【摘要】 目的 探討腹部閉合性損傷的外科急救方法。方法 2003年1月—2009年1月收治200例腹部閉合性損傷患者,根據病史、體征、輔助檢查等做出診斷后,在確保重要器官血流供應的基礎上進行外科手術治療。結果 治愈187例,治愈率93.5％；死亡13例,9例患者死于多臟器受損引起的出血性休克,2例脾破裂患者因失血過多術中死亡,2例患者因合并顱腦損傷形成腦疝死亡。結論 對于腹部閉合性損傷患者,應快速準確地根據病史、體征、輔助檢查等做出診斷,進行積極外科急救治療。有效控制出血,保證重要器官血液供應,是外科急救能否成功的關鍵。
With the post-disaster psychological crisis has aroused wide attention, psychological first aid which can relieve psychological trauma and prevent post-traumatic disorder has been valued by many countries. However, mainly domestic psychological first aid training is simply theoretical training while its popularizing rate is low, it is urgent to learn from international experience to carry out more effective psychological first aid training. In the context of combination of medicine and industry, the paper majorly embodied virtual simulation’s potential in improving psychological intervention ability, deep learning level and self-efficacy. Furthermore, the paper analyzed and illustrated theoretical basis and function module of constructing psychological first aid training platform in detail, and prospected further improvement, which laid foundations for follow-up studies.
目的:探討后路椎弓根螺釘固定在地震傷胸腰椎骨折中的應用及優點。方法:對19例胸腰椎骨折的地震傷患者行后路椎弓根螺釘內固定術。結果:本組病例的手術時間70～115分鐘,平均出血量約280mL,兩例病員術中出血超過400mL進行輸血,復位椎體前緣高度由術前平均57.5%恢復到術后平均93.6%,后突角由術前平均21°矯正到術后平均3°,術后3～7天轉往外地繼續治療,Frankel分級平均提高0.4。結論:后路椎弓根螺釘固定具有省時、節約醫療資源、提高救治效率、減輕患者痛苦的優點,尤其適用于大批傷病員的緊急救治。
ObjectiveTo investigate the epidemiological situation of pre-hospital emergency elderly and non-elderly patients in Chengdu and explore the characteristics of pre-hospital care in the city.MethodAll pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group (≥60 years old) and the non-elderly group (<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared.ResultsA total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for 29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61% (7 043 cases); the mortality rate was 11.74%, with sudden death (28.70%), cardiovascular diseases (25.95%), and respiratory diseases (16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases (35.41%), sudden death (unknown cause of death) (25.33%), and cardiovascular diseases (17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December; while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime (08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak (20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the non-elderly group was in the early morning (00:00 to 04:59) and night (20:00 to 23:59).ConclusionsThe number of pre-hospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.