广州市97 823例院前急救患者流行病学分析

目的 调查广州市院前急救患者流行病学情况,探讨院前急救病例特点.方法 从广州市急救医疗指挥中心系统数据库中导出2008年度全部数据进行统计分析.结果 ①在969 410次呼叫量中,日时间分布以16:00-18:00为最高(114 224次、占11.78%),以04:00-06:00为最低(23 237次、占2.40%).②在109 682次出车中,白云区出车量最多(29 364次、占26.77%),其次是海珠区(20 069次、占18.30%)、天河区(19 962次、占18.20%).③在97 823例院前急救患者中,男性的比例与死亡率均明显高于女性[比例:57.65%(56 394)比38.48%(37 641),死亡率:59.17%(3 269)比33.95%(1 876)].④在97 823例院前急救患者中,创伤类是院前急救中最多的,占34.57%(33 820),尤其是交通意外,占11.56%(11 307);且以21～50岁青壮年者最多;其次分别是神经系统、循环系统、呼吸系统、消化系统急症,且均以51岁(尤其是70岁)以上的中老年者最多.⑤在97 823例院前急救患者中,共死亡5 525例,占5.65%.循环系统急症死亡(尤其是猝死)居首位(1 827例、占33.07%),其次分别为其他系统急症死亡(1 646例、占29.79%)、创伤类死亡(866例、占15.67%)、呼吸系统急症死亡(413例、占7.48%)、神经系统急症死亡(329例、占5.95%);其中循环系统、呼吸系统、神经系统急症死亡均以51岁(尤其是70岁)以上的中老年者最多,其他系统急症死亡以61岁以上的老年者最多,创伤类死亡以21～40岁中青年者最多.结论 ①加强心脑血管疾病和呼吸系统疾病防治,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对降低死亡有重要意义.②加强安全生产、遵守交通法规、强化法制意识是降低创伤,尤其是交通意外发生及其死亡的有力手段.

Abstract：

Objective To investigate the epidemiological information of patients in pre-hospital medical care in Guangzhou city, and to explore the characteristics of the patients. Methods The data in the year of 2008 were retrieved from the computer database of Guangzhou Emergency Medical Rescue Command Center. Results ①In a total of 969 410 calls received, the time of distribution was found to be mainly between 16:00 and 18:00 [11.78% (114 224)], and least frequently between 04:00 and 06:00 [2.40% (23 237)]. ②Among 109 682 dispatches of ambulances, Baiyun district received the most [26.77% (29 364)], and followed by Haizhu district [18.30% (20 069)], Tianhe district [18.20% (19 962)], respectively. ③Among 97 823 cases of pre-hospital medical care, death rate of the male patients was higher than the female [amount: 57.65% (56 394) vs. 38.48% (37 641), mortality: 59.17% (3 269) vs. 33.95% (1 876)]. ④In 9 7823 cases of pre-hospital medical care, trauma constituted the highest rate [34.57% (33 820)], especially traffic accidents [11.56% (11 307)], and the age of most of the patients ranged between 21 and 50. Disease of the nervous system ranged the second, followed by diseases of circulatory system, respiratory system and digestive system, and most of them were over 51 years old, and most frequently above 70. ⑤In 97 823 cases of pre-hospital medical care, there were 5 525 deaths (5.65%), in whom the circulatory system diseases ranged first (especially sudden death) [33.07% (1 827)], followed by unclassified diseases [29.79% (1 646)], trauma [15.67% (866)], respiratory diseases [7.48% (413)], and neurological emergency illnesses [5.95% (329)]. The age of deceased was far older than 51, particularly 70. The age of most of the deceased was above 61, and age of traumatic death was 2140. Conclusion ①It is very important to reduce the death rate of the middle-old aged patients by strengthening prevention and timely treatment of cardiovascular and cerebrovascular diseases, and improve the medical strategies in emergency care, in order to lower the death rate during emergency. ②It is very important to emphasize safely in production lines and to strengthen traffic regulations in order to reduce the incidence of trauma, thus it is especially traffic accident, expect that the death rate of trauma could be lowered.     

广州市2001年至2010年突发群体事件院前急救分析

目的 分析2001年至2010年10年间广州市院前急救中突发群体事件的类型、特点及发展趋势.方法 从广州市急救医疗指挥中心数据库中获取广州市2001年至2010年突发群体事件全部数据,对其进行统计学分析.结果 2001年至2010年广州市急救中心共记录突发群体事件累计6 807起,导致26 749人受伤和917人死亡.在各类意外事件中,车祸无论从发生数量、伤患者数和死亡人数在各类突发事件中都居首位(分别占49.80％、55.29％和61.72％),其次为斗殴、火灾和中毒.车祸的发生数量和伤患者数呈上升趋势.2008年至2010年,大型突发群体事件在不同级别的突发群体事件中占76.65％.结论 车祸是广州市近10年来突发群体事件中导致伤亡的主要原因,车祸的事件数量、伤患者数都呈上升趋势.在各级别的突发事件中,大型突发事件是造成主要伤亡的级别.因此,有必要完善相应的应急预案,加强医护人员专业培训,定期开展突发群体事件医疗救援模拟演练.     

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。     

广州市5525例院前死亡患者流行病学分析

目的 调查广州市院前死亡患者流行病学情况,探讨院前死亡病例特点.方法 从广州市急救医疗指挥中心系统数据库中导出2008年度全部死亡数据进行统计分析.结果 院前非心脏性猝死与院前心脏性猝死患者均以白云区最多,其次是海珠区、其他区.院前非心脏性猝死组调度时间、到达时间、院前急救总时间均少于院前心脏性猝死组(P＜0.01),分别为调度时间(2.69±1.24)min vs(2.85±1.29)min,到达时间(11.28±5.57)min vs(12.72±6.43)min,院前出车总时间(42.97±20.68)min vs(44.96±21.18)min,院前非心脏性猝死组的现场时间和急救半径多于院前心脏性猝死组(P＜0.05或＜0.01),现场时间(18.99±7.96)min vs(17.53±7.52)min,急救半径(6.52±3.26)km vs(6.29±3.16)km.院前非心脏性猝死与院前心脏性猝死患者均以1～3月和8:00～10:00最多.在5 525例院前死亡中,其他类的死亡位居第一,循环系统(尤其是心脏性猝死)、呼吸系统、神经系统类的死亡分别位居第二、第四、第五,创伤类的死亡位居第三,＞70岁年龄段死亡最多.男性院前总死亡与院前心脏性猝死均明显高于女性.结论 院前死亡患者的病情复杂,出车医师难以在短时间内明确诊断,加强这方面工作极为重要.心脏性猝死与创伤死亡分别以中老年、青壮年阶段为高发,并已成为院前死亡的主要原因.     

耳鼻咽喉头颈外科采用护理风险管理的效果观察

目的对应用护理风险管理模式对耳鼻咽喉头颈外科的护理服务工作进行管理的效果进行研究分析。方法抽取78例耳鼻咽喉头颈外科就诊患者病例,将其分为对照组和实验组,平均每组39例。对照组患者在治疗期间对护理服务实施常规管理模式;实验组患者在治疗期间对护理服务实施风险管理模式。结果实验组患者住院时间明显短于对照组;患者对护理服务的满意度明显高于对照组;不良事件的发生率明显低于对照组。结论应用护理风险管理模式对耳鼻咽喉头颈外科的护理服务工作进行管理的效果非常明显。     

广州市院前急救患者流行病学调查分析

目的：分析广州市中心城区院前急救患者的流行病学特征。方法：分析2010年广州市急救医疗指挥中心系统数据库中广州市中心城区所有院前急救患者的资料,观察急救出车的时间分布情况,患者性别、年龄、疾病谱和死亡原因等。结果：2010年,1、7、8、9月份是出车急救的高峰,9：00～10：00和20：00～23：00是出车的高峰时段;广州市中心城区院前急救患者110652例;男女比例为1．51：1：70岁以上（23．14％）、31～40岁（14．93％）、21～30岁（19．83％）患者所占比例较高;前5位疾病依次为创伤类（34．79％）、神经系统急症（21．79％）、循环系统急症（8．92％）、常见急性中毒（7．28％）、呼吸系统急症（6．90％）。结论：提高创伤院前急救的技术水平,建立绿色通道;对有猝死高危因素的患者启动快速现场急救反应,是提高生存率的关键：根据呼叫出车密度和疾病谱．科学合理地安排院前急救工作．     

ZL-9100全自动血流变仪的使用及故障处理

血液流变学是研究血液流动和血球变形规律的一门新的医学分析学科。近十多年来,血液流变学在临床的应用越来越广泛,在疾病的诊断、治疗,疾病的发展和预防方面均具有非常重要的意义。1检测原理ZL9100全自动血流变仪是北京众驰伟业科技发展有限公司产品之一,它采用国际先进的锥/板式测量方式及毛细管法测量方式。它通过一个低惯性的转矩电动机对被测试流体施加一个受控应力,驱动轴由一个低阻力磁浮轴承保     

救治模式对不同程度急性心肌梗死治疗成本和效益的影响

目的探讨120-三甲医院CCU和120-二甲医院两种分流救治模式对不同程度急性心肌梗死患者治疗成本和效益的影响。方法由广州市“120”急救指挥中心提供资料，纳入2003年10月至2005年12月期间分流到广州市三甲医院进入CCU和分流到广州市二甲医院的急性心梗患者，分别按照梗死部位及严重并发症发生情况进一步分为单纯心梗组和复杂心梗组。在出院后半年进行随访，记录其住院总费用、住院期间死亡率，用SF-36量表量化其短期健康状况。以单因素方差分析及卡方检验比较两组间住院费用、死亡率、生活质量的差别。结果相对120-二甲医院模式，120-三甲医院CCU模式下单纯心梗组住院费用较高（P=0．016），住院死亡率无差别，社会功能、情感角色、心理健康、总体健康状况得分方面较高（P〈0，05）；复杂心梗组住院费用较高（P=0．011），住院死亡率较低（P〈0.01），躯体功能、一般健康状况、生命力、社会功能、情感角色、心理健康、总体健康状况得分方面较高（P〈0．05）。结论120-二甲医院CCU模式能为梗死面积大、伴有严重并发症的复杂AMI患者提供更好的治疗效率。分流救治模式的选择对该类患者生存和短期预后的作用不容忽视。     

经阴道超声监测不孕症患者自然月经周期卵泡发育的意义

目的探讨B超监测卵泡发育对不明原因不孕患者的病因学诊断意义及评价黄素化未破裂综合征的治疗效果。方法回顾性分析81例不孕患者阴道B超监测排卵情况,并对其中的24例黄素化未破裂综合征患者进行了37个周期的促排卵治疗。结果 81例不明原因不孕的患者有24例（29.63%）表现为黄素化未破裂综合征,高于对照组的10例（15.38%）,组间差异有统计学意义（P〈0.01）。81例患者共监测了132个周期的卵泡发育情况,黄素化未破裂综合征的周期占46.97%（62/132）,有35例进行了2次以上的监测,20例重复出现黄素化未破裂综合征,重复出现率为57.14%。结论黄素化未破裂综合征是造成不孕征的重要原因之一,B超监测是诊断黄素化未破裂综合征的主要方法,B超监测不明原因不孕患者的卵泡发育,有利于诊断和治疗时机的选择。