脊柱地震伤35例的手术配合

"5·12"汶川大地震以来,我院收治了大量的地震伤员.其中脊柱损伤需要手术治疗的伤病员35例,占手术地震伤员人数的9.21%.现将脊柱地震伤员的手术配合情况总结如下.     

四川汶川地震伤员心理状况及陪伴调查分析

目的：了解汶川地震住院伤员心理及陪伴情况。方法：使用自行设计问卷,对180名汶川地震伤员进行问卷调查。结果：54.04%的伤员震后存在恐惧,36.36%和37.88%的伤员存在抑郁和焦虑。20%地震伤员无亲友陪伴;75.56%的伤员希望得到亲友为他们提供生活照顾,63.89%的伤员希望亲友能为他们提供情感支持。结论：较多地震伤员存在焦虑、恐惧、抑郁情绪,大部分地震伤员认为陪伴提供的生活照顾和情感支持很重要,提示护理人员应关注地震伤员陪伴情况,协助伤员获得良好的生活照顾和情感支持。     

地震伤员创口病原菌感染特点及耐药性分析

目的分析地震伤员创口病原菌感染特点及耐药情况,为其感染控制提供病原学调查及临床治疗依据。方法收集本院的"5.12"地震伤员初次送检创口分泌物、坏死组织细菌培养及药物敏感试验结果,结合伤员临床资料及创口特征,分析其病原菌感染特点及耐药性。结果 85例地震伤员送检创口分泌物及坏死组织标本116份,细菌培养阳性49例,阳性率为57.6%;送检标本培养阳性74份,阳性率为63.8%;两种或两种以上细菌混合感染41份,占培养阳性的55.4%;同一伤员不同部位创口分离细菌不一致有13例(28份标本),专性厌氧梭状芽孢杆菌2份。分离细菌主要为大肠埃希菌、阴沟肠杆菌、产气肠杆菌、溶血葡萄球菌及表皮葡萄球菌。对临床常用青霉素、四环素、庆大霉素、左氧氟沙星及头孢菌素类、氨基糖苷类、喹诺酮类、青霉素类及大环内酯类抗生素均较为敏感。结论地震伤员创口病原菌感染率高,多重细菌感染较常见,同一伤员不同部位创口感染细菌可不一致,感染病原菌对临床常用抗生素较敏感,提示感染与创口受到环境细菌污染有关。     

一线三甲医院汶川地震7天内23例腹部闭合性损伤救治分析

目的回顾性分析德阳市人民医院23例汶川地震腹部损伤住院和死亡伤员伤情与死因,为今后完善和健全地震灾害应急预案机制和腹部损伤处置提供决策参考。方法从医院信息处系统收集震后1周内收治地震伤员的相关资料,分析伤员基本情况。资料录入采用EXCEL表格。结果我院共收治住院腹部伤员23例,占总住院伤员的1．9％;绝大部分伤员来自绵竹市,在12h内入院并得到救治。本组伤情严重、病情复杂;死亡5例,病死率21．74％;脾脏损伤采取脾切除术;切口感染2例,与围手术期未使用抗生素有关。结论建立我国地震灾害腹部脏器损伤的医疗救援应急预案,对保证救援人员配置和伤员分检、最优化手术安排、减少地震腹部伤病死率非常重要。     

我院1999～2001年抗生素使用情况分析

目的:了解近3年来我院抗生素的使用情况及变化趋势。方法:统计我院1999～2001年抗生素使用的种类及所需费用,分析我院抗生素的应用情况。结果:我院使用抗生素的种类主要以β-内酰胺类、大环内脂类、氨基甙类、喹诺酮类为主,所需费用呈逐年上升趋势。结论:抗生素的变化趋势为高价位的头孢类及青霉素复合制剂品种数量增长最快,而低价位的青霉素类则有所下降,导致抗生素药品费用上升。     

芦山地震后1月内四川大学华西医院应急药品保障分析

目的收集和分析汶川地震和芦山地震四川大学华西医院的应急药品使用数据,为科学、高效地开展应急救援药品后勤保障工作,提高类似突发事件的应对能力提供依据。方法以药品使用构成比和用药频度为评价指标,使用Excel软件进行数据录入,对芦山地震后当日～1月内该院地震伤员救治药品使用情况、药品金额以及汶川与芦山两次地震捐赠药品接收、分配和使用情况进行分析。结果芦山地震后1月内该院地震伤员用药共涉及26类、455个品规,其中治疗性用药量和用药频度高于辅助性用药;共接收捐赠药品8类、16个品规,本时间段均用于院内地震伤员救治。芦山地震后所接收的捐赠药品品规数和药品总金额分别较汶川地震减少90．91％和89．73％,实施了以收治地震伤员用药信息为导向的院内应急药品保障机制,应急药物的分配相对更准确、高效。结论实施以收治地震伤员用药信息为导向的应急药品保障机制,有助于提升地震医学救援的时效性和针对性。     

"5.12"汶川地震中地震伤员及急诊医疗救助分析

目的:研究"5.12"汶川地震中地震伤员的发病率和死亡率以及急诊科对突发灾难作出的反应.方法:回顾性分析四川大学华西医院救治685例地震伤员病历.将685例地震伤员中分为四组.(1)挤压综合症n=21;(2)骨折伤员n=503;(3)主要生命器官损伤伤员(包括脑、主要内脏器官)n=134;(4)非地震伤员但与地震有关的疾病发作的患者n=27.根据年龄、性别、诊断、预后、是否有复合伤等危险因素数据用spss13.0软件处理,找出伤员发病的特点和规律,探讨与之相适应的医疗救治特点及决策.结果:在685例地震伤员中,其中挤压综合症的死亡率为0%;骨折伤员,内脏损伤员及非地震伤员但与地震有关患者的死亡率分别为0%;0.145%;0.58%.急诊科总死亡率0.72%,有490例患者与强震后72小时入院.结论:在强震后24～72 h内大量的地震伤员拥入医院急诊科,恰当分诊和迅速抢救受伤严重的伤员可降低发病率和死亡率.通过这次汶川地震的回顾性分析能够对急诊科医生及医院急诊科管理者对应将来突发性自然灾害给予有用的启示.     

四川地震灾区药品使用分析及其意义

目的 通过分析四川地震灾区医学救援的药品使用情况,探讨地震伤的药品需求.方法 收集5 · 12地震1周内医院药品使用的类别和总量,采用Excel进行排序,计算用量前30位的药品;将地震中使用药物和抗生素药物分类,再进行分类统计用量.结果 前30位的药物主要包括镇痛药、镇静、抗感染药、抗休克药、止血药、水电解质和酸碱平衡药等.抗生素中以喹诺酮类量最大,其次为头孢类、抗厌氧菌类和青霉素类.结论 地震1周内药品使用的类别和总量呈现外伤类疾病急救的特点.使用分析预计地震灾区药品的需要量,可以减少医药资源的浪费.     

地震后群发挤压综合征血液净化治疗的资源管理

挤压综合征是获救的地震伤员除创伤外死亡的最重要原因[1],死亡率高达50%[2].多因地震、矿井塌陷、车祸等外界物体压迫肢体、躯干引起[3].而挤压综合征通常并发急性肾功能衰竭(ARF),我院本次所收治的地震伤员中,挤压综合征的发生率达5.43%,急性肾损伤达3.81%.对这些伤员,血液净化治疗是挽救其生命最有效的方法.     

地震灾区伤员感染标本细菌学监测

目的了解地震灾区病房伤员感染标本的细菌学分布特点及其对抗生素敏感性。方法采用细菌学鉴定技术和K-B试验法对伤员感染标本进行细菌学鉴定和抗生素敏感试验。结果本医院接受77名地震灾区伤员,发生感染53例,感染率为69.74%。采集病人感染检标本83份,检出细菌77株,检出率为92.77%,包括革兰阴性杆菌58株,革兰阳性球菌19株。革兰阴性杆菌主要有醋酸钙鲍曼复合不动杆菌21株、大肠埃希菌12株、铜绿假单胞菌9株、真菌6株及其他菌株。革兰阳性球菌主要有表皮葡萄球菌9株、金黄色葡萄球菌5株及其他菌株。革兰阴性杆菌和革兰阳性球菌对多数临床常用抗生素耐药率均达50%以上,革兰阴性杆菌对测试的18种抗生素中的9种耐药率达80%以上。结论地震灾区伤员感染率达69.74%,感染病原菌75%以上为革兰阴性杆菌,所有分离菌株对多数抗生素耐药。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.