目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
ObjectiveTo observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). MethodsProspective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO2) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group D. We recorded the time when SpO2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. ResultsThere was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO2 in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO2 in group C and D was higher than that in group B (P<0.05); PaO2 and SaO2 in group C and D were higher than in those in group A and B (P<0.05); SaO2 in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). ConclusionFor emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.
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.
ObjectiveTo understand the pre-hospital emergency medical staff's knowledge on crush injury and crush syndrome, and the influence of active and effective pre-hospital measures on the prognosis of patients with crush injury. MethodsWe retrospectively analyzed the clinical data of 51 patients with crush injury treated from September 2004 to August 2014, and recorded the number of cases in which pre-hospital emergency medical staff recognized and/or took effective measures to control crush syndrome. Treatment group included those patients who accepted effective prevention and control measures, and the rest of the patients were included in the control group. We compared the two groups of patients in terms of the incidence of serious complications such as crush syndrome and amputation. ResultsTwenty-five cases (49.0%) of crush injury were recognized before the patients were admitted into the hospital, among whom 20 (39.2%) accepted effective preventive and control measures. The mangled extremity severity score between the two groups of patients had no significant difference (6.69±1.96 vs. 7.23±3.54, P>0.05). After being admitted into the hospital, the treatment group had one complication case of crush injury, while the control group had 10 complication cases including 7 of crush injury and 3 of amputation. The complication rate of the treatment group (5.0%) was significantly lower than that of the control group (32.3%, P<0.05). ConclusionActive and effective prehospital preventive and control measures are very important in the treatment of crush syndrome and reduction of morbidity, but the pre-hospital emergency personnel's knowledge of crush injury and crush syndrome is not enough.
目的 总结躯干及肢体大血管损伤救治的经验体会。 方法 对37例躯干及四肢大血管损伤病例资料进行回顾性分析，总结其院前急救、手术方法和围手术期处理经验。结果 全组病例中除2例因失血性休克死亡外，其余病例均痊愈，无血管损伤术后并发症。结论 加强基层医院医生在躯干及四肢大血管创伤救治技术上的培训并得以提高，有利于降低大血管损伤的死亡率和致残率。
ObjectiveTo investigate the disinfection effect of dry-fogging hydrogen peroxide (DFHP) on ambulance inner surfaces.MethodsThis study was carried out using simulated field test and field test from October to December 2018. In the simulated field test, the carriers with Geobacillus stearothemopilus (ATCC12980) spores were placed in 6 places in the ambulance, and disinfected for 60 minutes with DFHP of 0.38–0.72 g/m3. The carriers were cultured for up to 7 days to observe whether the bacteria were eliminated. Before and after the DFHP disinfection, the microbial sampling of the surface in the ambulance was carried out, and the colonies were counted after the cultivation.ResultsThe eliminating rate of the bacteria carriers on the uncovered surface was 100% (20/20), and that of the covered surface was 10% (1/10). The pass rate of microbial sampling was 100% (26/26).ConclusionsThe DFHP had a significant decontamination effect on the ambulance inner uncovered surfaces. The DFHP equipment is automated and their disinfecting quality is consistent, therefore it is suitable for the disinfection of ambulance inner surfaces. But the limitation of disinfection effect on covered surfaces should be avoided.
Through reviewing the regulations on the right of emergency treatment of hospitals, we analyzed reasons of emergency treatment of hospitals, including uninformed patients and informed patients without consent in emergency situations, as well as the risk of emergency rescue of hospitals. We put forward how to consider the judgment of emergency situations, justification of emergency treatment of hospitals, and risk attribution. We suggested improving the related legislation and regulations, developing compulsory medical insurance and a medical rescue system on emergency treatment.