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find Keyword "急诊" 121 results
  • Emergency Coronary Artery Bypass Grafting: Clinical Analysis of 27 Consecutive Patients

    Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.

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  • 护理美学应用于急诊中的难点及对策

    随着医学模式和护理模式的转变,护理美学的重要临床价值逐渐地被发现和印证。虽然护理美学从南丁格尔时代即已萌芽,但真正在国内受到重视,是在整体护理模式兴起之后。国内的医疗现状和文化背景使其在发展过程中既有特色,也面临着特有的困难,尤其是在诊疗大环境特殊的急诊科,作者结合临床实践,尝试在本文中分析这些难点并提出相应的对策。

    Release date:2016-09-08 10:04 Export PDF Favorites Scan
  • Empirical study on the response policy to COVID-19 epidemic based on the new public management theory: take the emergency department rescue area of West China Hospital of Sichuan University as an example

    With the change of COVID-19, the prevention and control of COVID-19 infection epidemic entered a new stage in December 2022. How to quickly complete the emergency treatment of a large number of patients in a short period of time, and ensure that patients in emergency department can get rapid and effective medical treatment has always been an urgent problem that emergency department need to solve. The Department of Emergency Medicine of West China Hospital of Sichuan University has adopted patient-oriented management measures based on the core idea of the new public management theory, and has achieved remarkable results. Therefore, this article summarizes the workflow and nursing management strategies of the emergency department rescue area of West China Hospital of Sichuan University in dealing with the batch treatment of COVID-19 infected patients, including optimizing and correcting the environment layout of the ward, implementing the “secondary triage” mode in the rescue area, adding an inter-hospital referral platform for critical patients with COVID-19 emergency, building a conventional COVID-19 reserve material repository in the emergency department, setting up a field office for multi-department joint emergency admission service, optimizing emergency transport services for patients with COVID-19, scientific scheduling and reasonable human resource management, and providing humanistic care for employees, in order to provide reference for the management practice of the emergency department.

    Release date:2023-11-24 03:33 Export PDF Favorites Scan
  • Clinical Effect of Noninvasive Positive Pressure Ventilation on Severe Acute Pancreatitis Combined with Acute Lung Injury in Emergency

    ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P<0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P<0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P<0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.

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  • The Perioperative Management of Living Donor Liver Transplantation

    ObjectiveTo evaluate and summarize the perioperative management experience of living related liver transplantation (LRLT). MethodsA retrospective analysis was made in perioperative management of 13 cases undergoing LRLT (15 times operation, including 2 cases of liver retransplantation) in our department from January 2001 to December 2002. ResultsAll the operations were successful. All the 13 donors were followed up regularly, 12 donors were uneventfully recovered after operation and 1 donor suffered from bile leakage due to T tube. The survival rate of recipients, who achieved longterm survival at 2 months to 2 years, was 92.3%(12/13); the survival rate of graft was 86.7%(13/15). One adult recipient with Wilson’s disease died of serious rejection on the 72nd day postoperatively. Two cases suffered from embolism of hepatic artery, one case received reduced size cadaveric liver retransplantation, the other case received liver retransplantation from cadaver, and they both achieved longterm survival after retransplantation. The other complications included: 1 case of serious rejection, 2 cases of ARDS, 6 cases of infection of microbe, 7 cases of serious hydrothorax, 1 cases of leakage of biliary tract, and so on. ConclusionPerfect preoperative management, which composes one of the key parts of LRLT, is critically important for both donor and recipient.

    Release date:2016-08-28 04:49 Export PDF Favorites Scan
  • Emergency Coronary Artery Bypass Grafting after Failed Percutaneous Coronary Intervention

    Objective To summarize the experience of emergency coronary artery bypass grafting (CABG) after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection (5 cases)or perforation (2 cases) and acute arterial occlusion (2 cases). The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • 早期干预对缓解急诊危重患者心理危机

    【摘要】 目的 通过对急诊重症监护室(emergency intensive care unit,EICU)患者心理干预对照试验,总结早期心理干预在急诊临床中的意义。 方法 将2009年10月-2010年10月入住急诊EICU的46例患者,根据就诊单双号顺序分为对照组和试验组,每组23例。对照组按整体护理常规进行,试验组在常规护理基础上加行心理干预,通过测量两组患者干预前后的焦虑评分值,判断心理干预的效果。 结果 患者入住EICU时试验组、对照组焦虑量表基线评分分别为(19.35±5.83)、(19.69±6.03)分,两组差异无统计学意义(t=0.066,P=0.948);24 h后评分,试验组、对照组评分分别为(12.00±7.18)、(28.91±9.18)分,两组比较,差异有统计学意义(t=6.959,P=0.000)。试验组的焦虑评分较入EICU评分差异有统计学意义(Plt;0.001);对照组焦虑评分较入EICU时升高,差异有统计学意义(Plt;0.001)。 结论 早期干预对缓解急诊危重患者心理危机有一定帮助。

    Release date:2016-09-08 09:26 Export PDF Favorites Scan
  • Effect of Early Enteral Nutrition on Postoperative Nutritional Status and Clinical Outcomes of Patients with Upper Digestive Tract Ulcer Perforation after Operation

    ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.

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  • 急诊外科手术治疗危重心瓣膜病192例

    目的 总结危重心瓣膜病患者行急诊手术的临床经验,以提高其疗效和治愈率。 方法 自1996年10月至2007年11月对192例危重心瓣膜病患者施行了急诊手术。所有患者均为心瓣膜病合并严重心力衰竭,心功能分级(NYHA)为Ⅲ~Ⅳ级。经内科治疗2~7 d无效时采取急诊手术治疗;行二尖瓣置换术76例次,主动脉瓣置换术64例次,双瓣膜置换术43例次,三尖瓣置换术4例次,三尖瓣成形术45例次,左心房血栓清除和左心房减容 术各5例次,冠状动脉旁路移植术5例次,其他心血管手术9例次。 结果 术中和术后早期分别死亡3例和8例,总手术死亡率为5.7%(11/192),主要死亡原因为术中不能脱离体外循环机、术后发生低心排血量综合征和突发心室颤动等。随访168例,随访时间1个月~11年,失访13例。随访期间死亡8例,主要死于左心衰竭、瓣周漏或心内膜炎复发、尿毒症、夹层动脉瘤等。长期生存160例,心功能恢复至Ⅰ级132例,Ⅱ级15例,Ⅲ级13例;生活质量较术前有所提高。 结论 危重心瓣膜病患者经内科治疗无效时急诊手术具有良好的疗效,是较好的治疗选择。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 互联互通,共享发展——急诊医学未来发展模式的探索

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