我国八个大中城市院前急救流行病学调查分析

目的 调查我国大中城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年度全部数据,就其有完整记录的资料进行统计分析.结果 (1)院前急救组调度时间、到达时间、现场时间、返回时间、出车总时间、急救半径分别为(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和(8.50±4.18)km,院前非死亡组分别为(2.19±1.13)min,(14.15±7.14)min,(11.60±6.72)min,(14.92±6.89)min,(41.86±19.53)min和(8.63±4.31)km,院前死亡组分别为(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和(7.86±3.91)km,院前非心脏性猝死组分别为(2.09±1.03)min,(13.58±6.78)min,(25.53±12.34)min,(13.60±6.54)min,(53.79±23.77)min和(7.67±3.86)km,院前心脏性猝死组分别为(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和(7.90±3.92)km.院前死亡组的调度时间、到达时间、返回时间、急救半径均明显小于院前非死亡组,前组的现场时间、出车总时间均明显大于后者(P＜0.05或P＜0.01).院前心脏性猝死组的调度时间、返回时间与院前非心脏性猝死组的差异无统计学意义(P＞0.05),但前组的到达时间、出车总时间、急救半径均明显大于后组,而现场时间明显小于后组(P＜0.05或P＜0.01).(2)院前急救组、院前非死亡组、院前死亡组、院前非心脏性猝死组、院前心脏性猝死组的病例数均以第一季度为最多,其最少时间段分别是4:00-6:00、4:00-6:00、4:00-6:00、22:00-24:00、2:00-4:00,其最多时间段分别是20:00-22:00、20:00-22:00、8:00-10:00、2:00-4:00、8:00-10:00.(3)在241 876例院前急救病例中,创伤类患者是院前急救中最多的,年龄以21～50岁青壮年最多;其余依次是神经系统、循环系统、其他、消化系统、呼吸系统、中毒类,且神经系统、循环系统、呼吸系统类均以51岁(尤其是70岁)以上的中老年最多;其他、消化系统类均有两个高峰年龄段,其一是21～30岁青年阶段,其二是70岁以上的老年;中毒类以21～50岁青壮年最多,其中急性酒精中毒是最常见的病因.(4)在12 568例院前死亡病例中,循环系统、其他、呼吸系统、神经系统、消化系统类的死亡分别居第一、二、四、五、八位,均以51岁(尤其是70岁)以上的中老年最多,其中心脏性猝死又是循环系统类的死亡中最多的;创伤、中毒类的死亡分别居第三、六位,均以21～50岁青壮年最多.(5)男性患者院前急救的数量、总死亡量及院前心脏性猝死均明显高于女性.(6)院前死亡患者占院前急救的5.20%,院前心脏性猝死占院前急救的1.29%,院前心脏性猝死占院前死亡的24.87%,院前心脏性猝死占循环系统类死亡的67.33%.结论 (1)创伤与心脏性猝死已分别成为我国大中城市最常见的院前急救和致死原因.(2)加强心脑血管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率有重要意义.(3)加强安全生产、遵守交通法规、强化法制意识将是降低创伤,尤其是交通意外伤发生及其死亡的有力于段.     

东莞市镇区创伤院前死亡病例分析

目的:探讨严重创伤院前死亡病例的临床特点和高危因素。方法:回顾性分析本院2000～2005年创伤院前死亡患者285例的临床资料。结果:本组创伤院前主要致死原因是交通伤(73.3%),其次是坠落伤(12.6%);现场或送医院已经死亡214例(75.1%),途中死亡13例(4.6%),急诊科死亡58例(20.4%);91.2%的患者是多发伤;急救反应时间为15.3min。结论:尽快健全急救医疗服务体系(EMSS),努力提高急救人员对严重创伤的救治水平,普及全民的急救意识,可最大限度地降低创伤院前死亡率。     

上海市某城区近5年来院前急救患者疾病谱及流行病学变化分析

目的:分析上海市院前急救患者疾病谱变化和流行病学特点。方法:回顾性分析2013-01-01—2017-12-31期间上海市闵行区236 723例院前急救患者病例资料,收集患者的性别、年龄、出诊时间、疾病类型等进行统计分析。结果:近5年来上海市闵行区院前急救病例数呈逐年上升趋势,男女比例为1.33∶1,其中20～29岁和80～89岁分别为两个发病小高峰。在疾病谱排名方面,创伤一直居于首位,且呈逐年增加的趋势。在院前急救呼救时间分布方面,院前急救患者的呼救小高峰期为8:00～11:00,其中8:00～9:00为最高峰。结论:通过对院前急救疾病谱的分析,有助于以疾病谱为依据,对急救资源和人员配备进行调整和加强,做到有备无患,全面提高应急能力。     

6928例创伤的院前急救特点

目的探讨院前创伤急救的组织实施及救治技术当前的特点。方法回顾性分析总结2000年12月至2003年12月我院“120”出诊急救的创伤病人6928例救治资料。结果21～50岁占79.30%;伤因:交通伤39.00%、治安事件伤30.00%、工伤及坠落伤10.74%;伤情按院前创伤指数(TI)分:重伤病人20.99%,中度伤38.11%;院前急救成功率96.43%,现场心肺复苏成功率12.97%。结论控制救治反应时间,落实“三线出诊”机制,实施有效的现场急救技术,完善急救及转运设备,建立专业化、专职化的急救队伍是提高创伤救治成功率的关键。     

武汉市江汉区2198例院前急救患者流行病学分析

目的：调查武汉市江汉区院前急救患者流行病学情况,探讨院前急救病例的特点。方法：对从武汉市急救中心系统数据库中导出的2008年度武汉市江汉区全部数据进行统计分析。结果：（1）院前急救患者总的调度时间、到达时间、现场时间分别为2.24±1.05（min）、16.41±7.82（min）、12.39±6.17（min）,急救半径为9.17±4.36（km）。其中院前死亡患者的调度时间、到达时间、现场时间分别为2.17±1.13（min）、15.86±8.17（min）和23.26±11.39（min）;急救半径为8.96±4.28（km）,院前心脏性猝死患者分别为2.26±1.08（min）、16.23±7.94（min）和22.97±10.48（min）;急救半径为9.25±4.13（km）。院前死亡及院前心脏性猝死患者到达现场时间明显长于未发生院前死亡的患者（P〈0.01）。（2）院前急救,包括院前死亡及院前心脏性猝死患者均以第1季度为最多。（3）在2 198次院前急救中,创伤类居首位,年龄以21~50岁青壮年段最多;其次分别是循环系统、神经系统、呼吸系统、消化系统等疾病。（4）创伤类的死亡位居首位;循环系统、神经系统、呼吸系统、消化系统类的死亡分别位居第2~5位,其中循环系统类的死亡中居首位的是心脏性猝死。（5）男性的院前急救例数、总死亡及院前心脏性猝死均明显高于女性。结论：（1）心脑血管病和呼吸系统疾病是中老年患者的院前急救的主要原因;（2）应重视创伤,尤其是交通意外伤发生及其死亡。     

969例院前急救创伤患者的流行病学研究

目的 探讨院前急救创伤患者的流行病学特征,提高救治水平.方法 回顾分析我院2007-11-11～2008-11-11院前急救的969例创伤患者致病原因及临床特点.结果 男女之比为2.47∶ 1;年龄1～95岁;20～49年龄段67.24%,受伤原因:交通伤44.58%,斗殴伤14.04%,跌伤10.01%,坠落伤3.3%;创伤部位的前四位依次是头部(36.5%)、四肢(29.1%)、腰部(7.43%)、胸部(2.48%)和脊柱(2.48%);死亡率1.34%,交通伤是最主要的死因.结论 创伤尤其是交通伤是当今威胁人类健康的严重问题.应加强交通法规的宣传和教育,提高人们的交通安全意识.控制救治反应时间,实施有效的现场急救技术,完善急救及转运设备,加强医疗急救网络建设是提高创伤救治成功率的关键.     

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。     

基层医院创伤患者院前救护特点分析

目的探讨基层医院创伤患者院前救护的模式和技术应用特点。方法回顾分析2005年1月-2006年1月院前创伤救护1 973例临床资料,从一般构成情况、伤因、伤情、急救技术措施、创伤患者转运中意外风险等方面分析院前创伤患者救护的组织实施和技术应用特点。结果院前创伤男性比女性多,年龄分布以21~50岁为最多占79.30%;创伤原因分类以交通事故和斗殴为多,占69.49%;创伤急救技术运用以吸氧为最多占100.0%。结论快速到达创伤现场,及时准确、有效的急救措施是抢救成功的关键,而装备有各类先进的抢救器材、药品、通讯设备的救护车和一支管理科学、训练有素、操作规范的专业队伍是院前急救成功的保证。     

院前急救1876例分析

目的 分析院前急救疾病的种类、诊断的要素,提高院前抢救成功率.方法 回顾性分析2010年9月至2011年9月收治的1876例院前急救病例的临床资料.结果 院前急救中以男性患者及中老年患者居多,以18:00~24:00时间段发病居多,排在前3位疾病分别是创伤、心脑血管疾病、急性中毒.结论 普及公众急救知识,畅通急救信息网络,提高院前急救服务技能,并及时规范的予以施救,对提高院前抢救成功率有十分重要意义.     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.