院前急救对心脏骤停患者复苏成功率的影响因素

目的 探讨院前急救对心脏骤停患者复苏成功率的影响因素.方法 2015年1月～2016年12月收集328例心脏骤停患者急救临床资料,分别应用单因素及Logistic多因素分析影响心脏骤停患者院前急救效果的相关因素,并提出院前急救相关措施.结果 328例心脏骤停患者院前复苏成功率为67.07％（220/328）,失败率为32.93％（108/328）.经单因素分析可知,影响心脏骤停患者院前急救的相关因素包括患者发病时间、目击者是否施救、临床表现、原发性疾病、院前急救反应时间、心肺复苏方法、急救中心出车时间等.经Logistic多因素分析可知,患者发病时间、目击者是否施救、院前急救反应时间、心肺复苏方法、急救中心出车时间是影响心脏骤停患者院前急救效果的独立危险因素.结论 心脏骤停患者院前急救效果受到多重客观因素影响,对患者实施心肺复苏时可根据患者发病时间、目击者是否施救、院前急救反应时间、急救中心出车时间等综合因素综合考虑合适的复苏程序,以提高患者复苏成功率.     

插入式腹部按压心肺复苏术和标准心肺复苏术对心脏骤停病人脑复苏效果的对比研究

[目的]为明确院内心脏骤停病人在行标准心肺复苏术(CPR)的同时加插入式腹部按压(IAC)能否提高脑复苏成功率。[方法]将72例心脏骤停病人随机分为实验组和对照组。对照组按照ABC程序行标准心肺复苏术(S—CPR)；实验组在进行S—CPR的同时，在胸部按压放松时行一次腹部按压，按压力度为13．33kPa～26．67kPa，按压频率为100／min，压胸与压腹交替进行。监测两组心肺脑复苏效果。[结果]实验组在自主循环恢复率、自主呼吸恢复率、24h生存率、出院存活率及脑复苏结局评价方面均明显优于对照组，差异有统计学意义，并未发现明显并发症。[结论]IAC—CPR在显著提高心肺复苏成功率的同时提高了远期存活率和脑复苏效果，是一项有利于脑复苏的循环支持新技术。     

插入式腹部按压心肺复苏术和标准心肺复苏术对心脏骤停病人脑复苏效果的对比研究

[目的 ]为明确院内心脏骤停病人在行标准心肺复苏术 (CPR)的同时加插入式腹部按压 (IAC)能否提高脑复苏成功率。 [方法 ]将 72例心脏骤停病人随机分为实验组和对照组。对照组按照ABC程序行标准心肺复苏术 (S -CPR ) ;实验组在进行S -CPR的同时 ,在胸部按压放松时行一次腹部按压 ,按压力度为 13 .3 3kPa～2 6.67kPa ,按压频率为10 0 /min ,压胸与压腹交替进行。监测两组心肺脑复苏效果。 [结果 ]实验组在自主循环恢复率、自主呼吸恢复率、2 4h生存率、出院存活率及脑复苏结局评价方面均明显优于对照组 ,差异有统计学意义 ,并未发现明显并发症。[结论 ]IAC -CPR在显著提高心肺复苏成功率的同时提高了远期存活率和脑复苏效果 ,是一项有利于脑复苏的循环支持新技术     

单纯胸外按压心脑复苏研究进展

目击者所实施的传统心肺复苏(CPR)包括胸外按压和口对口通气,是"生存链"抢救的主要部分,但迄今只有不到1/3的心脏骤停者被实施传统的CPR.近来,不少试验研究结果提示,单纯胸外按压心脑复苏(CCR)与传统的CPR相比有相似或更优的生存率与神经学预后,尤其是CCR在现场急救方面更具操作性.     

育龄期宫颈癌患者二元应对水平及影响因素分析

目的 调查育龄期宫颈癌患者二元应对水平的现状,并分析了龄期宫颈癌患者二元应对水平的影响因素。方法 采用一般资料调查表、二元应对量表对妇科收治的220例宫颈癌患者进行调查。结果 育龄期宫颈癌患者二元应对得分为(117.50±13.24)分,多因素分析结果显示,患者年龄、是否已育、病程、家庭总年收入为育龄期宫颈癌患者二元应对水平的独立影响因素(F=23.461,P＜0.001),解释50.1%的变异。结论 育龄期宫颈癌患者二元应对水平仍待进一步提高,尤其是年龄较大、未育、病程短、家庭年收入较低的患者。     

穴位贴敷在顽固性腹腔积液患者中的应用效果

目的 探讨穴位敷贴在肝硬化顽固性腹腔积液患者中的应用效果。方法 选取2019年1月-2020年12月在肝胆病科住院或门诊就诊的60例顽固性腹腔积液患者作为研究对象,将其随机分为对照组28例和治疗组32例;对照组采用常规临床护理,治疗组在对照组基础上给予穴位贴敷。比较2组生化指标、腹胀情况及治疗有效率。结果 治疗后,治疗组生化指标好于对照组(P<0.05),治疗有效率高于对照组(Z=-2.459,P=0.014),腹胀症状积分、腹围、腹腔积液深度均低于对照组(t=2.550,P=0.013;t=6.292,P=0.001;t=2.587,P=0.010),24 h尿量多于对照组(t=3.758,P=0.001)。结论 中医穴位敷贴联合基础治疗方案治疗顽固性腹腔积液疗效可靠,值得推广。     

分阶段视频教育在老年患者预防跌倒中的效果

目的 探讨分阶段视频教育对老年患者预防跌倒护理结局的影响。 方法 采取整群随机抽样法抽取2个院区住院的258例老年患者,分别纳入观察组和对照组各129例。观察组住院期间采用分阶段视频教育,对照组住院期间实施常规预防跌倒健康教育。比较2组预防跌倒护理结局评分和患者满意度。 结果 出院时,观察组预防跌倒护理结局评分显著优于对照组(P＜0.001),患者满意度高于对照组(Z=-5.720,P＜0.001)。 结论 分阶段视频教育能有效改善老年患者预防跌倒护理结局,提高患者满意度。     

安全核查表对神经外科重症监护室患者院内转运的影响观察

目的 探讨安全核查表在神经外科重症监护室院内转运患者中的应用效果。方法 选择2019年1月-2020年6月神经外科重症监护室收治的患者180例作为对照组,选择2020年7月-12月神经外科重症监护室收治的患者180例作为观察组。对照组实施传统院内转运,观察组在对照组的基础上应用安全核查表。比较2组转运不良事件发生率、转运时间、转运纠纷发生率。结果 观察组转运不良事件发生率低于对照组(χ²=26.452,P＜0.001);转运时间短于对照组(t=47.455,P＜0.001);转运纠纷发生率低于对照组(χ²=13.553,P＜0.001)。结论 安全核查表应用于神经外科重症监护室患者院内转运中,可降低转运不良事件发生率,缩短转运时间,减少转运纠纷,提升患者转运安全,值得临床推广应用。     

个体化减压联合术肢康复运动在冠心病经皮冠状动脉介入术患者中的应用效果

目的 探讨个体化减压联合术肢康复运动在冠心病经皮冠状动脉介入术(percutaneous coronary intervention,PCI)患者中的应用效果。方法 采用便利抽样法,选取江西省某三级甲等综合性医院心内科住院的经桡动脉入路行PCI治疗的冠心病患者360例,按所在病区分为对照组和观察组,各180例。对照组给予常规术后减压,并引导患者完成伸肘屈肘、松握拳头等动作;观察组根据患者个体化情况调节止血器减压,并指导其进行术肢康复操运动,比较2组术肢疼痛、肿胀、焦虑和穿刺点出血情况。结果 观察组术后4 h和12 h疼痛程度均轻于对照组(Z＝-2.096,P=0.036;Z＝-3.791,P＜0.001);术后1 h、4 h和12 h局部肿胀程度均轻于对照组(Z＝-2.373,P=0.018;Z＝- 2.045,P=0.041;Z=-2.834,P=0.005);术后4 h和12 h焦虑得分均低于对照组(t＝2.813,P=0.038;t＝2.644,P=0.009);2组术后24 h内穿刺局部出血情况比较,差异无统计学意义(Z=-0.891,P=0.763 )。结论 个体化的减压方法与肢体康复运动相结合,不仅能减轻患者疼痛和肿胀,还可改善患者的焦虑情绪,且不会增加出血的风险,值得临床推广应用。     

患者参与的饮食管理模式对肝移植术后患者胃肠功能恢复的影响

目的 探讨患者参与的饮食管理对肝移植术后患者胃肠功能恢复的影响。方法 选取2018年1月-2019年1月在郑州某三级甲等医院行肝移植的84例患者为研究对象,将其随机分为对照组和观察组,对照组给予常规饮食指导,观察组给予患者参与的饮食管理模式,比较2组患者术后的胃肠功能恢复情况、相关并发症发生率,并采用患者营养主观评估量表(patient-generated subjective global assessment,PG-SGA)评价患者术后1周、出院4周和3个月的营养状况。结果 干预后,观察组患者术后7d胃肠道补给量多于对照组(t=15.025,P=0.021),术后感染发生率低于对照组(χ²=9.355,P=0.002);2组PG-SGA评分在时间、组间及交互效应上比较,差异均有统计学意义(F_时间=46.215,P＜0.001;F_组间=53.845,P＜0.001;F_交互=66.914,P＜0.001)。结论 对肝移植患者实施患者参与的饮食管理模式,能够促进患者胃肠功能恢复,改善患者营养状况,降低相关并发症的发生率。     

Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients

Objectives: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). Results: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P=0.039), their cardiac arrest was witnessed less frequently (P=0.01), they received more prolonged resuscitation (P=0.008), and needed more accumulated doses of adrenaline (epinephrine) (P=0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P<0.001), less survival to hospital admission (P<0.001), less 24 h survival (P<0.001) and less survival to discharge (P=0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. Conclusion: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.     

山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响

目的:探讨山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响。方法:选择急诊科抢救的心脏骤停患者119例,骤停时间≤10min,随机分为对照组和干预组。两组均按照美国心脏学会心肺复苏指南进行标准的心肺复苏,干预组在标准心肺复苏基础上静脉注射山莨菪碱,比较两组患者自主循环恢复(ROSC)率及复苏后24h存活率;分别在自主循环恢复后和复苏24h后测定血清总超氧化物岐化酶(T-SOD)活力、总抗氧化力(T-AOC)和丙二醛(MDA)含量,比较两组间差别。结果:干预组患者自主循环恢复率与对照组比较差异无统计学意义(P>0.01);复苏24h后,干预组患者存活率显著高于对照组(P<0.01);自主循环恢复后及复苏24h后,干预组T-SOD活力和T-AOC显著高于对照组,MDA含量显著低于对照组(P<0.01)。结论:早期应用山莨菪碱可能会减轻心脏骤停患者体内氧化应激,可能有助于提高复苏后24h存活率,但对于短期自主循环的恢复可能没有明显改善。     

信息-动机-行为模型在冠心病患者经皮冠状动脉介入术后心脏康复中的应用研究

目的 探讨信息-动机-行为(information-motivation-behavioral,IMB)模型在冠状动脉粥样硬化心脏病(冠心病)患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后心脏康复中的应用效果。方法 选取2021年1月-12月在心血管内科行PCI术的120例冠心病患者。按照随机数字表法将其分为对照组和研究组,各60例。对照组给予心脏康复健康教育,研究组在对照组基础上应用IMB模型进行个体化教育,比较2组干预3个月后的心脏康复信息需求和依从性。结果 干预3个月后,研究组心脏基础知识、营养知识、药物知识、心理压力、紧急与安全、风险因素评分及心脏康复依从性各条目评分均高于对照组(P＜0.05)。结论 应用IMB模型进行个体化教育,能改善冠心病PCI术后患者的心脏康复信息需求和依从性。     

A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation

Background  

Hands-Only cardiopulmonary resuscitation (CPR) is recommended for use on adult victims of witnessed out-of-hospital (OOH) sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2) CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR.     

出诊医师参与电话指导目击者实施心肺复苏

目的 评估出诊医生参与电话指导目击者实施心肺复苏(CPR)的可行性和有效性,并探讨电话指导的方法及影响电话指导的相关因素.方法 回顾分析2008-01～2009-04 32例院前心脏骤停(CA)患者的救治方法,没有电话指导或指导不成功18例,目击者未实施CPR;出诊医生采用预先制定的电话指导方案成功给予了电话指导14例,目击者实施了CPR.比较两组的复苏结果,并计算通过电话指导方案正确识别CA的比率,目击者对出诊医师电话指导CPR的接受率及CPR正确率等.结果 电话指导目击者25例,接受指导19例(19/25,76%),不接受6例.经指导成功完成CPR 14例(14/19,73.7%),未完成5例.指导人员采用电话指导方案正确识别CA 17例(17/19,89.5%),目击者正确实施CPR 5例(5/14,35.7%).目击者行CPR 14例中院前成活5例(35.7%),目击者未行CPR 18例中院前成活1例(5.6%).院前成活率两组比较有统计学意义(P＜0.01).结论 出诊医生依据简化的电话指导CPR方案参与电话指导目击者实施CPR能提高CA院前复苏结果.但值得注意的是电话指导受诸多因素影响.     

Efficacy of chest compression-only BLS CPR in the presence of an occluded airway

Reluctance of the lay public to perform bystander CPR is becoming an increasingly worrisome problem in the USA. Most bystanders who admit such reluctance concede that fear of contagious disease from mouth-to-mouth contact is what keeps them from performing basic life support. Animal models of prehospital cardiac arrest indicates that 24-h survival is essentially as good with chest compression-only CPR as with chest compressions and assisted ventilation. This simpler technique is an attractive alternative strategy for encouraging more bystander participation. Such experimental studies have been criticized as irrelevant however secondary to differences between human and porcine airway mechanics. This study examined the effect of chest compression-only CPR under the worst possible circumstances where the airway was totally occluded. After 6 min of either standard CPR including ventilation with a patent airway or chest compressions-only with a totally occluded airway, no difference in 24 h survival was found (10/10 vs. 9/10). As anticipated arterial blood gases were not as good, but hemodynamics produced were better with chest compression-only CPR (P < 0.05). Chest compression-only CPR, even with a totally occluded airway, is as good as standard CPR for successful outcome following 6.5 min of cardiac arrest. Such a strategy for the first minutes of cardiac arrest, particularly before professional help arrives, has several advantages including increased acceptability to the lay public.     

心肺复苏后组织因子和组织因子途径抑制物的动态变化和临床意义

目的 观察院内心肺复苏后不同时间点组织因子(TF)和组织因子途径抑制物(TFPI)水平的动态变化特点并探讨其临床意义.方法 选择2005年9月至2007年9月温州医学院附属第一医院急诊科收治的年龄>16岁明确心搏停止时间的心肺复苏患者24例,依据是否达到自主循环恢复标准随机分为ROSC和末ROSC两组,分别记录小同患者心搏停止的病因和临床特点,并用ELISA方法 检测心肺复苏(CPR)后30 min,60 min,6 h,24 h,48 h血清TF和TFPI抗原浓度,10例来自健康体检的健康自愿者为对照组.计量数据用均数±标准差((-x)±s)来表示,两组计量数据的比较采用独立样本t检验,三组及以上计量数据比较采用单因素方差分析法,计数数据的比较采用旧格表精确x2榆验,以P<0.05为差异具有统计学意义.结果 与对照组比较,ROSC组患者在CPR 30 min血TF水平显著升高(P<0.01),在CPR 6 h达高峰,在CPR48 h时已下降;与对照组及ROSC组同时点比较,末ROSC组血TF水平更是显著升高(P<0.01).与对照组比较,在CPR后30 min,ROSC和未ROSC两组血清TFPI水平差异无统计学意义(P>0.05),60 min后ROSC组血清TFPI水平逐渐升高并有显著差别(P<0.01或<0.05).与对照组比较,未ROSC组和ROSC组患者在CPR 30 min时的TF/TFPI水平均显著性升高(P<0.01),且前者显著高于后者(P<0.01),在ROSC组IF/TFPI值在CPR后6 h有显著升高(P<0.01),在48 h下降.结论 血清TF和TFPI水平在院内心肺复苏的患者中明显升高,CPR后半小时的TF和TF/TFPI的水平可用于判断预后.     

An outcome study of out-of-hospital cardiac arrest using the Utstein template--a Japanese experience

Publication of the Utstein style template has made it possible to evaluate and compare national, regional, and hospital based Emergency Medical Services. This research was a national investigation to present outcome data for out-of-hospital cardiac arrest (OHCA) patients in Japan. 3029 OHCA patients who were transported to 10 Emergency and Critical Care Medical Center from November 1997 to April 1999 were recorded according to the Utstein style and the outcome evaluated by logistic regression analysis. Among 3029 OHCA patients, 109 were found dead. The remaining 2920 patients who underwent cardiopulmonary resuscitation (CPR) by emergency medical technicians (EMT) were included in this study. Among these patients, 1294 were considered of primary cardiac origin patients by the EMT and 722 of these patients suffered a witnessed cardiac arrest. Bystander CPR were performed in 28.4% of these witnessed patients and the discharge rate was 3.5% overall and 11.4% in witnessed VF/VT. Outcome analysis showed that a discharge rate in witnessed primary cardiac arrest was 30% in prehospital resuscitation which was 7.5 times higher than in-hospital emergency room resuscitation groups (4.0%). The longer the interval between an emergency telephone call and defibrillation, the lower the 1 month survival rate, which reached almost 0% at 30 min. Follow up evaluation after discharge revealed that the survival rate rapidly decreased from 24 h to 3 months, then became a plateau in primary cardiac patients was rapidly decreased from 24 h to 1 month, then became a near plateau in non-cardiac origin group. To improve the resuscitation rate in the prehospital phase, a prehospital medical control system should be developed with expansion of on scene techniques by Japanese paramedics such as tracheal intubation, administration of emergency drugs and early defibrillation with standing orders. Education and motivation of first responders will be needed and every effort should be concentrated on improving bystander CPR rate.     

Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis

BACKGROUND: We sought to evaluate the risk factors for developing ventilator-associated pneumonia (VAP) and whether the location of intubation posed a risk in trauma patients.METHODS: Data were retrospectively reviewed for adult trauma patients requiring intubation for > 48 hours, admitted between 2010 and 2013. Patients’ demographics, clinical presentations and outcomes were compared according to intubation location (prehospital intubation [PHI] vs. trauma room [TRI]) and presence vs. absence of VAP. Multivariate regression analysis was performed to identify predictors of VAP.RESULTS: Of 471 intubated patients, 332 patients met the inclusion criteria (124 had PHI and 208 had TRI) with a mean age of 30.7±14.8 years. PHI group had lower GCS (P=0.001), respiratory rate (P=0.001), and higher frequency of head (P=0.02) and chest injuries (P=0.04). The rate of VAP in PHI group was comparable to the TRI group (P=0.60). Patients who developed VAP were 6 years older, had significantly lower GCS and higher ISS, head AIS, and higher rates of polytrauma. The overall mortality was 7.5%, and was not associated with intubation location or pneumonia rates. In the early-VAP group, gram-positive pathogens were more common, while gram-negative microorganisms were more frequently encountered in the late VAP group. Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION: In trauma, the risk of developing VAP is multifactorial. However, the location of intubation and presence of chest injury could play an important role.     

视网膜脱离患者围手术期体位护理效果的Meta分析

目的 系统评价并对比分析视网膜脱离患者围手术期单纯常规护理与加以体位护理的护理效果,为体位护理的临床应用提供理论依据。方法 计算机检索中国知网(CNKI)、万方数据库、维普数据库(VIP)以及中国生物医学文摘数据库(CBM),研究分析视网膜脱离患者围手术期常规护理与体位护理的中文文献。由2位评价者独立对纳入研究进行筛选和资料提取。运用RevMan 5.2软件对纳入文献进行Meta分析。结果 最终纳入8篇文献,包含662例患者。Meta分析结果显示:与单纯常规护理相比,在常规护理基础上实施体位护理有较高的视网膜复位成功率(OR=0.130,P＜0.001)及较低的疾病复发率(OR=7.560,P＜0.001),实施体位护理能提高患者对护理服务的满意率(OR=0.260,P＜0.001)。结论 体位护理能够显著提高视网膜脱离患者术后视网膜复位成功率和护理满意度,值得进行临床推广应用。