The Resuscitation Outcomes Consortium Epistry-Trauma: design, development, and implementation of a North American epidemiologic prehospital trauma registry

Injury is a major public health problem generating substantial morbidity, mortality, and economic burden on society. The majority of seriously injured persons are initially evaluated and cared for by prehospital providers, however the effect of emergency medical services (EMS) systems, EMS clinical care, and EMS interventions on trauma patient outcomes is largely unknown. Outcome-based information to guide future EMS care has been hampered by the lack of comprehensive, standardized, multi-center prehospital data resources that include meaningful patient outcomes. In this paper, we describe the background, design, development, implementation, content, and potential uses of the first North American comprehensive epidemiologic prehospital data registry for injured persons. This data registry samples patients from 264 EMS agencies transporting to 287 acute care hospitals in both the United States and Canada.     

急性视神经炎54例临床分析

目的：探讨急性视神经炎的病因和疗效。方法：回顾性分析我科1996年10月至2007年10月收治的急性视神经炎患者54例（81眼）的临床资料。结果：急性视神经炎病因较多，其中多发性硬化占9%。及时采用以静脉滴注甲基强的松龙为主的综合治疗后，治愈率为62%，总有效率为93%。结论：急性视神经炎病因众多，及时诊断治疗是提高视功能的关键。     

浅表淋巴结结核病灶清除术合并淋巴漏66例的原因及处理

目的分析浅表淋巴结结核病灶清除术合并淋巴漏的原因及处理方案。方法回顾性分析1 254例浅表淋巴结结核病灶清除术中34例、术后32例淋巴漏的原因,总结较合理的处理方案。结果术中发生淋巴漏的34例全部位于颈部（34/1 056,3.22%）,术后淋巴漏32例患者中颈部26例（26/1 056,2.46%）,腋窝1例（1/104,0.96%）,腹股沟区5例（5/94,5.32%）。术中淋巴漏34例经术中缝扎后33例术后无淋巴漏,1例仍有淋巴漏;术后淋巴漏32例经控制饮食、通畅引流、加压包扎、敞开创口换药及手术缝扎等措施均治愈。结论浅表淋巴结结核病灶清除术出现淋巴漏主要发生在颈部及腹股沟区,术中难以避免,总体发生率约5.26%,术中、术后采取合理的处理方案均可治愈。     

住院精神病患者发生噎食的影响因素

目的 探讨住院精神病患者发生噎食的原因。方法 将1997年1月至2007年12月在本院住院的120例精神病患者随机分为研究组与对照组，两组患者均接受系统的抗精神病药物治疗，研究组在进餐时给予改进的方式。同时分别给予药物不良反应量表评定，加强医院各种制度的完善及医务人员的岗位及专科知识的培训。结果 3个月来研究组进餐只有少数患者发生噎食，明显优于对照组，与对照组比较差异均有统计学意义（P〈0．05）。结论 加强责任心、培训专科知识、熟悉病情、观察患者进餐以及给予社会支持系统等对预防精神病患者噎食有重要意义，同时也可提高患者的生存质量。     

前交叉韧带损伤的3D MRI诊断价值

目的 评价3D MRI在前交叉韧带(ACL)损伤诊断中的价值.方法 对膝关节损伤拟行关节镜检查的病人行术前MRI扫描,46只患膝在常规MRI序列完成后加扫3D MRI序列.在不知道病人信息和病史的情况下先评估常规MR图像,然后评估3D MR图像.评估内容限于ACL完整或撕裂的表现.最后以关节镜检查结果为准,分别计算常规MRI和3D MRI诊断ACI.损伤的敏感性、特异性和准确性.结果 常规MRI诊断ACL损伤的敏感性、特异性和准确性分别为92.0%、95.2%和93.5%;3D MRI诊断ACL损伤的敏感性、特异性和准确性分别为96.0%、100%和97.8%.结论 3DMRI可以提高前交义韧带损伤诊断的敏感性、特异性和准确性.     

吗啡后处理对大鼠心肌缺血再灌注损伤的保护作用

【目的】探讨吗啡后处理对大鼠心肌缺血再灌注损伤的保护机制。【方法】健康成年S-D雄性大鼠40只,随机分成4组,每组10只。假手术组（S组）仅开胸并分离冠状动脉左前降支,但不阻断血流150 min;缺血再灌注组（IR组）行冠状动脉左前降支阻断30 min ,再灌注120 min;吗啡后处理1组（M1组）于开放左冠状动脉即刻1 min内静推吗啡0．1 mg/kg ,再灌注120 min ,吗啡后处理2组（m^2组）于开放左冠状动脉即刻1 min内静推吗啡0．3 mg/kg ,再灌注120 min。再灌注末测心肌梗死面积,免疫印迹法测心肌细胞色素C氧化酶（CcO）的表达。【结果】和IR组相比,M1组和m^2组心肌梗死面积均减小（ P ＜0．05）,m^2组心梗面积降低较M1组更为明显,且差异有显著性（ P ＜0．05）;M1组和m^2组CcO表达均上调（ P ＜0．05）。【结论】吗啡后处理对心肌损伤有保护作用,其机制可能与促进心肌CcO表达有关。     

2013年浙江省新昌县伤害监测首诊病例流行特征分析

目的了解浙江省新昌县伤害的流行特征,为该地区伤害预防控制措施的制定提供依据。方法采用统一的登记表对2013年1月1日至2013年12月31日期间在新昌县3家伤害监测医院就诊的伤害首诊病例进行登记,采用EpiData 3.02软件建立数据库,使用Excel 2003和SPSS 13.0软件进行统计分析。结果 2013年绍兴市新昌县共报告伤害首诊病例9694例,其中男性多于女性,男女性别比为1.56∶1;年龄构成以15~44岁为主,占37.11%;职业构成以农/渔业劳动者(29.54%)、农民工(25.06%)和工人(22.74%)为主。伤害发生地点构成前4位的依次为家中(33.41%)、工作场所(28.19%)、街道/城区(19.25%)和城际间公路(12.54%)。受伤原因前5位的依次为跌伤/坠落(26.82%)、交通伤(25.02%)、钝器伤(19.26%)、刺/割伤(17.80%)和动物伤(7.22%)。受伤部位前3位的依次为上肢(31.30%)、下肢(27.85%)和头部(27.11%)。99.72%的监测对象以轻微的浅表伤和中等程度的伤害为主,97.92%的监测对象伤害意图为非故意伤害。结论浙江省新昌县伤害发生状况不容乐观,针对重点人群和高危行业,亟需建立伤害预防控制措施。     

Requirement for a structured algorithm in cardiac arrest following major trauma: Epidemiology,management errors,and preventability of traumatic deaths in Berlin

Background

Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA.

Material and methods

Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n = 101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n = 52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n = 22) and trauma-management failures were prospectively assessed.

Results

In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death.

Conclusion

Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.     

爆裂样头痛的病因及其诊断评价

爆裂样头痛是一种突发的严重头痛,是一种不常见的头痛类型.由于这类头痛常伴有严重的脑部疾病,因此及时识别和正确诊断相当重要.文章对其病因和诊断评价进行了综述.     

云芝多糖防止缺血再灌注心肌早期损伤

为了探讨云芝多糖对心肌缺血再灌注损伤的预防作用，制备犬心肌缺血再灌注损伤模型，输血再灌注组不用药物干预，云芝多糖组手术前2天每天口服云芝多糖150mg/kg。在缺血再灌注过程不同时间点测定左心室舒张压，超声心功能和冠状静脉窦血浆丙二醛浓度，心肌标本行透射电镜检查。结果发现，缺血再灌注组再灌注前和再灌注早期左心室舒张压显著升高，云芝多糖组仅再灌注前左心室舒张压升高，再灌注前两组缺血心肌节段收缩期增厚百分率显著下降，并表现为矛盾运动，再灌注期两组缺血心肌节段收缩期增厚百分率呈进行性改善，至再灌注120min两组均未恢复至结扎前水平，且云芝多糖组显著高于相应时间咪缺血再灌注组；左心室射血分数的变化趋势与缺血心肌节段收缩期增厚百分率相似，但恢复较快，云芝多糖组于再灌注90min即恢复至结扎前水平。缺血再灌注组再灌注期丙二醛浓度明显升高，至再灌注120min尚未恢复至结扎前水平。而云芝多糖组再灌注早期丙二醛浓度升高，但回降较快，于再灌注30min即恢复至结扎前水平，缺血再灌注组心肌组织水肿，心肌细胞少部分肌丝断裂，收缩带模糊，线粒体轻度肿胀，脱颗粒，胞质水肿；云芝多糖组心肌组织除轻微水肿外，未见其它明显结构改变，结果提示，云芝多糖对缺血再灌注早期心肌有显著保护作用。