在急救中心开展多发伤一体化救治分析

目的 探讨提高多发伤救治成功率的措施。方法 回顾性总结2002年6月～2003年6月间中山市急救中心开展多发伤救治的效果，分析多发伤一体化救治的模式和关键点。结果 共收治135例，抢救成功107例，成功率79．3％；死亡28例，死亡率20．7％。结论 (1)住急救中心实施多发伤一体化救治是提高其成功率的有效途径，也是多发伤救治的发展趋势，(2)在急救中心实施多发伤一体化救治的模式：急救中心设立创伤中心、建立成套的创伤急救体系，培养高素质专业人员．多发伤的诊治由急救中心医师实施或组织实施。(3)严重多发伤救治的关键点：抓好院前、院内急救——抢救生命；开展急诊手术——尽早修复损伤器官，消除致死致残因素；重视重症监护及治疗——进一步治疗原发损伤，保护各脏器功能，促进机体恢复，防止并发症。     

应用计算机网络系统提高门急诊管理水平

作者介绍的门急诊计算机管理网络系统，应用软件使用ＦＯＸＰＲＯ２．５ＦＯＲＤＯＳ语言，在两台网络服务器之间应用镜像技术，门诊号的录入使用光笔和条形码技术，实行划价、收费一体化，采用星型拓扑网络结构，保证了网络的先进性、安全性、稳定性和可扩充性。网络系统实现挂号、划价收费、调剂、药品使用管理、工作量统计及经济核算的全程闭环管理格局，有效地堵塞了管理和经济上的漏洞，提高了工作效率和管理水平。该系统已正常运行了１２个月，并通过省级科技成果鉴定。     

参加新婚教育人群对紧急避孕的知识、态度和实践

为探讨新婚前后人群对避孕方法(特别是紧急避孕方法)的知识、态度和使用以及新婚前后人群对紧急避孕的需求及对推广EC的意愿的建议。采用描述性流行病学研究方法,以郑州市新婚学校为研究现场,直接收集第一手数据。采用EPI INF6.04软件包,和SPSS7.5 FOR WINDOW95软件包,进行数据处理、统计与分析。统计分析的主要指标有:频数分布,单因素分析,logistic多元回归分析等。结果平均年龄26.41岁,女性占49.4％。在第一次同房时,仅有46.4％的人使用过避孕方法。第一次同房时最常用的避孕方法是避孕套(76.1％)。在女性应答者中,25岁以下开始同房者占76.6％,有9.3％的人有过人工流产史。88.2％的人每周有1～6次同房。有43.2％的人听说过EC方法,有35.9％的人听说过紧急避孕片,有29.9％的人知道使用EC片有时间限制,有24.7％的人听说过上环可作为紧急避孕方法,有17.4％的人知道上环紧急避孕方法有时间限制。仅有12.9％的人使用过某种事后避孕方法,其中有事后3天内使用者占82.0％。92.6％的人赞成开展EC教育。73.7％的人认为,应在未婚青少年中开展EC教育。80.7％的人认为,在本单位进行EC教育是可行的。应答者认为,最易的接受的EC教育形式依次为:阅读材料(40.4％),录相(20.6％)和讲课(15.7％)。认为EC的最可靠的信息来源     

Population-based study of emergency department admissions and deaths from injuries in Barcelona,Spain: Incidence,causes and severity

The aim of this study was to estimate the incidence of morbidity and mortality due to injuries in the population over the age of 14 years in Barcelona, Spain. Injury distribution according to sex, age, external cause, place of occurrence of the injury and severity was also obtained. A one-year survey was conducted in the emergency departments of the six main hospitals in Barcelona, based on a multistage sampling. Information was collected prospectively in emergency services by specially trained non-staff interviewers. Mortality data were drawn from death certificates. The incidence rate was 74.7 injury cases per 1,000 person-years over 14 years of age, higher in males than in females. Injury rates were highest in the youngest age-group and progressively lower until people over 75 years of age. Main external causes of injury were falls, being struck or caught by objects, and traffic-related injuries. The leading specific causes of injury mortality were traffic injuries, suicides and poisonings. While the overall admission incidence was 3.34 cases per 1,000 inhabitants, the proportion of hospitalized cases was 45.0 per 1,000 injury cases admitted to emergency rooms, higher for females, for traffic injuries and in the elderly population. Ninety-six percent of injury cases had an ISS value of 8 or less, mean ISS being highest for traffic injuries and falls. Injury morbidity and mortality amongst residents of Barcelona follow sex, age and cause of injury patterns which are, overall, comparable to those observed in other industrialized countries, suggesting that similar etiologic factors might be operating in those areas. The results should enable the orientation of injury prevention policies in the urban environment targeted on the young and the elderly population.     

千捶膏配合生肌玉红膏治疗感染性伤面的临床观察

我院多年来应用千捶膏和生肌玉红膏治疗感染性伤面。千捶膏用于去腐,生肌玉红膏用于生新。据我们观察二药有较强的抗感染作用,尤其有抗绿脓感染作用。应用千捶膏可以较快地达到脱腐作用,应用生肌玉红膏可以促进肉芽增生,达到伤面早期愈合,值得推广。     

An action of disodium cromoglycate: inhibition of cyclic 3',5'-AMP phosphodiesterase.

Disodium cromoglycate (DSCG) prevents allergic asthma by inhibiting the release of chemical mediators of immediate-type allergic reactions. The mechanism of this action is unclear and prompted us to examine the effect of DSCG on cyclic adenosine 3',5'-monophosphate (cAMP), the implicated regulator of IgE-mediated reactions. We used the peripheral blood lymphocyte as a model to mirror the biochemical events occurring in the allergic shock organs. Isolated peripheral blood lymphocytes from perennial allergic asthmatic children receiving only DSCG had significantly (p less than 0.005) lower phosphodiesterase (PDE) activity (mean 1.05 +/- 0.17 SE per 10(6) cells) than normal individuals (2.93 +/- 0.14) and allergic children receiving methylxanthines (4.08 +/- 0.28) or no medications (3.58 +/- 0.2). DSCG (10 mug/ml) significantly lowered PDE activity in normal lymphocytes (p less than 0.005) in a beef heart extract (p less than 0.001), and 100 mug/ml lowered PDE activity in fetal rabbit lung homogenates (p less than 0.001). DSCG (10 mug/ml) significantly elevated (p less than 0.01) cAMP concentration in normal human lymphocytes (118 +/- 38 vs 30 +/- 10 picomoles cAMP/10(6) lymphocytes). Thus, DSCG appears to inhibit chemical mediator release by increasing intracellular cAMP through the inhibition of cAMP PDE.     

Benzylpenicillin preparations can evoke a systemic anaphylactic reaction in guinea pigs

All of the five commercially available benzylpenicillin preparations obtained from different sources and a PcG preparation prepared by filtration of a commercial PcG on Sephadex G10 elicited the systemic anaphylactic reactions in guinea pigs which had been immunized with benzylpenicilloyl (BPO)-Ascaris extract conjugate (BPO-As) mixed with aluminum hydroxide gel. These preparations could evoke no such reactions in guinea pigs immunized with BPO-bovine gamma globulin conjugate (BPO-BGG) emulsified with complete Freund's adjuvant. The severity of the systemic anaphylactic reactions correlated significantly with the titers of either 8-day passive cutaneous anaphylactic (8-day PCA) reactions or 4-hr PCA reactions evoked with the same benzylpenicillin preparations. In vitro benzylpenicillin preparation contracted the tracheas of the guinea pigs immunized with BPO-As. These results indicated that the commercially available benzylpenicillin preparations have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with BPO-As mixed with aluminum hydroxide gel. Such guinea pigs represent an animal model for investigation of penicillin allergy.     

Inhibitory effects of rat alpha2 macroferoprotein (alphaMFP), an acute phase globulin, on galactosamine hepatitis.

Refractoriness to Gal N toxicity occurs especially in fetal rats, newborn rats, and in rats after partial hepatectomy. An injury however (laparotomy, incision on the back or ip BaSO₄ suspension), prior to Gal N administration, also inhibits Gal N toxicity. In all these circumstances high levels of rat α₂-macrofetoprotein (α_MFP) occur. This protein is an acute phase reactant and is identical to rat α₂-macroglobulin. α_MFP isolated from the serum of injured rats and then administered to normal rats strongly inhibits Gal N toxicity. When time interval between the preceding injury, provoking α_MFP production and Gal N administration shortens, the inhibiting effects are less and α_MFP production remains low.During resistance to Gal N, the primary and secondary biochemical lesions of Gal N persist and the protecting effect of α_MFP must be due to another mechanism, operating in later phases of cell injury. Very probably this is attributable to the stabilizing effect on membranes of hepatocytic organelles and the plasma membranes. As α_MFP is an acute phase reactant the importance of these proteins to the course of hepatitis must be considered.     

Egg allergy, influenza vaccine, and immunoglobulin E antibody.

In a study of 70 patients with asthma, rhinitis, and eczema, those giving a definite history of allergic reactions to egg more frequently showed positive skin tests to egg extracts (p = less than 0.003), the wheal diameters of which were significantly larger (p = less than 0.01) than in patients with only a possible or no such history. Patients with a definite history of egg allergy had significantly higher levels of specific IgE antibody against egg yolk, egg white, and allantoic fluid than patients in the other two groups (p = less than 0.005). Seven patients, all of whom had given a definite history of allergy to egg, were found to have positive skin prick tests to influenza vaccine, at the concentration used in medical practice. Two of these patients had previously been given influenza vaccine and both had developed adverse reactions. Of the 22 patients giving a definite history of allergy to egg, the 7 (35 per cent) with positive skin tests to influenza vaccine had significantly larger skin tests and higher levels of specific IgE antibody to the egg extracts than the group as a whole (p = less than 0.001). Allergic reactions to influenza vaccine are likely to occur in patients who have a definite history of allergy to egg and large skin prick test reactions or high levels of specific IgE antibody to egg extracts. Those at risk can best be identified by skin prick testing with egg extracts and undiluted influenza vaccine.     

Immunologic mechanisms in hypersensitivity pneumonitis: I. Evidence for cell-mediated immunity and complement fixation in pigeon breeders' disease

Immunologic studies were performed on 5 patients with pigeon breeders' disease. Intradermal injection of pigeon serum produced an immediate wheal-and-flare reaction within 15 minutes and a secondary Arthus-type reaction within 4 to 8 hours. Immunofluorescent studies of the secondary reaction site showed IgG, C3, and C4 in 2 patients. Patients' sera produced multiple precipitin bands with pigeon serum when reacted by double diffusion in gel. IgG antibody isolated from each of the patients' serum formed precipitating immune complexes that fixed large amounts of complement (C4) when added to fresh human serum. Peripheral blood lymphocytes from 4 of the 5 patients produced macrophage migration inhibitory factor (MIF) when challenged with dilute pigeon serum. These studies are the first to show complement fixing antibodies and macrophage MIF production by lymphocytes from patients with hypersensitivity lung disease and suggest that both humoral and cellular immunity may be important in the pathogenesis of these disorders.