目的 探讨院内心搏骤停(IHCA)患者心肺复苏(CPR)预后相关影响因素.方法 按国际Utstein模式登记东部战区空军医院2013年1月—2018年1月行CPR的IHCA病例.收集每例患者的资料,选取患者年龄、发病科室、发病时间段、发病原因、初始心律、CPR启动时间、CPR持续时间、通气方式8个因素为研究变量.记录CPR的预后,包括自主循环恢复(ROSC)、24 h生存、生存出院和1年生存情况.比较8个不同因素分组的CPR疗效.对影响CPR预后的相关因素进行单因素和多因素Logistic回归分析.结果 102例CPR病例中,ROSC、24h生存、出院生存、1年生存分别为71例(69.6％)、46例(45.1％)、24例(23.5％)、18例(17.6％).Logis?tic回归分析结果显示,急危重症科室和气管插管是ROSC的有利预测因素;而年龄≥65岁、心源性病因是不利因素.CPR持续时间≤15 min是24 h生存的有利预测因素;年龄≥65岁、心源性病因是不利因素.初始心律为心室颤动/无脉性室速(VT/VF)、CPR持续时间≤15 min是患者存活出院和1年生存的有利预测因素;年龄≥65岁是不利因素.结论 可除颤心律、CPR持续时间≤15 min是IHCA患者生存出院和长期生存的独立预测因素;心源性病因预后较差;早期气管插管与球囊通气相比,预后并无显著差别.

对"和谐使命-2017"任务的前期准备与组织实施进行分析和思考,总结经验和不足,为今后执行类似海外医疗任务提出合理化建议,包括:合理配备全科医生是完成和谐使命任务的必备素质、及时根据医疗服务状况改变诊疗模式、强化军人服从意识及纪律意识等等.

目的 探讨长航人员功能性便秘(functional constipation,FC)的患病情况及枯草杆菌二联活菌肠溶胶囊联合莫沙必利干预性治疗的效果观察.方法 采用整群分层抽样方法分别于长航前后对1298名任务官兵进行问卷调查,调查问卷采用罗马Ⅲ标准流行病学调查问卷,有180例诊断为FC,随机分为联合治疗组(枯草杆菌二联活菌肠溶胶囊联合莫沙必利治疗,83例)和对照组(单纯用莫沙必利治疗,97例).结果 任务官兵FC患病率高达13.87%,经过药物治疗后2组便秘症状均有明显改善;同组比较观察指标较治疗前均明显改善,差异有统计学意义(P<0.001).组间比较,联合治疗组较对照组改善更为明显,差异有统计学意义(P<0.001).联合治疗组总有效率为91.57%,对照组总有效率为62.89%,2组比较差异有统计学意义(P<0.001).结论 枯草杆菌二联活菌肠溶胶囊联合莫沙必利对长航官兵FC治疗疗效显著,值得临床推广.

Objective To investigate the prevalence of anxiety/depression among navy officers and men during long navigation and influencing factors thereof.Methods 305 navy officers and men,all males,aged (25.6±11.61)(18 ～ 45),who took long voyages to execute the tasks of "Harmonious Mission-2012","Harmonious Mission-2013",and "Harmonious Mission-2014",were studied by cluster sampling.The Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to a access their psychological health.Logistic regression analysis was used to identify the risk factors.Results The prevalence rate of anxiety/depression after navigation was 28.42％,significantly higher than that before the navigation (2.05％,P ＜0.01).The prevalence rate of anxiety/depression after navigation of the navigation department was 31.25％,higher than those of the mechanical and electrical department and logistics department (28.42％ and 24.71％ respectively),however,there were no significant differences among these 3 departments (all P＞0.05).Analysis showed that having been abused,parents' divorce,and bereavement were all risk factotrs for anxiety/depression.Conclusion The prevalence of anxiety/depression is rather high among the navy officers and men during long navigation.Relevant risk factors include having been abused,parents' divorce,and bereavement.

法属波利尼西亚为多岛国家,位于太平洋东南部[1]."和谐使命-2015"任务中,和平方舟医院船于2015年10月20日至24日对其塔希堤岛(又称大溪地岛)进行访问和医学交流,与法国海军实施人道主义救援联合演练(简称联演) [2]. 法方纸质伤票信息丰富,伤票上解剖简图及图例直观易懂,为联演顺利实施提供了有效帮助. 现报道如下.

思诺思和安坦均为CNS用药,大量服用两种药物所致中毒临床未有报道,现将本院成功救治1例两药重度中毒患者报告如下. 1 病例 男,64岁,因"口服思诺思(10 mg)100~120片,安坦(2 mg)200~300片后18 h"于2015年11月29日入本院急诊.患者呈昏迷状,伴呕吐,呕吐物为胃内容物.患者既往有帕金森病、焦虑症、睡眠障碍病史,长期口服思诺思和安坦.查体:体温38.2℃(腋下),血压116 mmHg/79 mmHg (1 mmHg=0.133 kPa),呼吸25次/min,指脉氧94%(面罩吸氧,6 L/min),昏迷状(GCS评分3分),双侧瞳孔等大等圆,约5 mm,对光反射迟钝,两肺呼吸音粗,未闻及明显湿啰音,心率120次/min,律齐,各瓣膜听诊区未闻及杂音,腹软,肠鸣音正常,病理征未引出.

Objective The overseas service module of the electronic medical information workstation (EMIW) onboard the hospital ship "Ark Peace" was summarily analyzed in this paper.Yet,shortfalls still existed in the system.For further improvement,suggestions were provided for upgrade.Methods Shortfalls in EMIW,were colleted in terms of hardware and software.Results There were shortfalls in terms of hardware and software.With respect to hardware,there were insufficient printers.Certain registration cards could not be recognized by the card reader,so card replacement should be implemented without delay.Due to insufficiency of network capability,CT images could not be transmitted via network.With regard to software,the doctor/nurse station could neither rectify wrong information stored in the registration card,nor recognize the corrected in.formation in the card.The tool buttons and the size of the words on the interface were too small,without a 3-dimensional sensation,and as a result,it was difficult for the operators to recognize whether a command had been executed or not.As the doctor/nurse station had outpatient and ward functions,there were too manv ineffective items.In addition,there were too many tedious procedures to operate.Conclusions In view of the shortfalls in the present EMIW,following recommendations were proposed:providing more printers,ensuring the quality of registration cards,easy replacement and correction of the information stored in the card at the doctor/nurse station,and provision of reliable network with stable,high speed and sufficient performance.Separate outpatient and inpatient doctor/nurse station system should replace the present system with more friendly interface and simple operation.

"环太平洋-2016"联合军演中,作者参观了美海军"美国"号两栖攻击舰的医疗舱室区域,与美军医务人员进行了多方面交流,以所见所闻总结美海军"美国"号两栖攻击舰医疗舱室在设计布局、设施设备方面的特点,希望对我军未来大型舰船医疗舱室的设计、改装与使用提供借鉴性参考.

On Sept 7, 2015, Chinese hospital ship Ark Peace left its home-port in Zhoushan, Zhejiang Province, for"Harmony Mission-2015", the fifth in a series of annual international humanitarian and free medical assistance endeavors by the PLA Navy.This mission lasted 142 days, involving a visit to Malaysia and participation in "Peace Friendship-2015 exercise",before she was dispatched to seven countries (regions) including Australia, Polynesia, USA, Mexico, Barbados, Grenada, Peru and provided a wide range of medical , humanitarian assistance to the last four countries .A total of 12 589 patients were treated on the main platform , 4852 patients by the 29 fore-lying medical corps , 59 surgeries performed , 46 patients hospitalized ,and 7130 CT and DR et al auxiliary examinations conducted during four mission stops .We organized academic exchanges , visits and interviews , get-togethers , dynamic and static exhibitions in each country .The experience from "Harmony mission-2015"is of great significance for such tasks in the future .

By learning about the specific methods of humanitarian assistance and disaster relief ( HADR) table-top exercise ( TTX ) of the US Armed Forces and participating in the TTX on the basis of fundamentals of global health engagement(GHE) course,we had a better understanding of the definition of GHE and principles , planning, activities, and monitoring of the US Armed Forces HADR actions , which will contribute to Chinese PLA HARD action and training.

实践证明,需要改变医院船的结构,以节省伤者和病者的转移时间,以减少二次伤害.为了改善检伤分类质量,需要更多的医护人员应补充到检伤分类区,医生与护士的比例为1:1至1:2.根据战伤分类的原则,伤者和病者应尽快分为4个等级,并任命不同专科的专家到不同等级病患所在的区域.

During the "Peace Friendship-2015"and "Harmony Misson-2015", the medical personnel aboard the hospital ship performed extensive medical exchanges , medical service shows ,and skill training many times and visited some local medical institutions .The exchanges involved war wound , seawater-immersion wound, drill wound, common disease, infectious disease .This paper gave an account of characteristics of and specific methods used in oversea medical exchanges . The experience from these visits and afterthoughts were presented in order to contribute to medical exchanges of this kind in the future.

As medical staff onboard Ark Peace Hospital Ship of PLA ( N) , the author participated in the whole process of both RIMPAC-2014 and RIMPAC-2016 exercises.He embarked on USNS Mercy Hospital Ship as one of the members of the ship-riding delegation in RIMPAC-2014.After close and intensive obsenation of US counterparts′approaches to ATLS course training, the author outlined medical staff ATLS course training, combination of exercise and test , scenario settlement of combat injury as well as its treatment principles and cosmetic features.He also raised proposals for PLA medical logistics services .

针对历次和谐使命医疗服务中拟手术患者在门诊完成术前常规检查(包括抽血化验、心电图、影像检查及超声检查等)耗时长,术前专家组病例讨论审核开始时间晚,占用时间长使手术不能尽早开始,以及手术安排不紧凑导致手术结束时间过晚的情况.在和谐使命-2015任务格林纳达站医疗服务期间,采取有手术需求患者优先就诊、专门设置术前检查套餐、开通绿色通道提前检查,完善术前检查基本条目及注意事项提醒,专家讨论酌情提早开始并采用常规及简化两种审核程序,手术统筹安排,在保障安全前提下多台同时展开,缩短接台手术的时间间隔等举措,缩短了围手术期处理时间,做到了在高峰期10台以上手术的情况下在当天24:00前完成手术,给外科医生节省出了宝贵的休息时间,效果理想.

[目的]总结结膜瓣遮盖术治疗角膜溃疡穿孔的护理。[方法]对26例角膜溃疡穿孔病人行结膜瓣遮盖术，同时加强心理护理、术前准备、术中配合、术后正确用药以及出院后按时复诊的必要性的指导。[结果]26例全部治愈，术后疼痛明显减轻，治疗效果满意。[结论]加强结膜瓣遮盖术治疗角膜溃疡穿孔的护理是手术成功的保证。

Objective:To discuss the effective means of foreign civilian outpatient service on Peace Ark Hospital Ship Platform.Methods: Concerning the onboard outpatient service feature towards overseas civilian, which involves such countries as Maldives, Pakistan, Bangladesh, Myanmar, Indonesia and Cambodia, during the time of mission Harmony-2013, some related experience was summarized from varied aspects of primary sorting and allocation, reception, consultation awaiting and final consultation respectively.Results: Such experience was helpful for effectively enhancing onboard foreign civilian outpatient service efficiency of Hospital Ship. Conclusion: It would provide positive example for Peace Ark Hospital Ship in terms of excellent accomplishment of subsequent similar outpatient service mission.

通过介绍美国医院船执行美军2015“太平洋伙伴”任务,以期对我军医院船执行“和谐使命”或其他人道主义医疗服务任务提供借鉴.“仁慈号”医院船完成的任务包括医疗服务、学术交流、课程培训及其他服务等.本文从如何扩大对外影响、丰富服务内容、提高服务质量、完善结构及人员配置等方面进行了论述.提出医院船应积极参与国际人道主义医疗援助,更好地完成“和谐使命”及类似任务,扩大影响、展示国家及我军的形象.

On June 15th 2016, the Chinese PLA Hospital Ship "Ark Peace"left its home-port in Zhou Shan, Zhejiang Province, for Hawaii for Exercise "RIMPAC-2016".This paper introduced the medical evacuation organization of"RIMPAC-2016",involving the medevac practice and the revelation to the PLA .The experience during "RIMPAC-2016"is of great significance for such multi-national exercises that will be organized by the PLA in the future .

医院船是海上灾害救援过程中医疗救护和卫勤保障的综合平台，是各军事大国海军发展过程中的重要内容。随着海军执行远洋灾害救援、演习、护航及访问交流任务的越来越频繁，海上卫勤保障力量的发展显得尤为重要。“和平方舟”号作为我国海军第一艘自主研发的医院船，自2007年列装以来，已经执行了多国海军活动、万里海疆行、环太平洋2014军演和4次“和平使命”任务，并参加西沙搜救、2013年赴菲律宾执行国际人道主义医疗救助等，充分体现了海上医院船的强大功能，被誉为海上“生命之舟”[1-2]。虽然我国海军医院船的发展已经取得了诸多成绩并积累了丰富的经验，但在实际应用过程中仍然存在着一些需要改进的问题。现从多个方面介绍“和平方舟”号医院船的基本情况，并根据实践经验总结讨论我国海军医院船在将来的发展中需要改进及注意的问题。

Objective To investigate the prevalence and the risk factors of essential hypertension in long-term sailor of navy. Methods A total of 305 subjects (199 male and 106 female) were included in the study. The survey was conducted 8 weeks after the long-term voyage. A total of 292 valid answers were collected (191 male and 101 female) for analysis. The risk factor analysis was compelled by Logistic Regression. Results The prevalence of essential hypertension was 9.6% at 8 weeks respectively. It revealed a low incidence of 8.8% in logistic and nautical departments due to a low work load and a high incidence of 11.5% in mechanical services department and catering department for a reason of high work load. However, the difference didn’t carry out any statistical meaning (aP>0.05,χ2=0.52). The results of logistic regression demonstrated a significant correlation between essential hypertension and mental stress, age, BWI, family history, high-salt diet, and smoking (P<0.05). Conclusion The high prevalence of essential hypertension in the sailors was found to be correlated with mental stress, age, BWI, family history, high-salt diet, and smoking. A strategic prevention plan shall be made based on the factors found.