严重多发伤规范化院前紧急救护流程的探讨

目的探讨规范化严重多发伤院前紧急救护流程。方法对2010年1～12月柳州市医疗急救指挥中心（亦称柳州市“120”急救指挥中心）接警紧急处置98例严重多发伤患者各环节流程的疏理、总结和分析。结果98例伤员经院前紧急应急反应、现场对症处置、及时转送医院抢救,91例成功救治安全转送医院后续治疗（成功率为92．86％）。结论规范化的院前紧急救护流程、及时有效的院前救护,是成功救治严重多发伤的关键。     

多发创伤早期紧急救治的护理体会

目的探讨如何做好创伤早期紧急救治,以提高治愈率,确保患者生命安全。方法通过对50例多发伤患者实施紧急救护措施,积极配合医生抢救,准确、及时、熟练地进行早期救护工作。结果通过急诊抢救与住院治疗,治愈35例,治愈率70%;好转12例,好转率24%;死亡3例,死亡率6%;抢救成功率94%。结论严重多发创伤早期采取及时有效的救治和行之有效的护理,是抢救成功的关键。     

重型颅脑损伤合并多发伤的救治体会

目的探讨重症颅脑损伤合并多发伤的救治及预后。方法回顾性分析33例重症颅脑损伤合并多发伤患者的临床资料。结果33例患者经抢救存活22例,存活率为66．7％,死亡11例,病死率为33．3％;存活者术后半年按格拉斯哥昏迷量表（cos）评分分级为恢复良好8例（占36．4％）;中度残疾5例（22．7％）;重度残疾6例（27．3％）,植物生存2例（9．1％）,死亡1例（4．5％）。结论重症颅脑损伤合并多发伤病死率、致残率高,应早期诊断、及时抢救,正确处理危及生命的合并伤、维持重要脏器功能及术后严密监护、预防合并症对成功救治及改善预后起重要作用。     

基层医院多发伤的救治体会

目的：探讨多发伤的临床特点，探索基层多发伤的救治措施，提高基层多发伤患者的生存率。方法：对我院救治的28例进行回顾总结，根据多发伤分类，2个部位的损伤26例，3个部位的损伤2例。结果：治愈24例（85．71％），死亡4例（14．29％）。死亡原因器官衰竭（MOF）3例和不可逆休克1例。结论：多发伤具有突发性、严重性、复杂性的特点，死亡率较高，现场救护至关重要，诊断处理是否及时、准确往往比伤情本身更影响生存率，专业化救治是基层医院提高多发伤救治水平的有效途径。     

一体化救治模式并行早期创伤控制性手术对严重多发伤患者救治效果的研究

目的探讨采用一体化救治模式（ITM）并行早期创伤控制性手术（DCS）对严重多发伤患者的救治效果。方法对达州市中心医院2011年10月～2013年8月救治的53例严重多发伤患者采用ITM及行DCS救治的临床资料进行回顾性分析。结果53例严重多发伤患者,存活46例（86．8％）,病死7例,病死率13．2％,其中就诊救治时间≤1h的病死2例（6.3％）,〉1h的病死5例（23．8％）,经比较差异有统计学意义（P〈0．05）,与病死患者比较,存活患者组损伤严重程度评分较低,差异有统计学意义（P〈0．05）。结论ITM并行DCS对严重多发伤患者的救治效果显著,能够明显减少并发症发生率,降低病死率,提高患者生存率及生存质量,改善其预后。     

严重多发伤的急救护理体会

目的通过对严重多发伤的救护经验总结,提高救治水平。方法通过对2005年1月～2008年1月收治的资料完整的112例多发伤病人的急救及护理经验分析,总结出严重多发伤的救护要点。结果本组死亡11例,死亡率98％,抢救成功率902％。结论严重多发性创伤常累及多器官组织,病情复杂、危急、伤情变化快,处理不当极易引起病情加重,甚至死亡。及时而全面的评估伤情,采取紧急救护措施;建立完善的创伤救治的绿色通道。同时培养具有处理多发性损伤能力的专业化队伍和完善急救体制是提高多发伤抢救成功率的关键。     

汶川大地震被埋164小时严重多发伤1例的早期救治

目的 总结5．12汶川大地震致严重多发伤早期抢救的经验。方法1例因地震被埋164小时致全身严重多发伤患者，损伤严重程度评分（ISS90）为39分，立即予现场、救护车上初级救治，入院后予快速有效抗休克、手术清创、损害控制、ICU监护、容量复苏、多次清创等救治措施。结果患者救治3天后各项检验指标逐渐恢复，病情稳定，送北京进一步治疗。结论地震灾害紧急救援网络中各环节有机连接，发挥多学科合作，运用损伤控制理论，综合运用各项救治措施是本例成功救治的关键。     

重度颅脑损伤合并多发伤的急诊救护体会

目的探讨重度颅脑损伤合并多发伤患者的急救护理方法，提高抢救护理水平。方法回顾性分析2003年1月至2005年12月本院急诊的46例重度颅脑损伤合并多发伤患者的临床资料。结果46例患者，抢救无效急诊死亡3例，术后死亡7例，自动出院3例（经随访证实均于出院后5天内死亡），治疗好转存活33例。死亡率28．3％。结论对重度颅脑损伤合并多发伤患者的临床特点，正确评估伤情，确保呼吸道通畅，维持有效循环，进行各项生命体征监测，早期、准确、主动地采取有效的救护措施是提高抢救成功率的关键。     

护士定位抢救在急诊多发伤患者救护中的应用探讨

目的探讨护士定位抢救对于多发伤患者救护的影响。方法60例急诊多发伤患者分为2组,采用护士定位抢救（干预组）和非定位抢救（对照组）方式进行抢救,观察2组抢救处理情况。结果非定位救护的30例患者,30min内初步处理完毕送入病房或手术室者占50％;护士定位救护的30例患者30min内初步处理完毕送入病房或手术室者占75％。结论护士定位抢救对于急诊科多发伤患者的快速救护至关重要。     

损伤控制理论在严重多发伤救治中的探讨

目的探讨损伤控制急救在严重多发伤中的应用效果。方法回顾性分析我院2007年1月～2010年6月救治的79例多发伤病例资料。结果79例患者中临床治愈52例（65．8％）,致残16例（20．3％）,死亡11例（13．9％）。5例死于严重颅脑损伤,4例死于严重胸腹部损伤,2例死于MODS等严重并发症。应用损伤控制抢救25例,21例抢救成功,4例死亡。结论把握救治时间,早期采取积极急救处理,合理运用损伤控制理论,抢救或术后积极进行并发症的防治,可降低其病死率,提高生存率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.