目的:研究地震对非伤员的其他内外科危重患者急诊医疗的影响。方法:采用病例对照研究方法,研究和分析汶川地震发生前后一周急诊科内外科危重患者情况。结果:地震后内外科危重患者数量明显减少,转诊患者和救护车来诊比例降低,但抢救患者比例增加,优化处理流程后急诊诊疗时间明显缩短。结论:虽然地震期间急诊科内外科危重患者总量减少,但存在抢救患者比例增加和院前急救资源减少的问题。应该重视这部分患者的急救医疗需求以及优化处理流程。
Severe trauma is a challenging medical problem. Uncontrolled post-traumatic hemorrhage and traumatic coagulation dysfunction are closely related to the prognosis of these patients. In May 2019, the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma published the fifth edition of the European guideline on management of major bleeding and coagulopathy following trauma. To assist Chinese in better understanding of the latest developments, this paper translated the main treatment recommendations in the guideline and interpreted the updated content from the fourth edition.
The hemodynamic management of adult patients with distributed shock often includes the use of catecholamines vasoconstrictor drugs. It was unclear whether adding vasopressin or vasopressin analogs to catecholamine therapy was beneficial for the treatment of patients with distributed shock. The Canadian Society of Intensive Care recently updated its clinical practice guideline to provide recommendations for the addition of vasopressin to catecholamine boosters in adults with distributed shock. This paper interprets it to assist domestic doctors for better understanding of the latest progress.
Brain injury after cardiopulmonary resuscitation is closely related to the survival rate and prognosis of neurological function of cardiac arrest (CA) patients. Recently, the American Academy of Neurology (AAN) published a practice guideline which had updated the evaluation of different treatments for reducing brain injury following cardiopulmonary resuscitation. In order to master and transmit AAN 2017 practice guideline on reducing brain injury following cardiopulmonary resuscitation, this paper interprets the new AAN clinical practice guideline to assist Chinese clinicians for better studying the guideline.
ObjectiveTo systematically evaluate the efficacy of fiberoptic bronchoscopy for patients with stroke-associated pneumonia (SAP).MethodsAll randomized controlled trials on fiberoptic bronchoscopy in treating SAP were collected from Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese Biology Medicine database, Wanfang database, and Chongqing VIP database. Two reviewers screened the literature, extracted data, and assessed the methodological quality of included studies. And then meta-analysis was conducted using RevMan 5.3 software.ResultsTwelve studies with 1 107 patients were included. Compared with the routine therapy, the fiberoptic bronchoscopy combined with routine therapy showed a better efficacy [relative risk (RR)=1.26, 95% confidence interval (CI) (1.17, 1.36), P<0.000 01], and indicated a shorter hospital-stay [mean difference (MD)=–4.29 days, 95%CI (–5.06, –3.52) days, P<0.000 01] and lower Clinical Pulmonary Infection Score values [MD=–1.13, 95%CI (–1.77, –0.49), P=0.000 5]. Meanwhile, a downward trend in the level of procalcitonin [standardized mean difference (SMD)=–3.86, 95%CI (–4.22, –3.50), P<0.000 01], tumor necrosis factor α [SMD=–2.75, 95%CI (–3.84, –1.66), P<0.000 01], and C-reactive protein [SMD=–2.55, 95%CI (–3.83, –1.26), P=0.000 1], as well as a higher level of partial pressure of oxygen in arterial blood [MD=15.34 mm Hg (1 mm Hg=0.133 kPa), 95%CI (6.38, 24.31) mm Hg, P=0.000 8] appeared after the combined treatment.ConclusionBased on the conventional therapy, the treatment of fiberoptic bronchoscopy can improve the efficacy, shorten the hospital stay, relieve the systemic inflammatory responses, and improve the oxygenation of SAP patients.
ObjectivesTo systematically review the efficacy and safety of enteral nutrition (EN) for severe acute pancreatitis (SAP) patients within 48 hours after admission.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on early EN (starting within 48 hours after admission) in SAP from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 RCTs involving 1 074 patients were included. The results of meta-analysis showed that: compared to patients with EN after 48 hours or parental nutrition, the patients given EN within 48 hours after admission had lower mortality (RR=0.53, 95%CI 0.29 to 0.96, P=0.036) and morbidity of multiple organ dysfunction syndrome (MODS) (RR=0.58, 95%CI 0.44 to 0.77, P<0.001). However, no significant differences were found in systemic inflammatory response syndrome (SIRS) (RR=1.00, 95%CI 0.86 to 1.16, P=1.00).Conclusions The current evidence shows that EN within 48 hours after admission can reduce the mortality and morbidity of MODS in SAP patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
Anemia and coagulopathy are frequently presented in critically ill patients on the intensive care unit. Scientific use of blood products assist the treatment of critically ill patients. However, life-threatening adverse effects are also a risk. In 2020, the European Society of Critical Care Medicine (ESICM) published a clinical practice guideline on transfusion strategies for non-bleeding critically ill adults in an attempt to resolve the transfusion strategy problems of relevant critically ill patients. This paper interprets the key contents in order to assist Chinese clinicians for better understanding and using of the guideline.
ObjectiveThis study aimed to analyze the disease burden of pancreatitis in China from 1990 to 2019 and to provide references for the prevention and treatment of pancreatitis. MethodsThe data were obtained from the Global Burden of Disease Study 2019 (GBD 2019). The incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and their corresponding age-standardized rate, and annual average percentage change (AAPC) were selected as the main indicators to compare the burden of pancreatitis in China, the United States and globally from 1990 to 2019. ResultsIn 2019, the age-standardized incidence, mortality, DALY, YLL, and YLD rates in China were 26.76/100 000, 0.59/100 000, 16.09/100 000, 14.61/100 000, and 1.48/100 000, respectively, and decreased by 8.94%, 45.33%, 49.12%, 50.98%, and 18.49%, respectively, compared with those in 1990. The burden of pancreatitis in China gradually increased with age, but was lower than that in the United States and globally. The DALY due to alcohol continually increased in China, the United States, and globally. ConclusionFrom 1990 to 2019, the burden of pancreatitis in China shows a decreasing trend and is lower than that in the United States and globally. However, the disease burden caused by alcohol and aging is increasing; therefore, effective measurements to alleviate the burden of pancreatitis in China are needed.
ObjectiveTo explore the value of T-SPOT.TB test in the diagnosis of active tuberculosis and its influencing factors. MethodsFrom July 2010 to November 2012, a total of 289 suspected active tuberculosis patients were enrolled in the study and underwent T-SPOT.TB test. All the patients enrolled were from West China Hospital of Sichuan University. The diagnostic value of T-SPOT.TB applied in determining active tuberculosis was then evaluated. ResultsAccording to the diagnostic criteria, 84 patients diagnosed with active tuberculosis were eligible for analysis and enrolled as a tuberculosis group, and 156 patients were enrolled as a control group. The sensitivity of T-SPOT.TB test was 83.3%, while the specificity was 80.1%. Both univariate and multivariate analyses showed the characteristics of patients such as general conditions (eg. age, sex) and basic diseases (eg. immunosuppression condition, malignant tumour) were not the risk factors of false-positive or false-negative result of T-SPOT.TB. ConclusionT-SPOT.TB test for the diagnosis of active tuberculosis has high sensitivity and specificity, with important value referred for diagnosing suspected active tuberculosis patients.