艾箱灸预防肛肠病术后尿潴留的临床疗效观察

目的探讨采用艾箱灸预防肛肠疾病术后尿潴留的疗效。方法选取2016年10月～2018年5月我院肛肠外科收治的肛肠病患者,随机分为试验组与对照组,试验组在术后1 h予艾箱灸气海、关元、中极穴;对照组采用常规护理方法。观察两组患者术后首次排尿时间、首次排尿后膀胱残余量、术后6 h尿潴留发生率及艾箱灸预防尿潴留的疗效。结果试验组首次排尿时间为(195±55)min,首次排尿后膀胱残余量为(41±12)mL,术后6 h尿潴留发生率为9.54%;对照组首次排尿时间为(256±62)min,首次排尿后膀胱残余量为(156±23)mL,术后6 h尿潴留发生率为38.10%。结论艾箱灸气海、关元、中极穴能促进肛肠病患者术后排尿,缩短自主排尿时间,减少首次排尿后膀胱残余尿量,有效预防术后尿潴留的发生。     

Does a shorter residual first metatarsal length after first ray amputation in diabetic patients leads to poorer outcomes – A risk factor study

BackgroundThe first ray plays a vital role in the normal function of the foot and the gait cycle where in its absence can lead to abnormal changes in weight distribution to the residual first metatarsal stump and lesser metatarsals with predisposition to developing lesser toe deformities reulcerations and reamputations particularly in diabetic patients. This study aims to characterise the outcomes after first ray amputation and its associated risk factors with focus on the impact of residual first metatarsal length.MethodsAll diabetic patients with first ray amputations from January 2012 to December 2016 were reviewed. Residual first metatarsal length was measured using postoperative radiographs. Risk factors for outcomes such as readmission, reulceration and/or reamputation, transfer ulceration and/or amputation of lesser toes, proximal amputations, ulcer-free duration (UFD) and mortality were analysed using bivariate logistic/linear regression followed by multiple logistic/linear regression models adjusting for confounding factors.ResultsAmong 89 patients with first ray amputations, 65.3 % needed readmission for further treatment. Although only 10.1 % had reulceration at the first ray which all led to reamputation, there were 56.2 % with transfer ulceration and 40.4 % with transfer amputation of the lesser toes in this cohort. The prevalence of transmetatarsal amputation was 18 % and proximal amputations at 12.4 % while the average UFD was 27 months. Mortality rate was 31.5 % with an average of 3-year survival. Preservation of the first metatarsal length via metatarsophalangeal joint disarticulation independently reduced likelihood of readmissions and residual metatarsal length of > one third when compared to < one third after first ray amputations had lower likelihood of transfer amputation of lesser toes.ConclusionFirst ray amputation in diabetic patients leads to significant morbidities and mortality. Preservation of the residual first metatarsal length independently reduced the likelihood of readmissions and transfer amputation to the lesser toes.     

Distribution,prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus

BackgroundPrevious simulated weight-bearing CT (WBCT) studies classifying first metatarsal (M1) pronation suggested a high prevalence of M1 hyper-pronation in hallux valgus (HV). These findings have prompted a marked increase in M1 supination in HV surgical correction. No subsequent study confirms these M1 pronation values, and two recent WBCT investigations suggest lower normative M1 pronation values. The objectives of our WBCT study were to (1) determine M1 pronation distribution in HV, (2) define the hyperpronation prevalence compared to preexisting normative values, and (3) assess the relationship of M1 pronation to the metatarso-sesamoid complex. We hypothesized that the M1 head pronation distribution would be high in HV.MethodsWe retrospectively identified 88 consecutive feet with HV in our WBCT dataset and measured M1 pronation with the Metatarsal Pronation (MPA) and α angles. Similarly, using two previously published methods defining the pathologic pronation threshold, we assessed our cohort’s M1 hyper-pronation prevalence, specifically (1) the upper value of the 95% confidence interval (CI95) and (2) adding two standard deviations at the mean normative value (2 SD). Sesamoid station (grading) was assessed on the coronal plane.ResultsThe mean MPA was 11.4+/−7.4 degrees and the α angle was 16.2+/−7.4 degrees. According to the CI95 method, 69/88 HV (78.4%) were hyperpronated using the MPA, and 81/88 HV (92%) using the α angle. According to the 2 SD method, 17/88 HV (19.3%) were hyperpronated using the MPA, and 20/88 HV (22.7%) using the α angle. There was a significant difference in MPA among sesamoid gradings (p = 0.025), with a paradoxical decrease in MPA when metatarsosesamoid subluxation was increased.ConclusionM1 head pronation distribution in HV was higher than in normative values, but threshold change demonstrated contradictory hyper-pronation prevalences (85% to 20%), calling into question the previously reported high prevalence of M1 hyper-pronation in HV. An increase in sesamoid subluxation was associated with a paradoxical decrease in M1 head pronation in our study. We suggest that a greater understanding of the impact of HV M1 pronation is warranted before routine M1 surgical supination is recommended for patients with HV.Level of evidenceLevel III, retrospective cohort study.     

初诊2型糖尿病两种胰岛素治疗模式效果比较

目的探讨多次胰岛素注射法和胰岛素泵持续皮下胰岛素输注用于初诊2型糖尿病治疗临床效果。方法比较两组患者临床缓解率、血糖达标时间,治疗前后FPG、2hPG血糖指标。结果对照组和治疗组患者临床缓解率分别为30.0%,64.0%;而血糖达标时间分别为（7.1±1.4）天,（3.3±0.5）天;治疗组患者临床缓解率及血糖达标时间均明显优于对照组,组间比较差异显著（P〈0.05）;对照组和治疗组患者治疗前FPG、2hPG等血糖指标组间比较无显著差异（P〉0.05）;两组患者治疗后FPG、2hPG等血糖指标较治疗前均明显改善,且改善程度组间比较无显著差异（P〈0.05）。结论胰岛素泵持续皮下胰岛素输注用于初诊2型糖尿病可有效改善临床症状,缩短疗程,血糖控制效果更佳。     

第一趾蹼区游离皮瓣修复虎口及指腹缺损的疗效

目的介绍用第一趾蹼区游离皮瓣修复虎口及指腹软组织缺损的疗效。方法对2例虎口瘢痕挛缩以及5例外伤后手指指腹软组织缺损者,采用第一趾蹼区游离皮瓣修复瘢痕切除后的创面和软组织缺损创面。供区用全厚皮片植皮。结果7例皮瓣全部存活。术后平均随访8个月,虎口开大为健侧的70%,手指指腹外形良好,屈伸自如,两点分辨觉为10~12mm。7例术后3个月足部行走正常,无疼痛;其中2例趾蹼处有瘢痕。结论应用第一趾蹼区游离皮瓣修复虎口及手指指腹皮肤缺损,手术虽然复杂,但术后感觉恢复满意。     

Minor burn injuries in adults presenting to the regional burns unit in Western Australia: a prospective descriptive study

INTRODUCTION: Western Australia is the largest state in Australia, accounting for approximately one third of the Australian continent. The adult Burns Unit in Western Australia is at Royal Perth Hospital, which provides for the whole adult population of approximately 1.8 million, 80% of which live in and around the state capital city, Perth (approx. 1.4 million). The unit also offers a minor burn care facility. METHODS: The aim of this study was to perform the first prospective review of minor burn injuries in Western Australia, to classify patient demographics, injury patterns and primary treatment. RESULTS AND CONCLUSION: Two hundred and twenty seven patients were referred to the minor burn facility at Royal Perth Hospital (RPH) during the study period. One hundred and three patients (45%) sustained a scald, a further 44 (19%) received a flame burn. Thirty-seven (16%) patients sustained a contact burn, 18 (7.8%) patients attended the clinic with a chemical burn. Sixty percent of all patients reviewed had burns less than one percent. Only 39% of all our patients received adequate first aid. Sixty one percent of all patients received inadequate or inappropriate first aid. This study highlights a number of important issues. The over representation of metropolitan patients coupled with the low numbers of aboriginal patients reinforces the need for rural burns education. The best service we can provide is education on burns prevention and primary management. There are a number of other areas we hope to address in the future, the high incidence of domestic accidents, home safety must be a priority, coupled with seasonal promotional campaigns to address issues such as car radiator injuries. The most striking, and perhaps the most worrying finding in this study is the poor application of basic first aid principles. This is something that is unacceptable, needs further investigation and the lack of basic knowledge needs to be addressed at all levels of the community.     

芦山地震伤员震区驻军医院内的早期规范救治

目的 总结震区驻军医院在雅安芦山“4·20”地震伤员早期救治经验. 方法 启动应急预案,建立帐蓬医院,依据《战伤救治规则》基本原则,针对本次地震伤员特点对伤员展开急救拣伤分类、紧急救治、分流、专科处理和后送等. 结果 地震后医院迅速启动重大灾害紧急救援预案,20min后向震心重灾区派出了装备齐全的应急医疗队;在医院展开了帐篷医院.2周内共收治地震伤员181例,现场直接转入伤员68例(37.6％),从经初步救治处理后转入(包括其他医院转院)伤员113例(62.4％);实施手术49台次,其中急诊手术30台次;34例(含14例重度伤员)在生命体征平稳后转送至上级医院.所有伤员无一例死亡,手术伤口无一例感染. 结论 军队医院平时完善的应急预案和物资储备、统一有序的指挥、规范的分级救治体系和训练,保证了对地震伤员的高效、高质量规范救治.但在精确的伤势(情)判断方法与标准、完善设备条件、伤员后送标准等方面还需要进一步深入研究.     

深圳市急救网络医院2002-2004年创伤患者院前死亡情况分析

目的 分析2002-2004年深圳市创伤院前急救的时效关系,以期降低死亡率.方法选择2002-2004年67个急救网络医院经电话呼救创伤院前死亡患者的资料,用Foxpro 6.0软件建数据库,用SPSS 11.0软件进行分析. 结果 2002-2004年全市院前呼救创伤患者共161 364例次,死亡3 967例(院前和院内);院前死亡分别为360,528和645例,占当年所有创伤急救死亡总数的32.57%、37.69%和44.15%;院前死亡率分别为1.15%、0.88%和0.99%;死亡年龄分别为(29.04±13.98)岁、(27.84±18.54)岁和(29.25±17.06)岁;男/女构成比分别为79.17/20.83、77.65/22.35、71.63/28.37;交通伤/非交通伤构成比分别为48.33/51.67、26.14/73.86和37.98/62.02;救护车院内反应中位数时间分别为2,2和1 min;到达现场中位数时间分别为5,8.5和7 min;往返医院中位数时间分别为15,35和30 min. 结论 深圳市院前创伤死亡患者数量有增加趋势,其中交通伤构成比和死亡率有下降趋势,院前创伤死亡平均年龄较全市所有急救患者死亡年龄的平均值低10岁.救护车院内反应时间加快,但到达现场时间和往返时间延长.     

综合三甲医院护士长心血管急救技能培训及效果探讨

目的：通过分析某综合三甲医院护士长心血管急救技能培训考核成绩,探讨影响护士长培训效果的因素,提出改进、完善培训制度的措施。方法分类统计50名受训护士长的考核成绩,采用SPSS 13．0统计软件进行分析,结合问卷调查结果,分析影响考核成绩的相关因素,从而研究应对措施。结果大专以下学历护士长与大专（含大专）以上学历护士长相比差异无统计学意义（P＞0．05）;但任职时间大于5年（含5年）的与小于5年的相比、急救科室与非急救科室相比差异均有统计学意义（P＜0．05）。问卷调查显示,培训总体满意度超过90％,其中对授课方式和导师授课情况的满意度最高。结论心血管急救培训可以从参训人员分组、培训方法和培训条件等方面改进和完善。     

创伤急救体系的发展与现状

中国在过去的30年里随着经济的巨大进步,工业化水平的逐年提升导致了意外伤害事故也随之增加,中国每年因创伤死亡人数超过400 000,是继恶性肿瘤和心、脑、呼吸道疾病后的第五大死亡原因,是青壮年死亡的首要原因［1］,同时创伤已成为和平时期一项严重的社会问题。目前,中国对于创伤急救体系的建设仍然处于起始阶段,投入还相当不足,也没有特定的政府机构来协同处理创伤急救相关问题,如决策的制定、急救基金的设立、急救的立法、创伤急救系统的建立、创伤医师的再教育和认证等［2］。 欧美等发达国家的创伤急救系统建设起步于20世纪60年代,发展到今天已经相对比较完善［2］,而我国创伤急救系统的建设才刚刚起步,近年来姜保国教授团队也在大量研究的基础上提出了适合中国国情的创伤救治模式,但尚未形成规模,还处于试行与推广阶段。创伤救治体系从评价医疗服务质量角度分析,目前世界上主要有两大急救体系：即美英模式和德法模式。前者的特点是“将患者带往医院”,强调在现场紧急处理后尽快把伤员安全转运至医院再行有效治疗;后者则是“将医院送至患者身边”,强调医院抢救小组尽快到达现场进行救治,再转运患者至医院继续治疗［3］。目前采用美英模式的国家和地区有澳大利亚、加拿大、以色列、日本、新西兰、菲律宾、中国台湾、中国香港、美国、英国;采用德法模式的国家和地区有奥地利、比利时、拉脱维亚、挪威、波兰、葡萄牙、俄罗斯、瑞典、瑞士、德国、法国。中国目前的创伤救治模式总体上介于两者之间,下面对两种模式的代表国家德国和美国进行分类介绍,并阐述我国当前救治现状中的优缺点。