中医院校学生院前急救知识与技能掌握情况调查

目的:调查中医院校学生对院前急救知识与技能的掌握情况,分析其影响因素,为制定提高学生院前急救水平相关的措施提供依据。方法:采用问卷调查法了解270名某中医院校学生对院前急救知识与技能的掌握情况。结果:院前急救知识与技能掌握情况回答正确149名(55.19%)、回答错误121名(44.81%),其中常见意外伤害方面掌握最好,心肺复苏掌握最差;本组学生院前急救知识与技能掌握情况影响因素包括学生是否学习过急救相关课程、近5年是否经历过意外伤害(P0.05);本组2.96%认为急救培训没必要,6.30%认为急救培训一般重要,86.30%认为急救培训有必要,4.44%认为急救培训很重要。结论:中医院校学生对院前救护知识与技能的掌握情况不佳,缺乏系统的学习与训练,需建立一套规范系统的学生急救培训模式,以提高其院前急救意识和自救、互救水平。     

社区医护人员对房颤抗凝知识掌握现况及影响因素研究

目的 社区医护人员对房颤抗凝相关知识掌握情况,分析了影响房颤抗凝的主要问题,为进一步加强规范化抗凝质量管理提供理论依据。方法 本研究为多中心横断面调查,2022 年1月,采用方便抽样的方法,选取浦东新区心房颤动 (专病) 联盟范围内的47家社区卫生服务中心医护人员,于当日对医护人员进行调查。本研究应用自制问卷,调查形式为通过问卷星进行线上数据收集。问卷由5名心律失常专家和2名心血管内科护士长基于文献研究和对医护人员进行心房颤动抗凝相关内容半结构化访谈的基础上制定,问卷内容主要包括问卷内容包括医护人员对房颤患者缺血性脑卒中抗凝的风险评估、抗凝药物 (维生素拮抗剂和非维生素拮抗剂) 相关因素的影响、抗凝并发症的观察和处理、抗凝监测的维度。采用EpiData3.1软件对数据进行统计学处理,采用SPSS 21.0软件进行统计学处理。结果 本研究共发放问卷有效问卷538份,对抗凝管理相关知识评分 (13.36 ± 2.47) 分,合格率为51.3%。调查显示,85% 以上的掌握率为: CHA2DS2-VASC 评分、HAS-BLED 评分、维生素 K 拮抗剂药代动力学特点、不良反应观察部位。掌握率低于50% 的分别是达比加群酯肌酐清除率的选择、NOAC治疗患者出血类型、NOAC轻微出血处理、NOAC非危及生命的大出血处理、NOAC危及生命或关键部位出血。 单因素分析结果显示,专业、职称、学历、工作年限、参加相关培训、房颤患者照顾者对房颤抗凝知识掌握水平差异均有统计学意义(P＜ 0.05)。多因素Logistic回归分析结果显示,专业、职称、学历、工作年限、参加相关培训是社区医护人员房颤抗凝知识掌握情况的主要影响因素(P＜0.05)。结论 社区医护人员对房颤抗凝知识掌握情况欠缺,需要对房颤患者缺血性脑卒中抗凝的风险评估、抗凝药物 (维生素拮抗剂和非维生素拮抗剂) 相关因素的影响、抗凝并发症的观察和处理、抗凝监测的维度相关知识的培训。     

人体模型训练在大学生心肺复苏技能培训中的应用效果分析

[目的]了解大学生急救知识与技能培训需求,并探讨心肺复苏训练人体模型在高校心肺复苏(CPR)培训中的应用。[方法]采用自行设计问卷先对50名大学生进行急救知识与技能培训需求调查,并由5名急救资深护士结合人体模型对该人群进行CPR培训,比较培训前后CPR相关知识与技能掌握情况。[结果]50名大学生均表示希望获得急救知识与技能,其中49人表示愿意参加急救知识培训,且84.0%学生表示最喜欢的急救知识培训方式为现场讲座培训;培训后大学生对CPR相关知识掌握情况显著高于培训前。[结论]大学生急救知识与技能培训需求普遍较高,以学校为单位应用心肺复苏训练人体模型开展大学生CPR培训可显著提高其CPR知识与技能。     

急诊急救专科护士培训模式的实施与效果评价

[目的]探讨急诊急救专科护士培训的模式和效果评价。[方法]对51名赴香港的江苏省急诊急救专科护士培训基地学员培训美国心脏协会制定的基础生命支持(BLS)和高级心血管生命支持(ACLS)课程。[结果]51名学员培训后理论、技术和Mage Code考核成绩均合格,获得美国心脏协会颁发的BLS及ACLS培训证书。培训后学员的考核成绩均较培训前提高,基础生命支持及高级生命支持得分培训前后比较差异具有统计学意义(P0.05)。[结论]急诊急救专科护士培训模式是对我国专科护士培训模式的一种探索和补充,培训课程规范化、培训资源标准化有利于急诊护士急救技能的提高。     

某市三级甲等医院手术室护士对急救技术及药品的认知状况

目的了解三级甲等医院手术室护理人员对急救物品、急救药品相关知识的认知程度及急救技能的掌握情况,为提高手术室护士急救水平提供依据。方法采用问卷调查法对某市3所三级甲等医院217名手术室护理人员对急救物品相关知识的掌握情况进行调查;采用现场考核法分次随机考核217名护理人员的急救技术。结果手术室护士对急救相关知识得分为（6.58±2.39）,及格率为39.2%。结论建议为手术室护士提供有针对性的急救知识与技能培训,并在急救质量评价中增加急救物品管理知识和急救技术的内容。     

社区医护人员急救知识技能培训的效果

[目的]提高社区医疗救治的成功率.[方法]对我社区卫生服务中心(站)96名医护人员进行急救理论知识考核评估,然后分批对这些医护人员进行为期3个月系统地强化培训后再进行急救知识理论和急救技能操作考试,并对培训对象就急救技能在实践中的应用进行调查.[结果]强化培训后考核合格率明显提高,与强化培训前比较差异有统计学意义(P<0.01).[结论]强化急救知识技能培训提高了社区医护人员急救知识和急救技能水平,有利于提高社区医疗救治的成功率.     

脑卒中患者家属急救知识需求调查分析

目的:调查脑卒中患者家属对脑卒中急救知识的了解程度和需求状况。方法:采用自制问卷调查法,对我科住院的160例脑卒中患者家属急救知识掌握情况和需求状况进行调查。结果:脑卒中患者家属对脑卒中急性发作时急救知识缺乏,需要医护人员的专业指导。结论:针对不同人群进行脑卒中急救知识的健康教育和基本急救技能培训,可提高患者家属对脑卒中的判断和处理能力,从而提高脑卒中患者的救治成功率。     

山西临汾县级医护人员基础生命支持认知及培训现状的调查

目的了解山西临汾县级医护人员基础生命支持认知及培训现状, 为制定针对性培训策略和方案提供参考。方法采用便利抽样法, 对山西临汾12所县医院的医护人员进行问卷调查, 调查内容包括科室和医护人员的一般特征、既往基础生命支持培训考核及认知现状。结果共纳入839名医护人员, 756人(90.1%)完成调查, 医生183名(24.2%), 护士573名(75.8%)。多数人员在环境安全、应急反应系统启动、足够按压、气道管理和电除颤上认知不足。结论临汾县级医护人员基础生命支持认知现状不容乐观, 需构建适用性的精准化培训课程和复训考核体系以提升认知水平和实际操作能力。     

社区全科医师急救技能培训效果评价

随着人们对健康保障需求的不断提高,社区卫生服务网络的逐步完善,社区居民一旦发生危急重症,社区医护人员即处于医疗急救的最前沿,能否及时有效地救治患者对挽救患者的生命有着重要的意义。但有研究指出,社区医护人员急救知识掌握明显不足,知识老化,对急救基本技能的手法和要求不到位[1]。为了探讨全科医师急救技能的培训效果,本次研究对203名社区全科医师进行调查。现报道如下。1对象与方法 1.1调查对象2012年3月至2012年4月参加全科     

上海崇明农村居民急救知识掌握现状的调查分析

目的了解上海崇明居民急救知识掌握情况及相关影响因素,为开展上海远郊农村居民急救知识培训提供参考。方法2016年2-7月,采用自行设计问卷,随机抽取崇明三岛居民262名,进行入户调查。结果崇明区居民急救知识的总知晓率为45.2%。不同居住地、年龄、职业、文化程度、经济水平均对知晓率有影响。结论崇明区居民急救知识掌握情况不足,亟待提高,且需加强有针对性的急救知识普及培训。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.