骨髓腔输液应用于危重患者急救的效果观察

目的探讨骨髓腔输液在危重患者急救中应用的效果。方法将42例危重患者随机分为治疗组(22例)与对照组(20例)。治疗组行骨髓腔输液,对照组予深静脉穿刺输液,其它救护措施两组相同。结果治疗组急救输液通路建成时间较对照组明显缩短,自抢救至血压回升时间及输液速度上差异无统计学意义。总结骨髓腔输液在危重患者急救中是一条快速、安全、有效的输液通路,而且便于院前急救和基层医院开展。     

急危重症患者骨髓腔内输液技术研究进展

骨髓腔输液技术是经骨髓腔内给药，是急危重症患者在需要紧急输液而又无法及时建立常规输液通道时，抢救生命的绿色输液通道。成年人或者儿童患者在危及生命的情况下建立静脉通路是关键，称之为生命线。在急危重症患者治疗中，采用骨髓腔内输液的成功率是静脉输液治疗成功率的两倍，所以在急危重症患者的抢救中需要优先应用骨髓腔内输液技术。骨髓腔内输液技术在实际应用中可以达到与静脉给药相似的作用以及相同的药物浓度，并且在脱水或者血流动力学不稳定患者的治疗中，静脉途径在建立中具有一定的挑战性。静脉插管失败率可以达到10%～40%，周围静脉置管的操作时间大约在2.5～13 min，对于难以建立静脉通道的患者，时间甚至可以达到30 min，这种额外的时间消耗会导致患者治疗延误。所以在进行急危重症患者的治疗中，骨髓腔内输液技术属于一种良好的治疗方式，对提高患者的抢救成功率具有重要价值。本文对急危重症患者骨髓腔内输液技术的相关研究进展进行综述，为急危重症的临床急救及治疗提供参考方案。     

骨髓输液在儿科急危重症中的应用进展

骨髓输液在对急危重症患儿抢救中可迅速、有效地建立液体通路而赢得宝贵的抢救时机,作为一种急救手段,逐渐受到重视.该文总结近年来国内、外骨髓输液在儿科急危重症中的应用进展,以推进对该项技术的认识,并促进其在医疗机构救治急危重患儿时的应用.     

骨髓腔内输液系统在急性创伤及急危重症患者抢救中的应用研究

目的:探讨EZ-IO骨髓腔内输液系统在急性创伤及急危重症患者抢救中的应用价值.方法:选取医院急诊科收治的80例急危重症患者,按照随机数表法将其分为植入式静脉(IV)通道组(IV组)和骨髓腔输液(IO)通道组(IO组),每组40例.IV组采用静脉常规穿刺方法建立静脉通道,IO组采用EZ-IO骨髓腔内输液通道,对比两组建立...     

吸毒患者骨髓腔输液引起局部感染的临床分析与预防措施

目的探讨吸毒患者骨髓腔输液引起的局部感染及其预防措施。方法将42例吸毒患者作为治疗组,40例非吸毒患者作为对照组,行骨髓腔输液,通过对结果的回顾性分析,探讨局部感染发生的原因及其预防措施。结果治疗组发生蜂窝组织炎3例,占7.1%,局部脓肿2例,占4.8%,骨髓炎1例,占2.4%;对照组发生蜂窝组织炎1例,占2.5%。结论吸毒患者病情特殊,骨髓腔输液可能增加蜂窝组织炎、局部脓肿和骨髓炎的发生,应充分考虑到患者当时的状况、穿刺装置和操作者的经验水平等因素,从多方面、多环节予以防范。     

骨髓输液技术的发展及应用

骨髓输液技术作为一项传统的静脉输液的代替途径，重新受到人们的关注。本文主要介绍骨髓输液技术的发展应用及国内外的骨髓输液装置的概况。     

倒在麻将桌前的年轻人

一个周末的清晨，伴随着120救护车的呼啸声，守候在急诊科门前的医护人员，和救护车中的急救人员一起，用担架床将一个插着氧气管，挂着输液袋的年轻人从救护车中推出，迅速送往急诊抢救区。     

骨髓腔输液在新生儿重度脱水、休克时液体复苏中的应用(附6例报告)

目的评价骨髓腔输液在新生儿重度脱水、休克时液体复苏中的应用价值。方法6例重度脱水、休克新生儿均经胫骨骨髓腔快速输液,输液计划分3期。0~1 h输液量和输液速度分别是40~50 m l/kg和40~50 m l/(kg.h),~8 h为90~110和12.8~15.7,~24 h为70~90和4.3~5.6。全日液体总量一般为200~250 m l/kg,约3/5张。结果所有病例主要临床症状和体状好转或消失的平均时间:精神好转18.6 h,脉博正常10.2 h,肤色转红16.8 h,皮肤弹性恢复22 h,排尿6.8 h,毛细血管充盈时间<3 s 7.2 h。该液路维持9~16 h。均抢救成功,无并发症发生。结论胫骨骨髓腔穿刺方法简单,成功率高,是新生儿重度脱水、休克液体复苏时一种有效、安全的静脉替代途径。     

吃出来的“石头”

深秋的夜晚，120急救人员把吐血的李大爷送到急诊科。值班的赵医生和护士们把李大爷从急救车中抬出来，送到急救区，开始给李大爷进行抽血化验，并输液和心电监护。     

一体化胸骨输液器的研制及应用

骨髓输液技术作为一项传统静脉输液的代替途径，重新受到人们的关注。本文介绍一种新颖的胸骨输液装置，采用骨骼表面定位原理，结合自行设计的深度控制机构，提供快捷、简便、安全的骨髓输液。     

Long-term supplementation of isomalto-oligosaccharides improved colonic microflora profile, bowel function, and blood cholesterol levels in constipated elderly people—A placebo-controlled, diet-controlled trial

Objectives

The main purpose of this study was to determine the long-term (8 wk) effects of isomalto-oligosaccharide (IO) supplementation on fecal microflora, bowel function, and biochemical indicators of nutritional status in constipated elderly subjects. We also assessed whether the effect of IO was sustained after its withdrawal.

Methods

Thirteen (five male) constipated subjects (age 82.5 ± 1.9 y) participated in this diet-controlled study that consisted of a 4-wk placebo period, two 4-wk IO (10 g/d) -supplementation periods (IO1 and IO2), and a 4-wk post period. Fasting blood was collected on the last day of each period. Stools were collected during the last week of each period. The bowel function was monitored throughout the study.

Results

The fecal bifidobacteria, lactobacilli, and bacteroides counts (log counts/g wet feces) significantly increased and clostridia count decreased at the end of the IO1 period. The effects were more pronounced in the IO2 period and then returned to the levels of the IO1 period at the end of the post period. Daily fecal excretion of acetate and propionate increased along with IO supplementation. The frequency of spontaneous defecation increased in the IO2 period, and wet fecal mass increased by 24% in both the IO1 and the IO2 periods. The effects of IO on bowel function diminished in the post period. Plasma total and low-density lipoprotein cholesterol levels were lower with 4- or 8-wk IO supplementation as compared with the placebo and post period, respectively.

Conclusions

IO supplementation into a low-fiber diet improved colonic microflora profile and bowel movement in a time-dependent fashion in constipated elderly subjects. These beneficial effects decreased after discontinuation of the supplements.     

The unstable shoulder

Not all unstable shoulders are the same, and careful patient selection ensures proper treatment. Improved understanding of the mechanisms of stability, advances in imaging and arthroscopic technology mean that repeated visits to the emergency department with a painful dislocated shoulder should be a thing of the past.     

Calcium iodate-another effective blocker of radioiodine uptake by the thyroid gland

KI and KIO3 are the commonly used prophylactic drugs for the protection of thyroid glands against radioiodine. In this study, we have demonstrated the use of another iodine containing salt, calcium iodate [Ca(IO3)2], as an effective blocker of radioiodine uptake by the thyroid gland in rats. Ca(IO3)2 is permitted by the FDA as a food additive and is "generally regarded as safe" (GRAS, CFR No.1206). We have also compared the efficacy of Ca(IO3)2 with KIO3 in blocking thyroidal uptake of radioiodine, which could be important considering the better shelf life of Ca(IO3)2. Laboratory rats were administered 131I and stable iodide in the form of KIO3 or Ca(IO3)2 was given orally, 2 h after the administration of 131I. All the animals were monitored for whole body retention (WBR) of 131I, at 24 h and further for 14 d. The results of the present study provide us with evidence that Ca(IO3)2 can serve as another promising radioiodine blocker, and is as equipotent as KI/KIO3 in protecting the thyroid gland. We have not found any studies that examined the property of Ca(IO3)2 in blocking radioiodine uptake by the thyroid gland and the present study is an attempt in this direction.     

核事故医学应急救援装备与技术需求

核事故医学应急救援是核事故应急救援的重要组成部分，相关装备配备和技术储备水平在很大程度上影响着核事故医学应急救援的效率与质量。因此，开展对核事故医学应急救援相关装备和技术需求研究有重要现实意义。在跟踪国内外核事故医学应急救援相关装备和技术现状与发展趋势基础上，结合核事故医学应急救援梯队的任务、分工．研究了核事故医学应急救援所需配备的装备和应建立的技术。包括：核辐射剂量监测、伤员体表污染洗消、医学应急救援人员自身防护、伤员医学应急救援诊治等设备和技术，列出了部分设备的技术参数。     

探索急诊现代化之路

清远市人民医院急诊科是本地区的急救中心,具有较高的抢救水平,注重急诊医疗管理体系(EMSS)的发展。由于医院实施人事聘任制,“四权”下放到科室,科室管理层次分明,责、权、利关系合理,所以在医院管理体系中形成了急诊科的准军事化管理,员工尽责敬业,积极向上的局面,使科室历年来成为医院的先进集体,为穷困地区的急诊事业,探索出一条成功之路。     

The Role of L‐Arginine and Inducible Nitric Oxide Synthase in Intestinal Permeability and Bacterial Translocation

Background: Arginine has been shown to have several immunological and trophic properties in stressful diseases. Its metabolites, nitric oxide (NO) and polyamines, are related to arginine's effects. Thus, the aim of this study was to determine the effects of the NO donor L‐arginine and the role of inducible NO synthase (iNOS) on intestinal permeability and bacterial translocation in a model of intestinal obstruction (IO) induced by a simple knot in the terminal ileum. Material and Methods: Male C57BL6/J wild‐type (WT) and iNOS knockout (iNOS–/–) mice were randomized into 6 groups: Sham and Sham–/– (standard chow), IO and IO–/– (standard chow +IO), and Arg and Arg–/– (standard chow supplemented with arginine + IO). After 7 days of treatment with standard or supplemented chows, IO was induced and intestinal permeability and bacterial translocation were evaluated. The small intestine and its contents were harvested for histopathological and morphometric analysis and the determination of polyamine concentration. Results: Pretreatment with arginine maintained intestinal permeability (P > .05; Arg and Arg–/– groups vs Sham and Sham–/– groups), increased polyamine concentration in intestinal content (P < .05; Arg vs IO group), and decreased bacterial translocation in WT animals (Arg group vs IO and IO–/– groups). Absence of iNOS also presented a protective effect on permeability but not on bacterial translocation. Conclusion: Arginine supplementation and synthesis of NO by iNOS are important factors in decreasing bacterial translocation. However, when intestinal permeability was considered, NO had a detrimental role.     

Arginine Supplementation Induces Arginase Activity and Inhibits TNF‐α Synthesis in Mice Spleen Macrophages After Intestinal Obstruction

Background: The purpose of this study was to assess the effect of arginine supplementation on arginase activity, tumor necrosis factor–α (TNF‐α) and interleukin‐10 (IL‐10) synthesis in cultured splenic macrophages from a murine model of intestinal obstruction (IO). The effects of nitric oxide synthase (iNOS) inhibition were also studied using iNOS knockout animals. Material and Methods: Male C57BL6/J wild‐type (WT) and iNOS knockout (iNOS–/–) mice were randomized into 6 groups: Sham and Sham–/– (standard chow), IO and IO–/– (standard chow + IO), and Arg and Arg–/– (standard chow supplemented with arginine + IO). After 7 days of treatment with standard or supplemented chow, IO was induced. Arginase activity as well as TNF‐α and IL‐10 levels were analyzed in splenic macrophage cultures. Results: Arginine supplementation and the absence of iNOS increased arginase activity in splenic macrophages (Arg, IO–/–, and Arg–/– groups vs the Sham group; P < .05). Arginine was also related to a decrease in TNF‐α levels (Arg vs IO group, P < .05) and maintenance of IL‐10 levels (Arg vs other groups, P > .05). The inhibition of iNOS did not result in effects on the concentration of cytokines (Sham–/–, IO–/–, and Arg–/– vs other, P < .05). Conclusions: Arginine supplementation and iNOS inhibition led to increased arginase activity. Arginine availability decreased plasma TNF‐α levels, which may be directly related to nitric oxide derived from arginine.     

Effects of isomalto-oligosaccharides on bowel functions and indicators of nutritional status in constipated elderly men

OBJECTIVES: To evaluate effects of isomalto-oligosaccharides (IO) on the bowel function and nutritional status of elderly men. METHODS: Seven older male subjects participated in this study that consisted of a 30-day control low fiber period followed by a 30-day IO-supplemented (10 g active components) experimental period. Bowel functions such as defecation, enema use and bloating were monitored daily. Fecal characteristics such as wet and dry stool weights, stool moisture, pH and short-chain fatty acid contents were determined on five-day fecal composites collected in each period. Feces were further fractionated into plant, bacterial and soluble fractions to determine the bases for the increase in stool weight. Nutritional status of subjects was assessed with anthropometric parameters, nutrient intake and biochemical measurements. RESULTS: Incorporation of IO significantly increased the defecation frequency, wet stool output and dry stool weight by twofold, 70% and 55%, respectively. Fecal acetate and propionate concentrations significantly increased by nearly two and a half fold with IO supplement. The increase in stool bulk was mainly attributed by increased bacterial mass. Mean serum sodium concentration decreased in the experimental period while other blood characteristics did not change significantly. Anthropometric parameters and nutrient intake remained constant throughout the study. CONCLUSIONS: Consumption of IO effectively improved bowel movement, stool output and microbial fermentation in the colon without any adverse effect observed in this study. Therefore, supplementation of IO into ordinary low fiber diets may be practical in relieving constipation in the elderly population.     

3G技术在公共卫生事件应急处置中的应用

通过对3G技术在突发公共卫生事件应急处置中的实践研究,进一步探索了如何将3G大流量无线移动通讯技术应用于突发公共卫生事件应急处置中,从而体现3G无线传输技术在其中的应用价值,为突发公共卫生事件应急处置的救治、处理、监控、决策提供技术支持,实现应急处置信息化的全覆盖。     

Theory-Based Approaches to Understanding Public Emergency Preparedness: Implications for Effective Health and Risk Communication

Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.