BNP、TnT水平对急性肺栓塞病情评估的临床意义

目的探讨脑钠肽(BNP)、肌钙蛋白T(Tn T)对急性肺栓塞(APE)病情评估的临床意义。方法选取2010年12月至2014年2月间首都医科大学大兴教学医院急诊科APE患者74例,男性42例,女性32例,年龄19~84岁,平均年龄(55.1±16.6)岁。根据BNP和Tn T水平分为3组,BNP+Tn T均阴性为A组40例,单纯BNP阳性为B组24例,BNP+Tn T均阳性为C组10例。测定所有患者BNP、Tn T水平;记录患者入院后症状缓解时间及住院总时间。结果与A组比较,B组发生晕厥的比例升高(2.5%vs.16.7%),与B组比较,C组发生晕厥的比例升高(16.7%vs.50.0%),差异具有统计学意义(P均0.05)。与B组比较,C组BNP水平升高,差异具有统计学意义(P0.05)。Tn T与住院总时间呈正相关(r=0.537,P0.05)。结论 BNP、TNT均是APE患者病情评估的重要指标,两者均升高的APE患者应积极处理。     

胸外按压器械AutoPulse在急诊科心搏骤停的应用及对血气和N末端B型钠尿肽的影响

目的 探讨胸外按压器械AutoPulse在急诊科心搏骤停患者心肺复苏(CPR)中的应用价值.方法 选择2008年9月至2009年8月首都医科大学附属北京朝阳医院急诊科发生心跳停止的病例,依据胸外按压方式分成徒手标准胸外按压组(42例)及器械胸外按压的AutoPulse复苏组(43例).两组患者均行气管插管接呼吸机,给予100%纯氧通气;其他抢救措施如开放静脉通道、心电监护、电击除颤等依据2005 CPR指南进行.剔除20 min内自主循环恢复的病例,复苏超过20 min者取股动脉血,检测复苏前及复苏20 min后血气及N末端B型钠尿肽(NT-proBNP),并观察两组全部患者2 h及24 h的复苏成功率.结果 复苏超过20 min者,AutoPulse复苏组(29例)复苏后pH值、动脉血氧分压(PaO2)高于标准胸外按压组[28例,pH值:7.142±0.134比7.010±0.136,PaO2(mm Hg,1 mm Hg=0.133 kPa):71.92±9.59比65.61±7.66,均P＜0.01],动脉血二氧化碳分压(PaCO2)及NT-proBNP低于标准胸外按压组[PaCO2(mmHg):39.43±14.09比51.07±16.31,NT-proBNP(ng/L):548.18±256.93比699.40±303.35,P＜0.01和P＜0.05].AutoPulse复苏组2 h复苏成功率明显高于标准胸外按压组[74.4%(32/43)比52.4%(22/42),P＜0.05];24 h复苏成功率高于标准胸外按压组,但差异无统计学意义[9.3%(4/43)比4.8%(2/42),P＞0.05].结论 AutoPulse装置改善了心搏骤停患者的组织灌注,短期内对病情有一定改善,但对患者预后无决定性意义.     

胸外按压器械AutoPulse在急诊科心搏骤停的应用及对血气和N末端B型钠尿肽的影响

Objective To investigate the value of AutoPulse in the patients with cardiac arrest (CA)in emergency department.Methods Patients with CA seen in the Emergency Department of Chaoyang Hospital, Affiliated to Capital Medical University from September 2008 to August 2009 were divided into standard manual external chest compression group (n= 42) and mechanical chest compression group with AutoPulse (n = 43), based on the method of the external chest compression.Tracheal intubation was performed and mechanical ventilation instituted in all the patients.Other rescue measures, such as intravenous infusion of fluids, electrocardiogram, electric shock for defibrillation were performed following the cardiopulmonary guideline of 2005.The patients with restoration of spontaneous circulation in 20 minutes were excluded.Among patients with resuscitation over 20 minutes, there were 29 cases in AutoPulse group and 28 cases in standard manual external chest compression group.The blood gas and N-terminal B-type natriuretic peptide (NT-proBNP) from the blood samples obtained from the femoral artery 20 minutes after resuscitation were determined, and the survival rate at 2 hours and 24 hours in both groups was recorded.Results Twenty minutes after cardiopulmonary resuscitation, the Ph value and the arterial partial pressure of oxygen (PaO2) of the AutoPulse group (n= 29) were significantly higher than those of the standard manual external chest compression group[n = 28, Ph value: 7.142 ± 0.134 vs.7.010 ± 0.136, PaO2(mmHg, 1mmHg=0.133kPa): 71.92±9.59 vs.65.61±7.66, both P＜0.01], the arterial partial pressure of carbon dioxide (PaCO2) and NT-proBNP were significantly lower than those of the standard manual external chest compression group[PaCO2(mm Hg): 39.43±14.09 vs.51.07±16.31, NT-proBNP (ng/L): 548.18 ± 256.93 vs.699.40 ± 303.35, P＜0.01 and P＜0.05].The 2-hour survival rate in AutoPulse group was higher than that in the standard manual external chest compression group, the disparity of the two groups was statistically significant[74.4% (32/43) vs.52.4% (22/42), P＜0.05].Though the 24-hour survival rate of AutoPulse group was higher than that of the standard manual external chest compression group, the difference was not statistically significant[9.3% (4/43) vs.4.8% (2/42), P＞0.05].Conclusion The device of AutoPulse can improve the tissue perfusion in patients with CA.Though this device may give rise some benefit in resuscitation for a short time, there is no decisive improvement in term of outcome of the patient.     

Mini-CEX在医学生临床能力培养中的应用

目的探讨Mini-CEX在医学生教学培训中的应用及价值。方法选取2011年12月~2013年12月间首都医科大学大兴教学医院急诊科进行实习的34名大专医学生,通过Mini-CEX量表对医学生进行测评。每名医学生在实习期间接受至少4次测评。结果经Mini-CEX测评,医学生了解到自身的薄弱环节并在以后加强练习,各项能力均明显提高。初次和末次各项能力的合格率比较,差异具有显著统计学意义(P均<0.01)。结论 Mini-CEX是一种方便易行、成效显著的医学教学方法 ,其推广实施有利于医学生更好的成长。     

95760例急诊外科病人病种分析

目的研究和探讨急诊外科病人的病种规律。方法对95760例急诊外科病人的年龄、性别、月分布、病种排序等进行回顾性分析。结果病人男性65096例,多于女性。男女之比2121。发病年龄以<20岁组和21-30岁组病人最多。6-9月份为病人高峰期。排列前三位均为外伤,分别是①躯干、四肢或身体未特指部位的损伤,②头部损伤,③腕和手损伤。外伤病人多于非外伤病人。经急诊外科处理的病人多于非外科处理病人。结论通过对急诊外科的病种分析提出,①急诊外科工作重点和发展方向;②急诊外科医学模式的转变;③急诊外科专业医师培养应向“独立自主型”方向发展。