【摘要】 目的 探討高血壓危象評估和處理原則及對高血壓危象急診處理的指導意義。 方法 依據高血壓危象評估和處理原則對2008年1月-2009年12月期間收治的160例高血壓危象患者進行診斷和治療。結果 160例高血壓危象患者中,高血壓急癥134例,高血壓亞急癥26例。高血壓急癥中,以心腦血管病變為主,包括腦卒中、急性冠脈綜合征和急性左側心力衰竭。依據高血壓危象評估和處理原則進行急診處理,能夠對高血壓危象進行準確評估和有效處理,減少診治失誤,降低死亡率并改善預后。結論 有關高血壓危象的評估和處理原則能夠指導高血壓危象的急診處理,取得良好的預后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
The traditional Chinese medicine has played an important role in the prevention and control of coronavirus disease 2019 (COVID-19). Based on the role of traditional Chinese medicine in dealing with the previous epidemics and COVID-19, this paper analyzes the problems and challenges of current situation, and focuses on improving traditional Chinese medicine scientific identification, strengthening the construction of traditional Chinese medicine system, and increasing the intensity of Chinese and Western medicine and so on. In order to improve the cooperation mechanism of Chinese and Western medicine for epidemic prevention and control, and give full play to the role of traditional Chinese medicine in the construction of national public health emergency system, this paper also gives ten corresponding suggestions.
Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
Objective To study the earthquake emergency response capability and post-earthquake psychological state of students after the Wenchuan earthquake. And also, to investigate the level of earthquake-related knowledge so as to provide basic information for enhancing the emergency response capabilities among college students. Methods We selected 1% Sichuan University students by convenience sample method and conducted the survey in person with a self-designed questionnaire. Results were analyzed with Epidata 3.0 and SPSS13.0 software. Results We distributed 527 questionnaires and 517 (97.27%) valid questionnaires were retrieved. Most college students had a good grasp of earthquake knowledge: 65.4% to 97.7% of the responders gave the correct answers, but only 12.77% said they had ever received earthquake survival training. 15.2% suffered from fear after the earthquake, 59.4% became uneasy, and 25.4% remained calm. Gender, grade, or major were not the factors influencing the psychological state of college students after the earthquake (P= 0.246, 0.216, and 0.406, respectively). Also, earthquake survival training did not influence the psychological state of college students after the earthquake (P=0.090). Psychological intervention after the earthquake was identified as an important factor that affected the psychological state of students (P=0.002). Conclusion College students have a good grasp of the basic knowledge regarding earthquake, but relevant survival training is far from sufficient. Universities should strengthen earthquake survival training, enhance the post-earthquake emergency response capacity of students, and carry out post-disaster psychological intervention directly following an earthquake. There is no significant difference in the mental status among students of different genders, grades, or professional backgrounds.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
ObjectiveTo research on the correlation between modified shock index (MSI), traditional vital sign assessment indexes and the proportion of patients entering resuscitation room through emergency triage, and to discuss its significance and advantages for emergency triage. MethodA total of 22 153 emergency patients between January 1 and May 31, 2009 were retrospectively analyzed. We counted the shock index (SI), mean arterial pressure (MAP), MSI, and evaluated the reference range of MSI, based on which, the patients were divided into groups, and the proportion of patients entering resuscitation room in each group was compared. Based on pulse, systolic blood pressure (SBP), SI, MAP and MSI, the patients were again grouped for comparing the proportion of patients entering resuscitation room, and the positive predictive value, negative predictive value, and odds ratio (OR) were also analyzed. ResultsReference value of MSI ranged from 0.34 to 1.70 times/(min·mm Hg) (1 mm Hg=0.133 kPa). Positive predictive values:MSI (16.239%) >MAP (6.115%) >pulse (5.746%) >SBP (5.321%) >SI (3.689%). The negative predictive values were all at high levels and similar with each other. OR:MSI (6.138) >MAP (2.498) >pulse (2.431) >SBP (2.117) >SI (1.361). ConclusionsPulse, SBP, SI, MAP, and MSI are correlated with the proportion of patients entering resuscitation room, and can be regarded as guide for emergency triage, among which MSI may be superior to all other indexes.
Objective To explore the utilization of emergency materials for mass disaster. Methods We retrospectively analyzed the 2 338 casualties from Wenchuan earthquake who visited our emergency department from 2:28 PM, May 12 to 2:28 PM, June 2. The injury condition and demand on emergency materials at different phase were also analyzed.Results mong the 2 338 casualties, the most common injuries were fracture, skin or soft tissue injury, and brain injury. Primary drugs are tetanus immune globulin, normal sodium and antibiotics. The injury condition and demand on medical resource were different at different phase. The demand on emergency materials depended on the category and severity of injury. Conclusion It is necessary to make a good medical resource planning for mass disaster. The catogory of injury and demand on emergency materials are different at different phase.
Objective To establish and verify the early prediction model of critical illness patients with influenza. Methods Critical illness patients with influenza who diagnosed with influenza in the emergency departments from West China Hospital of Sichuan University, Shangjin Hospital of West China Hospital of Sichuan University, and Panzhihua Central Hospital between January 1, 2017 and June 30, 2020 were selected. According to K-fold cross validation method, 70% of patients were randomly assigned to the model group, and 30% of patients were assigned to the model verification group. The patients in the model group and the model verification group were divided into the critical illness group and the non-critical illness group, respectively. Based on the modified National Early Warning Score (MEWS) and the Simplified British Thoracic Society Score (confusion, uremia, respiratory, BP, age 65 years, CRB-65 score), a critical illness influenza early prediction model was constructed and its accuracy was evaluated. Results A total of 612 patients were included. Among them, there were 427 cases in the model group and 185 cases in the model verification group. In the model group, there were 304 cases of non-critical illness and 123 cases of critical illness. In the model verification group, there were 152 cases of non-critical illness and 33 cases of critical illness. The results of binary logistic regression analysis showed that age, hypertension, the number of days between the onset of symptoms and presentation at the emergency department, consciousness state, white blood cell count, and lymphocyte count, oxygen saturation of blood were the independent risk factors for critical illness influenza. Based on these 7 risk factors, an early prediction model for critical illness influenza was established. The correct percentages of the model for non-critical illness and critical illness patients were 95.4% and 77.2%, respectively, with an overall correct prediction percentage of 90.2%. The results of the receiver operator characteristic curve showed that the sensitivity and specificity of the early prediction model for critical illness influenza in predicting critical illness patients were 0.909, 0.921, and the area under the curve and its 95% confidence interval were 0.931 (0.860, 0.999). The sensitivity, specificity, and area under the curve (0.935, 0.865, 0.942) of the early prediction model for critical illness influenza were higher than those of MEWS (0.642, 0.595, 0.536) and CRB-65 (0.628, 0.862, 0.703). Conclusions The conclusion is that age, hypertension, the number of days between the onset of symptoms and presentation at the emergency department, consciousness, oxygen saturation, white blood cell count, and absolute lymphocyte count are independent risk factors for predicting severe influenza cases. The early prediction model for critical illness patients with influenza has high accuracy in predicting severe influenza cases, and its predictive value and accuracy are superior to those of the MEWS score and CRB-65 score.
Objective To provide reference for hospital emergency preparedness for disasters in China by summarizing the main results from articles involving hospital emergency readiness. Method We systematically searched MEDLINE (1950 to June 2008), CNKI (1980 to June 2008) and some websites. The main results of the eligible articles are described. Results A total of 85 articles were included, of which expert articles and surveys accounted for 44% and 29%, respectively. An emergency hospital plan should address the following 4 phases of disaster management: mitigation, preparation, response, and recovery. The following factors should be considered when developing hospital emergency plans: surge capacity, disaster planning, collaboration, training, drill, personnel, equipment, triage, diagnosis, treatment, decontamination, funding, individual security, logistic, psychological support, etc. Questionnaires, checklists or specific tools could be applied to evaluate such emergency plans. Conclusion Hospital emergency preparedness is essential for effective disaster relief. Hospitals should develop emergency plans for a variety of disasters, based on their local situations.
Objective By analyzing the data of medicine use in a temporary trauma center, which set up by the national emergency medical team of General Hospital of Chengdu Military Region right after the 2015 Nepal earthquake in Kathmandu, to provide reference for the development of medicine emergency plan. Methods All 103 drugs (specifications) are divided into five categories: topical drugs, oral drugs, injectable drugs, drug use in the operating room, disinfectants and infusion. Sorting patient drug consumption, in order to determine whether the drug carries reasonable. Results Within 18 days, 267 patients received treatment, in which 132 patients received debridement, 71 patients were hospitalized, and 35 fractures underwent orthopedic surgery. All of the medicines shipped from China with the medical team, only one exception. Twenty drugs' consumption rates reached 100%, 37 drugs' consumption rates were more than 70%, 60 drugs' consumption rates were more than 50%, only 10 drugs’ consumption rates were zero. Conclusion Before the rescue mission, the preparation of medicine is reasonable. The basic composition of medicine emergency plan should be based on the different rescue mission. And do some adjustments according to the local climate and natural environment.