上海市头部外伤患者急诊流行病学特征

目的 了解我国上海市头部外伤急诊患者的就诊时间分布和流行趋势.方法 采用前瞻性资料收集的方法 ,对2004年1月至2004年12月在参加调查的上海市12家医院急诊首诊的头部外伤病例进行调查,并填写统一的调查表,内容包括年龄、受伤时间、致伤原因等.运用STSS 11.5统计学软件包对数据进行描述性分析和:检验.结果 本研究共收回调查表19 532份,去除重复病例和缺项较多的调查表后,共得到有效调查表18076份(占92.55%).病例男女性别比为2.11:1.女性患者年龄>性(t=10.575,P<0.01).20～29岁年龄组为最高发患者群,占24.7%.本市常住病例占所有统计病例的34.2%.12、1、3月份和8月份头部创伤急诊患者明显多于其他月份;而19:00-21:130,16:00-19:00和10:00-12:00为就诊高峰时段.5.1%患者的致伤原因与工作相关.就致伤原因而言,儿童组(<14岁)和老年组(>60岁)以坠落伤为首要致伤原因(分别占66.9%和48.4%);青少年组(15～34岁)以暴力击打伤最为常见(占3_4.2%);中青年组(35～59岁)以交通伤占第一位(占37.7%).受伤情况以头皮损伤(占40.2%)最为多见.85.8%的患者在就诊时接受了CT检查.71.1%的患者在急诊后自行离院,0.5%的患者死亡.结论 上海市头部外伤急诊患者在年龄、就诊时间、致伤原因等方面有一定的规律性,掌握头部外伤急诊患者的流行趋势将有助于医院合理安排急诊医疗资源.     

护理人力资源管理在急诊科中的应用

目的:了解急诊患者的就诊特点,为急诊科护理人力资源配备及合理使用提供依据。方法:采用回顾性分析法收集2010年1月～2011年12月山东省某三级甲等综合性医院急诊科就诊120 717例次的资料。结果:急诊总量达120 717例次。急诊患者最多的科室为内科76 686例次(63.53%),最少的为皮肤科1 320例次(1.09%)。急诊患者最多的月份为9月5 631例次,最少的月份为3月4 574例次,每月就诊(5 030±376)例次。24 h内急诊患者最高时段分布在18:00～20:00,最低时段在凌晨2:00～4:00。急诊患者年龄分布:14岁以下占4.83%,14～39岁占48.94%,40～59岁占24.53%,60～79岁占17.22%,80岁及以上占4.48%。结论:急诊患者就诊量大,且就诊时间分布有一定规律,建议管理者根据患者就诊科室、时段特点,科学合理地安排护理人力资源,以提高就诊效率,保证护理质量。     

急诊留观患者的疾病谱及流行病学特征

目的:研究急诊留观患者的疾病谱及流行病学特征。方法:回顾分析2005年1月1日—2009年12月31日在山西医科大学第二医院急诊科就诊且具有完整病史记载的20 331例留观患者的临床资料,按国际疾病分类标准第10版(international statistical classification of diseases,injuries and causes of death,10th revision,ICD-10)进行疾病分类,并对患者年龄、性别、病种、就诊时间等进行统计。结果:(1)急诊留观患者的前6大病种依次是:外伤中毒和其他外因所造成的特定影响、循环系统疾病、消化系统疾病、呼吸系统疾病、神经系统疾病及血液和造血器官及涉及免疫机制的疾患,其中前2大病种占前6大病种的51.33%。(2)循环系统疾病的患者就诊年龄最大,为(61.20±15.91)岁;精神和行为障碍患者的就诊年龄最小,为(32.34±11.32)岁;(3)男女性别构成比在各大病种中存在显著差异(P<0.001);(4)日就诊时间主要集中于16∶00～24∶00,该时间段就诊的患者人数占每日患者总人数的42.57%,就诊高峰点为22∶00左右;(5)前6大病种就诊时期呈季节性特点。(6)急诊前10位的诊断或主诉依次是损伤、冠心病、内科腹痛、外科腹痛、脑血管疾病、急性中毒、上呼吸道感染、头晕或头痛、心衰和心律失常以及贫血,占全部患者的67.38%。其中损伤占16.50%、腹痛(包括内科和外科腹痛)占14.66%、冠心病占9.98%。结论:应根据急诊留观患者的疾病谱及流行病学特点,合理安排急诊资源,确立学科建设重点和人才培养方向,以适应新形势下急诊发展和管理的需要。     

新冠肺炎疫情期间县级综合医院门诊发热患者临床资料的统计分析

目的 研究2020年1月20日至2020年7月19日新冠肺炎疫情期间郸城县人民医院门诊发热患者的就诊资料。方法 及时了解门诊发热患者的病例资料进行分析:包括性别、年龄、就诊时间、就诊诊室、临床诊断、去向、流行病史等进行统计调查分析。结果 就诊患者共1 2291例;男女比例为1. 15:1;年龄(14. 60±18. 12)岁,高发年龄组为0～10岁组;每日19:00-23:00为来诊高峰时间;其中,儿科门诊应诊患者(0～14岁) 6 208例,占50. 51%,发热门诊应诊3 627例,占29. 51%,急诊科应诊2 457例,占19. 99%;前三位的疾病分别是上呼吸道感染、扁桃体炎、肺炎;新型冠状病毒肺炎确诊患者3例,新型冠状病毒肺炎疑似患者20例。结论 在基层医院,小儿发热患者数量庞大,应与成人发热患者分开管理;发热门诊和急诊科是防控传染病的重点科室,同时也是力量薄弱科室,应加大人力、物力和管理投入,构建发热门诊、急诊一体化的医疗服务体系。     

上海嘉定南翔地区839例院前急救与转运患者的疾病谱分析

目的了解上海嘉定南翔地区院前急救与转运患者的疾病谱。方法对839例院前急救与转运患者的性别、年龄、呼叫时间、急诊诊断或主诉、不同病种求治人数、院前死亡病种、出车情况等进行分析。结果院前急救与转运患者839例中,男女比为1.66∶1,平均年龄49.6岁;每天9∶00~12∶00和15∶00~18∶00为出诊高峰时间;院前急救疾病谱排序的前5位依次是:颅脑损伤、下肢外伤、脑血管意外、新生儿窒息、早产儿;院前死亡疾病谱排序依次是:交通伤、中毒、溺水等。结论提高院前急救水平对人类健康和学科建设有重大意义,可根据院前急救的疾病谱排序特征制定急救工作重点,急诊诊断或主诉,对指导急诊专业人员培训有意义。     

270003例Ⅰ～Ⅲ级急诊患者流行病学研究

目的:对我院急诊科Ⅰ～Ⅲ级患者的流行病学特点进行分析,为明确学科发展问题和学科发展规划提供数据支持。方法:通过医院急诊预检分诊管理系统收集2017-01—2018-12期间急诊科Ⅰ～Ⅲ级患者的基本信息和就诊资料,分析流行病学特点。结果:2017—2018年我院急诊科共收治患者352 670人次,其中Ⅰ～Ⅲ级患者271 428人次,占77.0%。本研究纳入资料完整者270 003人次,资料有效率为99.5%。Ⅰ、Ⅱ、Ⅲ级的就诊患者分别为764、7 225、262 014人次,占0.3%、2.7%、97.0%。男女比例为0.81∶1,平均年龄(52.74±19.81)岁。2017年全年高峰期为9、10、12月,2018年全年高峰期为4-6月和12月;全天就诊高峰集中在9:00-10:00和19:00-20:00。56.2%的急症患者来自外区,医保持卡者占65.7%。来院方式以家属陪同、步行入院为主。急诊内科、神经内科和外科收治患者最多,分别占44.4%、22.9%和7.9%。疾病谱排名前3位的为脑血管疾病、呼吸系统疾病和心血管疾病。结论:要合理分流患者,缓解急诊拥挤现象。根据急诊患者的就诊密度,科学配置人员,合理安排工作。应加大急救技术的教育力度,关注急诊慢性病患者健康教育。     

老年病人急诊特点调查分析

目的 了解急诊科老年急诊就诊病人的疾病谱及相关信息,掌握24 h中就诊高峰时段及其它方面的流行病学资料,以明确老年人急诊就诊特点,为更好地在家庭、社区有针对性地对老年人开展疾病的预防、康复护理,提高老年人健康水平及减少老年人急症发生率提供参考依据.方法 设计电子表格,将2006年9月1日～2007年8月31日来我院急诊科就诊病人中大于60岁的老年急诊病人的相关信息,包括有姓名、性别、年龄、就诊时间、诊断等,输入到Excel软件中,进行统计分析.结果 年龄大于60岁的老年急诊病人有3 486人,占总急诊人数19.7%,男女之比为1.42:1.疾病谱排序中前6位的依次为:神经系统疾病、循环系统疾病、呼吸系统疾病、消化系统疾病、外科疾病、创伤类疾病;急诊就诊高峰时段相对集中在9:00～11:00,14:00～16:00,19:00～22:00.结论 根据急诊老年病人的就诊特点,科学合理地安排工作,提高救护质量.     

急诊病人就诊规律分析

目的:探讨和研究急诊病人的就诊特点及规律,为更好地进行护理人力资源的分配和管理提供参考依据.方法:采用回顾性调查分析法,确定北京某三级甲等综合性医院2018年1月-2018年7月上半年急诊就诊的69 662例病人作为研究对象,借助信息中心计算机系统,采用计算机病例管理系统对2018年1月-2018年7月急诊病人的就诊时间、就诊科室进行统计分析.结果:在69 662例急诊病人中,就诊前三的科室为内科、神经内科和神经外科,分别占31.51％、21.85％和13.84％;就诊高峰时间为08:00～12:00、16:00～20:00和19:00～22:00;就诊数量最高月份为1月份.结论:护理管理者应根据急诊科病人不同的就诊节律进行合理的人力资源分配,加强急诊护士专业技能培训,让急诊病人在最短的时间内得到迅速、高效的诊治.     

急诊观察室患者流行病学分析及对策

目的总结分析急诊观察室患者流行病学特点及临床疗效,为临床急诊治疗提供指导。方法以2007年1月-2010年12月收治的247 312例急诊观察室患者为研究对象,按年龄、性别、地域分布、疾病种类、发病时间、好转率、收入院百分率、死亡率等因素进行流行病学分析。结果各年度患者人数呈增加趋势,2010年减缓;城镇患者占91.5%;20～40岁患者占45.9%,40～60岁患者占27.2%,>60岁占21.3%;疾病种类分布中呼吸系统占42.4%,心血管疾病患者数量呈升高趋势,以老年人为主,中毒患者呈下降趋势。全年6、7、8月份因发热、上呼吸道感染患者较多,总数增加明显,其次11、12、1月份因慢性支气管炎急发患者较多,总数也有升高趋势;白天工作时间患者数量占66.2%;平均每天就诊人次为169.4人次,节假双休日平均每天就诊人次为191.1人次(P<0.01);各年度好转率呈升高趋势,收入院百分率无显著变化,死亡率无显著区别。结论近年急诊观察室患者以呼吸系统疾病为主,好转率呈升高趋势,但心血管疾病数量呈升高且有年轻化趋势,值得重视。     

急诊神经内科患者445例分析

目的分析急诊神经内科患者的病例特点。方法收集1 a内445例急诊神经内科患者的临床资料,分析其年龄、主诉、诊断的特点及规律。结果患者年龄有两个高峰,分别为15~30岁、50~60岁;以头晕类症状为主诉的患者最多,占35.7%;脑血管病为首位高发疾病,占38.2%。结论重视急诊神经内科的主要就诊人群、常见症状的鉴别、高发疾病的诊治;重视急诊神经病学流行病学的研究。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.