我国空中医疗急救发展现状与体系构建建议

目的 探讨我国空中医疗急救发展现状及体系构建策略。方法 基于现有资料分析我国空中医疗急救发展现状、模式、问题与挑战。结果 近年来我国通航企业及飞行器数量发展迅速,但是存在总体不足、多数通航企业规模较小等问题。空中急救网络主要有航空公司主导、医院或急救中心主导、通航企业-医院联合和政府主导4种发展模式;各模式均为自由发展,距离国家规划的目标尚远;现有体系内要素分散、结构不完整,大范围的空中急救网络尚未形成。结论 我国地形复杂,建成覆盖面广、运行模式统一的空中医疗急救网络困难较大,建议全国范围内构建多个主体共同参与的多元化区域性空中急救体系,而在青藏高原及周边区域优先构建公益性空中医疗急救体系。     

急性重度有机磷中毒24例救治体会

目的 探讨重度有机磷中毒患者的救治方法，提高救治率。方法 分析ICU24例急性重度有机磷中毒患者的救治情况。结果 抢救成功19例(79％)，5例死亡(21％)，结论 死亡患者与阿托品化、氯磷定重复使用不够有关。认为及时、反复、彻底、正确洗胃，突击、堆持，逐步解除阿托品化，氯磷定等足量重复使用尤为重要。     

25起职业性急性中毒事故分析

目的了解杭州市重大职业性急性中毒事故发生的原因及其救援情况，进一步提高对重大事故的防范和管理。方法收集杭州市１３年间发生的２５起重大职业性急性中毒事故的劳动卫生调查资料，对事故发生的行业、企业、毒物品种采用流行病学分析方法进行统计分析。结果２５起事故共发生中毒１３１人，死亡２２人，乡镇企业的发生率超过国有企业；引起中毒的毒物共１０种，发病人数在前５位的毒物依次为硫化氢、苯、一氧化碳、光气和有机磷农药；１３１名中毒人员中因救援中毒４０人，死亡８人，救援人员中毒和死亡率高于直接作业工人。结论发生事故的原因以缺乏防护知识最为突出。本研究结果为建立基层应急救援体系提供参考依据。     

Influence of trial design,heterogeneity and regulatory environment on the results of clinical trials: An appraisal in the context of recent trials on acute stroke intervention

The outcome of randomized controlled trials can vary depending on the eligibility criteria of the patients entering into the trial, as well as the heterogeneity of the eligible population and/or the interventions. If the subject population and/or interventions are heterogeneous, the final outcome of the trial depends on the degree of concordance of effects of the subgroups of interventions on the subgroups of the subject population. The considerations that go into the calculation of sample size and determination of the study stopping rules also would affect the nature of the outcome of the study. In this paper we try to examine these phenomena with respect to the recent trials on endovascular therapy in acute ischemic stroke.     

优质护理对急性心肌梗死患者的临床疗效观察

目的评估优质护理对急性心肌梗死临床疗效的影响。方法选择2014年1月-2015年8月我院收治的100例急性心肌梗死患者,实施优质护理,分析患者溶栓效果,从就诊到静脉溶栓的时间、患者死亡率、并发症的发生率和患者满意度几方面进行评估。出院后对患者进行12个月的随访,记录患者的恢复情况,并发症和死亡率。结果患者溶栓再通率为91%,从就诊到静脉溶栓的平均时间为(51.3±16.9)min。治疗过程中,无死亡病例,2例患者出现牙龈出血,1例患者出现上消化道出血,经对症治疗后均好转,其余患者未出现严重并发症。整个治疗过程中患者积极配合,依从性高,患者满意度达100%。12个月随访期间,患者心绞痛未复发。1例发生充血性心力衰竭,经治疗后好转,其余患者恢复良好。结论优质护理有利于提高急性心肌梗死患者的治疗效果和预后,降低死亡率和并发症发生率,提高患者满意度。     

Mortality predictors in complicated patients after anatomical lung resection

IntroductionFailure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.MethodPatients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.ResultsA total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77–0.88).ConclusionsOverall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.