Lu-shan earthquake occurred at 8:02 am, on April 20th, 2013. The epicenter of earthquake was located in Lu-shan county, Ya’an city, Sichuan province, about 100 km from Chengdu along the Longmenshan fault zone in the same province heavily impacted by the 2008 Wenchuan earthquake. The earthquake has resulted in 196 people dead, 24 missing, at least 11,470 injured as of 14:30, April 24th, 2013. After Lu-shan earthquake, medical rescue teams were dispatched from the West China Hospital, Sichuan University to the stricken area. This article written by a member of the rescue team reported the difficult and dangerous rescue work and the performance of rescue members in the stricken area.
目的 探讨适用于儿童的JumpSTART检伤分类程序在大型车祸所致的含儿童群体伤中，对患儿受伤严重程度评估的实践意义。 方法 回顾性分析2010年12月－2012年12月因大型车祸所致群体伤（3例以上伤员，至少含1例14岁以下儿童）就诊的20例患儿的病历资料。入急诊时对患儿行JumpSTART检伤分类程序，入院确诊后行国际公认的能较准确反映伤情严重程度的损伤严重度评分（ISS）。比较两种评估方法的一致性。 结果 JumpSTART检伤分类程序与ISS评分一致性较好（Kappa=0.474，P=0.003）。 结论 JumpSTART检伤分类程序可在含儿童的群体伤医疗急救时，初步评估患儿伤情严重度，从而进行检伤分类。
ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease. MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software. ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004). ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
目的 探讨H2受体拮抗剂和质子泵抑制剂（PPI）缓解急性胃黏膜损伤的时效性研究。 方法 对2008年1月－2010年1月在急诊科就诊的98例急性乙醇中毒后胃黏膜损伤患者，随机分为对照组50例，治疗组48例。常规给予休息、保暖，补液，维持水、电解质、酸碱平衡，维持循环功能等治疗基础上，对照组给予H2受体拮抗剂治疗，治疗组给予PPI治疗。通过观察急性胃黏膜损伤患者上消化道症状及体征，记录不同饮酒及饮酒量，并根据患者就诊时间及不同饮酒组治疗后上消化道症状完全缓解时间进行比较。 结果 治疗组上消化道症状缓解所需时间与对照组比较差异有统计学意义（P＜0.001），不同饮酒组上消化道症状缓解时间上差异有统计学意义（P=0.000）。 结论 PPI在缓解急性乙醇中毒所致胃黏膜损伤的时效上更明显，具有临床价值。
ObjectiveTo investigate the correlation between rapid emergency medicine score (REMS) and therapeutic intervention scoring system (TISS-28) score and analyze the feasibility of assessing the nursing workload by REMS score for critically wounded earthquake victims, in order to provide reference for rapid and effective resource allocation for earthquake victims. MethodsA retrospective analysis was carried out on 39 Lushan earthquake victims with their acute plysiology and chronic health evaluationⅡ scores higher than 25, who were directly transferred from the earthquake site to the Emergency Department of West China Hospital between April 20 and 27, 2013. Among them, there were 24 males and 15 females aged between 5 and 90 years old averaging (57.1±19.8) years. REMS score and TISS-28 score were calculated for each victim. The relationship between REMS score and TISS-28 score was analyzed by correlation analysis and curve estimation including linear model, quadratic model, composite model, growth model, logarithm model, cubic model and exponential model. Then, we tried to find out the most suitable description for the relationship between REMS score and TISS-28 score. ResultsThe Spearman correlation coefficient between the two score systems was 0.710 and the most suitable description for the relationship between REMS score and TISS-28 score was logarithmic curve model. The formula was TISS=-5.946+4.467lnREMS. ConclusionREMS score can be applied as a nursing workload predicting tool for critically wounded victims in Lushan earthquake and it provides a guidance for rational allocation of health resources.
ObjectiveTo study the value of revised trauma scores (RTS), major trauma outcome study (MTOS)-RTS scores and point of care test (POCT) in the early forecast of survival time in severe multiple trauma patients. MethodsMultiple trauma patients treated in the Emergency Department of our hospital between September and December 2015 were included in our study. We collected such data as the basic information on admission, physical signs (breath, blood pressure, state of consciousness) and POCT indexes, including pH value, hemoglobin, base excess, hematocrit value, lactic acid, sodium, anion gap, and blood glucose. We calculated each patient's RTS and MTOS-RTS scores. According to the 30-day prognosis, the patients were divided into survival group and death group. Risk factors for survival time were screened by Cox regression risk model. ResultsSeventy-five multiple trauma patients were included in our study. Among them, there were 51 males and 24 females. Fourteen of them died. The multivariate analysis in the Cox regression risk model showed that the risk factors for the death of multiple trauma patients included MOTS-RTS score [RR=0.726, 95%CI (0.608, 0.867), P < 0.001) and POCT lactic acid level [RR=1.139, 95%CI (1.010, 1.324), P=0.037]. ConclusionMOTS-RTS combined with lactic acid level may be used in the early forecast of survival time in severe multiple trauma patients.
ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.
目的 探讨修正创伤评分（RTS）、CRAMS评分及院前伤情评分（PHI）对于群体伤患者死亡的评估作用。 方法 回顾性分析2011年8月－2012年8月就诊且记录完整的45例群体伤患者的病历资料，根据病历记录计算RTS、CRAMS及PHI评分，并记录患者是否死亡。绘制受试者工作特征曲线并计算出曲线下面积；根据约登指数筛选出各个评分适宜的截断值，据此计算3种创伤评分的灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值并进行比较。将患者按照性别、年龄分为亚组进行对比分析。 结果 RTS曲线下面积最大，且与参考线下面积对比差异有统计学意义（P=0.016），与另外两种评分比较其差异有统计学意义。 结论 RTS较CRAMS及PHI评分对于群体伤患者死亡预测具有更高的价值。
ObjectiveTo find out the possible factors that may affect the survival time of patients undergoing return of spontaneous circulation (ROSC) within seven days of cardio-pulmonary resuscitation. MethodWe retrospectively collected 20 clinical indicators from 51 patients who underwent ROSC after cardio-pulmonary resuscitation in Emergency Department between August 2013 and February 2015. The indicators included gender, age, duration of cardio-pulmonary resuscitation, blood pressure acquired immediately after ROSC, heart rate, respiration, lactic acid, creatinine, prothrombin time, bilirubin, pH, arterial partial pressure of carbon dioxide, potassium, sodium, blood glucose, atrial natriuretic peptides, leukocyte, platelets, and hemoglobin. Then we analyzed the correlation of these indicators with survival time through Cox regression model. ResultsThe results showed that duration of cardiopulmonary resuscitation[RR=1.053, 95% CI (1.020, 1.088), P=0.002] and systolic blood pressure acquired immediately after ROSC[RR=0.991, 95% CI (0.982, 0.999), P=0.038] significantly affected the survival time of patients after ROSC. ConclusionsDuration of cardiopulmonary resuscitation and systolic blood pressure acquired immediately after ROSC may be useful in predicting the survival time of patients after ROSC.