Point-of-care testing(POCT)is a testing approach that can be completed promptly,and for patients with acute and severe diseases,it can help clinicians identify changes in patients'conditions early and save patients'lives.Currently,the application of POCT in critical and emergency situations lacks a comprehensive clinical management consensus,leading to a lack of standardized guidance for its practical application.In order to standardize the application of POCT in critical and emergency situations,Emergency Medicine Association of Wuhan Medical Association organized multiple experts in the field of emergency and critical care to discuss and identify the current clinical issues that require standardized consensus in the application of POCT in emergency and critical care.Furthermore,a comprehensive literature search of domestic and international literature was conducted,and discussions and modifications were organized among emergency and critical care medicine experts.Ultimately,the Expert management consensus for the application of point-of-care testing in emergency and critical care(2024),which involves personnel management,equipment management and data management was formed.This consensus aims to provide more comprehensive standards and guidance for the application of POCT in critical care,thereby improving the quality of patient care and medical efficiency.
Monitoring is more common in today's clinical practice, especially in critical care medicine. Any confusion between monitoring and diagnosis will mislead clinical behavior which could be disastrous. A monitoring parameter usually focuses on a specific physiological point and represents the immediate situation of the point with quantitative values. A series of numerical value of monitoring parameters indicate physiological change or a disease process. If the clinical intervention targeted at the point, the numerical value represents the strength and the direction of the intervention. However, monitoring itself is not a therapeutical method. Only when medical personnel understand the characteristics of the parameters totally and use them to guide feedback management, and then to constitute accurate implementation of intervention methods, monitoring is worth to practise, and it is of clinical significance.
目的 报告 1 例不明原因中毒患者的诊疗过程,分析其临床表现和中毒原因,为临床对不明原因中毒患者的确诊及治疗提出讨论与警示.方法 成都市第二人民医院于 2023 年 2 月 22 日收治 1 例以心律失常为主要表现的中毒患者,采用临床检查、病史分析及多方会诊的方法评估患者病情,制定治疗方案,抢救患者生命.结果 患者明确服用何首乌和天麻炖汤后出现全身症状,尤以心律失常为主,但具体临床表现和服用中药材所致不良反应并不相符,根据病史分析、临床表现、检查结果及会诊结果,考虑乌头碱中毒,进一步予以体外膜肺氧合(ECMO)、安置心脏起搏器、血液净化、保护器官功能处理,但患者病情危重,最终死亡.结论 乌头碱中毒以心律失常为主要表现,无相关基础疾病患者出现心律失常,应警惕中毒.
目的 研究免疫检验与常规检验在孕妇产前检查中的临床应用.方法 选择 2021 年 7 月—2022 年 7 月在龙口市人民医院就诊的 98 例孕妇作为研究对象,根据双色球法分为对照组和观察组,每组49 例.对照组实施常规检验,观察组在常规检验基础上加用免疫检验.比较两组的检查结果、并发症发生情况、分娩结局和分娩方式.结果 观察组的高危妊娠因素检出率和并发症发生率均明显低于对照组[高危妊娠因素检出率:6.12%(3/49)比 22.45%(11/49),并发症发生率:8.16%(4/49)比 24.49%(12/49)],差异均有统计学意义(均P＜0.05);观察组的流产率、早产率以及新生儿窒息发生率、死胎发生率均明显低于对照组[流产率:2.04%(1/49)比 14.29%(7/49),早产率:4.08%(2/49)比 18.37%(9/49),新生儿窒息发生率:0.00%(0/49)比 8.16%(4/49),死胎发生率:0.00%(0/49)比 8.16%(4/49)],差异均有统计学意义(均P＜0.05);观察组的阴道分娩率明显高于对照组,剖宫产率明显低于对照组,差异均有统计学意义[阴道分娩率:73.47%(36/49)比 40.82%(20/49),剖宫产率:16.33%(8/49)比 34.69%(17/49),均P＜0.05].结论 与常规检验比较,免疫检验能更有效地检出孕妇的高危妊娠因素,有助于尽早实施有针对性的治疗,从而优化妊娠结局,保障母婴安全.
目的 报告 1 例人类免疫缺陷病毒(HIV)感染合并肺炎链球菌脑膜炎患者的诊疗过程,分析和总结相关实验室检查结果的规律.方法 2021 年 1 月 18 日某三甲医院收治 1 例HIV合并肺炎链球菌脑膜炎患者,通过传染筛查、脑脊液生化常规检查、细菌鉴定及脑脊液培养,查找病因并确诊.结果 患者为 30 岁女性,因"2 d前无明显诱因出现头痛、发热,精神恍惚"入院.检测结果可见HIV阳性,脑脊液常规可见乳白色、浑浊,潘氏试验(+++),白细胞计数(WBC)为 112.0×106/L↑,多形核细胞比例为 83%,单核细胞比例为 17%,脑脊液蛋白为 4590 mg/L↑,氯化物为 116 mmol/L↓,葡萄糖为 0.1 mmol/L↓;脑脊液培养结果为肺炎链球菌.患者诊断为HIV感染合并肺炎链球菌脑膜炎,最终患者放弃治疗出院.结论 感染HIV的患者被肺炎链球菌侵袭的可能性比普通人群高 25%～50%,脑脊液检查是化脓性脑膜炎诊断的"金标准",在感染性疾病的最终确诊过程中病原学诊断依据更重要.
