突发意外伤病每年可致数百万人残疾或死亡,给家庭和社会带来了沉重的负担.因此,改善我国急救体系,提高大众的自救互救能力刻不容缓.如何提升大众急救能力一直是我国急危重症科医师关注的重点.

Objective:To systematically evaluate the change trend of recovery of spontaneous circulation(ROSC) in patients with cardiopulmonary resuscitation (CPR).Methods:The CNKI (1979-march 2019), Chongqing VIP (1989-2019 March), Wanfang database (1990-March 2019) and Web of Science(1900-May2020) were searched. The clinical data of patients with cardiac arrest before hospital, and analyze the cardiopulmonary resuscitation at different time were collected. Two researchers independently screened the literature and extracted the data. The meta package of R software was used for analysis (version No. 3.61).Results:114 articles met the inclusion criteria, a total of 26 334 patients, including 2 229 cases of cardiac recovery. Heterogeneity test showed χ2=5288.48 and I2=96.3% (P<0.01), suggesting high heterogeneity. Therefore, the random effect model was used for this analysis. The combined effect was 0.241 [0.192; 0.297]; the ROSC in 2004-2008, 2009-2013 and 2014-2018 was 0.200 [0.135; 0.286], 0.230 [0.147; 0.342] and 0.281 [0.203; 0.376], respectively, and the success rate of ROSC had an upward trend, but there was no statistical difference among the three groups.Conclusion:In recent 15 years, the ROSC of pre-hospital CPR has an increasing trend every five years, but there is no statistical difference.The CPR should start under the witness and it should be within 10 minutes oras soon as possible. It is correct to use the law of timeliness to guide the direction of efforts in the future. Only by storing the first-aid technology among the people and assembling AED equipment in public places can we realize the maximum rescue potential.

目的 调查"白金十分钟自救互救"知识和认知水平,寻找急救"白金十分钟"推广中存在的问题,为进一步推广提供科学依据.方法 2019年8月—10月,根据"北京白金十分钟时效应急技术研究院"专家委员会制定的调查方案,采用专家委员会设计的调查问卷,在某地现场调查医务人员和大众人群,并进行分析研究.结果 医务人员急救"白金十分钟自救互救"相关知识、自救互救意识和能力明显高于普通民众.部分医务人员和大众心肺复苏操作正确率低,急救知识普及现状不甚满意.基层医院和辅助科室的医务人员理论基础较薄弱,操作不规范,合格率低.结论 "白金十分钟自救互救"志愿者采取形式多样的培训方式是有效的,受欢迎的;要强化医务人员规范化和常态化急救技能培训和练习,进而普及提高全民自救互救知识;要通过政府进行"白金十分钟自救互救"的全社会系统建设,才能达到最好效果;针对大众"白金十分钟自救互救"体系建设,公共卫生、医疗救护、应急救援部门起到了积极促进作用.

通过对中外人文精神关怀方面的异同进行对比,探讨急救模式缺陷造成的人文关怀缺失,以及急救白金十分钟自救互救人文精神实践对现代急救人文关怀的补充指导作用.践行人民健康"预防–保健–诊断–治疗–康复"新模式,必须建立急救全链条(自救互救–120–急诊–重症–康复–康养)干预方案,发展急救时效学与时效经济学的理论,以便更好地提出不同阶段的急救措施和相应对策.

目的 探讨四点听诊导航法在危重患者床旁徒手盲插鼻肠管中的应用效果,为危重患者寻找一种简便快捷、安全有效、成功率高的徒手盲插鼻肠管的方法.方法 观察临床需要留置鼻肠管的患者41例,采用四点听诊导航法,即先将导管置入胃内,彻底排空胃内容物包括气体,在继续送管的过程中,顺序听诊剑突下、左肋下、脐上、右肋下四个部位,分别对应胃贲门部、胃底部、胃体部和胃幽门部.听诊四个部位的气流声并进行对比,声音最响亮的部位为导管尖端的部位,以此判断导航导管尖端走行.结果 41例置管,平均用时28.78±9.77 min,成功率92.7％.而且患者是否气管插管和置管前给予促胃肠动力药与不给药对置管成功率无影响.无严重并发症发生.结论 四点听诊导航法盲插鼻肠管操作简单用时少,成功率高,不受气管插管影响,无需额外药物辅助,值得在临床推广使用.

目的 以急救时效学观点和方法,分析探索应急医学救援的新理论、新实践、新传播、新发展.方法 总结白金十分钟理论产生与实践的发展过程,从时间和伤害效价关系进行分析研究,探求应急医学救援时效的时间段,获得了最佳时效段为救援实践提供了决策依据.从急救链找出"白金十分钟自救互救"阶段,补齐了急救链,通过建立"急救白金十分钟全国自救互救日"、"白金十分钟自救互救奖"等,在全国常态化地开展大众急救科普实践,传播以"白金十分钟"为代表的时效应急医学救援理论.结果 ①急救时效学观点和方法使时效应急救援的效益和资源的优化最大化;②时效规律为提高时效应急医学救援能力和应急救援体系建设提供了理论依据;③以"大众-专业-志愿"科普传播模式是应急救援、健康文化的创新教育文化.结论 ①时效学与应急医学救援结合,创立时效应急医学救援新理论和新实践体系;②时效应急医学救援提高社会救援的效率,指导全社会应急救援建设,提升国家应急管理水平;③从"专业、大众、社会、文化"等多维度践行社会救援,为新时代社会建设贡献力量;④宣传时效应急医学救援理论对提高社会自救互救率、建设中国急救文化、创新社会发展有着不可替代的现实意义.

按全链条干预观点分析各时段的伤病死亡与救治潜力,以急救时效学观点建立数学计算模型公式,代入课题组既往对现场、院前"120"、急诊和重症医学科的抢救成功率等结果,计算出实际、理想的结果.按照国家对意外事故的经济损失补偿为基础,引入经济学研究,模拟白金十分钟时效应急的经济学分析模型,计算白金十分钟理论进行院外自救互救因素的影响,可以推广到其他疾病的经济学研究,对促进社会和国家在应急救援的判断和决策、急救培训和相关设施投入方面有现实的指导意义.

自党的十八大报告首次正式提出全面建成小康社会以来,在党和国家各级领导的带领下,全国人民经过不懈努力,使我国最终进入全面建成小康社会的决胜阶段.从2017 年党的十九大报告提出"坚决打赢脱贫攻坚战",到2020 年在现行标准下农村贫困人口实现脱贫,贫困县全部摘帽,我国已现已基本实现贫困地区和贫困人口一道迈入全面小康社会.在这个过程中,国务院制定了重点实现"两不愁三保障"的政策[1] ,加大了对"三区三州"等深度贫困地区的脱贫攻坚力度,落实对特殊贫困人口的保障措施[2]等.此外,国家综合扶贫机制[3] (国家扶贫、东西部对口扶贫、省级扶贫、市级扶贫等)也发挥了巨大的作用.

死亡是一个连续和逐渐发展的过程.机体内各组织、细胞并非在同一时间进入死亡状态,它们的功能也不会在同一时间停止.伴随濒死过程的心理学研究也在不断发展.但就世界范围来看,要把它作为一种与临床医学同等重要的实施内容而被大家接受,目前还远不能达到.这就会影响我们对濒死或病危状态下不同人群的心理过程的认知和照顾处置的方式及对他们实施的态度.

目的:以2所医院为例,探讨三甲医院急救中心与二甲医院患者转运安全性和服务内容差异.方法:收集2013-2018年某三甲医院急救中心与2015年12月～2018年5月某二甲医院患者转运数据,比较其患者转运总死亡率及脑出血、消化道出血、肿瘤等疾病患者转运死亡率.结果:该三甲医院急救中心和二甲医院的患者转运总死亡率分别为3.4％、15.3％,差异有统计学意义.结论:该三甲医院急救中心医疗转运服务在安全性和转运服务水平上高于该二甲医院;应根据患者疾病状况选择转运方案,合理配置医疗资源;推进分级诊疗,加强医联体建设,促进急救体系全覆盖.

Systematic evaluation of the successful heartbeat recovery rate (HRR) in patients during the platinum ten minutes after cardiac arrest. The databases of CNKI (January 1979–March 2019), Chongqing VIP (January 1989–March 2019), Wanfang (January 1990–March 2019) and Web of Science (1900-May 2020) were searched. To collect the clinical data of patients with cardiac arrest before hospitalization and analyze the cardiopulmonary resuscitation (CPR) at different times. Literature selection and data extraction were carried out by two researchers independently, and the meta package of R software (version 3. 61) was used for analysis. A total of 116 papers met the inclusion criteria, including 37,181 patients. Of these patients, 3367 had their heartbeats successfully restored. The results showed a high degree of heterogeneity (χ2 = 6999.21, P < 0.01, I2 = 97.6%). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.199 (0.157–0.250). (1) According to the five CPR groups (International Cardiopulmonary Resuscitation Guide 2000, 2005, 2010, 2015 and other versions), the HRR of other versions [0.264 (0.176–0.375)] was higher than the International Cardiopulmonary Resuscitation 2005 edition [0.121 (0.092–0.158)]. (2) The rescue time was divided into the 0 to ≤5 min group, the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. The HRR were 0.417 (0.341–0.496), 0.143 (0.104–0.193), 0.049 (0.034–0.069), and 0.022 (0.009–0.051), respectively. The HRR was higher in the 0 to ≤5 min group than in the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. There was no difference between the 10 to ≤15 min group and the > 15 min group. (3) When the groups were stratified with the cutoff of 10 min, the ≤10 min group HRR [0.250 (0.202–0.306)] was higher than the > 10 min group rate [0.041 (0.029–0.057)]. (4) The HRR of the telephone guidance group was [0.273 (0.227–0.325)] lower than that of the 0 to ≤5 min group [0.429 (0.347–0.516)] but higher than that of the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. (5) The HRR of the witness group [0.325 (0.216–0.458)] was not different from that of the 0 to ≤5 min group, but it was higher than those of the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. (6) There was no significant difference HRR between the witnessed group, the telephone guidance group and the ≤10 min group. (1) The HRR is time-sensitive, and early rescue can improve it. (2) CPR performed within the platinum ten minutes must be executed by the public, and other forces are auxiliary. (3) The concept of peri-cardiac arrest period (PCAP) should be established and improved to guide CPR.

哲学强调事物有发生、发展、结束的客观规律,具有动态演变的特点. 换言之,一件事是应有头有尾的. 但临床工作中有些事要搞清楚头和尾是不容易的,一旦清楚了头尾,就会提升我们对于这个问题的认识,改善实践效果. 比如心肺复苏的头和尾在哪儿? 随着对急救"白金理论"[1-8]的深入研究,针对心跳停止、心跳骤停、心肺复苏、公众心肺复苏、猝死等问题的理论和实践的挑战是回避不了的. 目前,针对围心跳骤停期( peri-cardiac arrest period)这个概念进行研究和定义,并进一步阐明其临床意义就显得十分必要和重要. 这可以让大家对心跳骤停的头和尾有新的认识,从而提高我们临床工作的效果.

归纳我国急诊医学、灾难医学发展概况,展现了建国70年来医学救援发展成果.阐明灾难医学、突发公共事件之概念.总结了突发公共事件医学救援的主要内容,提出了医学救援中快速检伤、检诊的新方法和医学救援的时效法则.深入思考专业化医学救援队伍的建设,规范自救互救技能培训和演练,扩大社会力量参与自救互救,保障民众的生命健康安全,维护社会和谐稳定发展.

总结白金十分钟时效性自救互救的学术专业理论,阐明急救时效学、急救时效经济学、急救的时效性与时效值、时效学研究方法等概念,通过对流行病学数据的分析提出重特大自然灾害的自救互救的应对策略,重新认识白金十分钟全国自救互救志愿公益服务联盟的时效应急成果对国家应急救援的指导意义,规范白金十分钟自救互救理论与实践的培训和操作流程,提出链式流程的医学救援方案,开展白金十分钟围心跳骤停心理学研究,加快和推进国家时效应急领域的科学研究,为构建和实践新时代中国特色应急救援理论奠定基础.

随着对"急救白金理论" 的深入研究[1-12] ,针对心搏停止、心搏骤停、心肺复苏、公众心肺复苏、猝死等问题的理论和实践面临巨大挑战. 研究团队已 经 完 成 对 围 心 跳 骤 停 期 ( peri-cardiac arrest period) 的概念、定义、分期等理论总结,在此基础上,团队进一步对既往猝死的公众问题进行了研究. 以便提高社会大众、医务工作者对这个概念的全面认识,从而提高预防猝死发生的有效性.

随着我们放开视野,从对意外伤害开始观察时,才开始对伤病的全过程救治有了整体的认识.当我们把医疗救援放在应急反应的全过程时,我们才对时效概念有了更深刻的认识.我们才能从既往由工作空间决定只思考自己的工作环节的狭隘视角转换出大视角,这样才能真正比既往全面、公正地思考急救和救援工作.

据外交部相关数据显示,2017 年全年在海外意外身亡的中国公民高达695 人,其中各类旅游活动安全事故导致182名中国公民意外身亡,是中国公民海外出行的最大杀手[1]. 如何在疾病、意外等突发情况下迅速回国并得到及时有效救治成为很多人的迫切需求. 因快速、灵活、高效等特点,航空医疗救援已在世界发达国家广泛应用并形成覆盖面广的空中急救网络[2]. 中国作为拥有14 亿多人口的大国,却尚无完善的整体化空中医疗救护服务体系[3]. 只有建立完善的空中救援服务体系,才能满足重症患者的医疗转运诉求及远程转运安全,从而提高我国重症患者的整体救治率.

Objective To explore the difference between the chain flow method and the control transport method.Methods A review of 42 patients with chain transport from November 2011 to November 2014 was compared with 80 patients who had been transshipped with conventional method at the same period.The patient's average age was (49.38 ± 18.52) years old.The diagnosis of critically ill patients included:4 multiple injuries,3 high paraplegia,2 cervical fractures,2 Severe craniocerebral trauma,1 sepsis,4 severe burns.The transmission mileage,time and transfer rate between the two groups were compared.The status of the transfer was aggravated,stable,dead,and the condition of tumor patients who were transferred also were compared.Results Compared with the general emergency transport group,the chain procedure group had shorter time (P ＜ 0.01),and the difference of transit distance was statistically significant between the two groups (P ＜0.01).The transfer rate of the chain procedure group was lower than that of the control group (P ＜ 0.01).The aggravation rate (9.8％) of the chain procedure group was lower than that of the control group (40％) (P ＜ 0.01).The steady rate of chain group (85.4％) was better than that of control group (26.3％) (P ＜ 0.01).The mortality rate of chain group (2.4％) was lower than that of control group (23.1％) (P ＜ 0.01).There was a statistically significant difference in the rate of tumor transport between the two groups (P ＜0.01).The mortality rate of chain group (2.4％) was lower than that of the control group (23.1％) (P ＜ 0.01).Conclusions The chain transport method has better safety and superiority than the conventional transport method in the transport of critical patients.Strengthening the training and implementation of the chain transporters' guidelines for the transport of critical patients is safety protection of a long-distance transportation.

Objective:To investigate the effect of early progressive rehabilitation training on the neuromuscular function of patients with severe mechanical ventilation.Methods:Selected 80 patients with mechanical ventilation in severe our hospital from April 2015 April 2016.The patients were divided into observation group and control group by random number table method,each of 40 cases,after entering the ICU,they were given conventional mechanical ventilation.On this basis,the observation group was given early progressive rehabilitation training,evaluated the level of functional independence in two groups by functional independence measure (FIM) when the patients tracheal extubation,turn out ICU and discharge the hospital respectively,and compared the mechanical ventilation time,ICU treatment time,and total time in hospital,as well as the occurrence of complications in two groups.Results:The self-care ability,sphincter control,move function and total score in observation group were higher than control group when tracheal extubation,differences were statistically significant (all P＜0.05),self-care ability,sphincter control,move,walk,communication,social cognition and total scores were higher than the control group when turn out ICU and discharge the hospital respectively,the differences were statistically significant(all P＜0.05).Observation group mechanical ventilation time and ICU treatment time and total time in hospital and the complication rate is lower than the control group,the differences were statistically significant (P＜0.05).Conclusion:Using Early progressive rehabilitation training for treating the patients with severe mechanical ventilation,it can effectively improve the self-care ability,accelerate the recovery of consciousness and weaning,reduce the hospital stay,and reduce the incidence of complications of patients.