Objective:To analyze the effect of lappaconitine on the accuracy of diagnosis in unexplained acute abdomen.Method:Pain was measured with a standard visual analog scale(VAS).180 patients with moderate-severe diagnosis in unexplained acute abdomen were randomized into two groups,the control group and the lappaconitine group respectively,each of 90 patients.8 mg lappaconitine was administered intramuscular for the management of pain in patients in the lappaconitine group.VAS,the ratio of pain sign and clinically diagnostic accuracy were compared.Result:After 30 minutes treatment,VAS were(5.7±1.4)scores in lappaconitine group,while(7.0±1.2)scores in control group ,the difference was statistically significant(P<0.05);the ratio of positive pain sign was 69%in control group and 64%in lappaconitine group,the difference was no statistically significant(P>0.05).After 2 h treatment,VAS were(5.4±2.3)scores in control group and(3.2±1.6)scores in lappaconitine group,the difference was statistically significant(P<0.05);the accuracy of clinically important diagnostic was 86.7% in the control group and 84.4% in the lappaconitine group ,the difference was no statistically significant(P>0.05).Conclusion:Administration of lappaconitine to patients with acute abdominal pain provides analgesia without impairing clinically important diagnostic accuracy.

Objective To observe the changes of disease spectrum and the rescue success rate of critically illnesses in emergency department.Methods 5263 critically illnesses in emergency department(from 2003 to 2012) were divided into three age groups and two time periods according to their ages and the times when they were treated.The composition and of the critically illnesses were compared between groups.Results ①Ten years of critically ill disease of nervous system diseases,trauma,and higher constituent ratio of circulatory system disease,were the first to third place.②Disease ranks first in the disease,are wound in the young and middle-aged group,elderly group first,two of the nervous system and circulatory system diseases respectively. ③The emergency success rate of rescuing critical patients increased year by year,trauma,nervous system diseases and poisoning the case fatality rale of decline has a significant statistical significance,but wounds,and nervous system disease mortality is still the top two.Conclusion Trauma,nervous system and cardiovascular diseases are the major critical disease in the department of emergency Shall establish complete first aid system and mechanism focus on conducting joint research of major emergency critical care research.

Objective To explore the epidemiological characteristics of the pre-hospital care for traffic injury in Mianyang City from the year 2006 to 2007.Methods The patients recieved by Emergency Medical Rescue Command Center of Mianyang during 2006 to 2007 were chosen as the surveyed object.The type of damage,date,time,geographic distribution were used as the main observation indexes.The database has been established and statistical analyze has been given hereby.Results Among all 4,452 cases of pre-hospital care,there were 3,018 person-time of male and 1,434 person-time of female(χ2=1127.1590,P=0.0000).Types of injury were head trauma,fractures,soft tissue injury,spinal fractures,chest injuries,facial injuries,abdominal injuries and so on.The emergency peak of a day was 10∶ 44~22∶ 52(r=0.2851,P0.05),but no significant seasonal peak in emergency during the whole year was found(r=0.0668,P0.05).In the geographical distribution,urban areas accounted for 59.91%(χ2=348.6797,P=0.0000).Conclusion The pre-hospital care for traffic injury in Mianyang has its own epidemiological characteristics,we should strengthen safety awareness of public to reduce accidents.Reasonable allocation of aid resources,to improve pre-hospital care,reduce morbidity and mortality.

Objective To study the feasibility of the application of MEWS grade to the prognosis forecast of brain-injured at emergency room.Methods According to prefixed choosing and excluding standards,we chose 94 cases of brain-injured that hospitalized from Jan.2007 to Mar.2008 in our hospital.We observed them,gathered the data and the samples for test as soon as they hospitalized;then we gave grade to every patient according to the APACHEⅡ and MEWS separately;we finished the observation after three months and took the prognosis as the observing index;lastly we made the statistical analysis after the data-collection.Results When choose the death as the forecast index,the cut-off of APACHEⅡ grade is 21,Sen=100%,spe=94.81%;and area of ROC'S curve:Az=0.9809;U=39.0337;P=0.0000.The cut-off of MEWS grade is 5, Sen=100%,Spe=88.31%;and area of ROC'S curve:Az=0.9756;U=35.2844;P=0.0000.They all show strong intensity of forecasting value.However,when choose the mutilation as the forecast index,the cut-off of APACHE Ⅱ grade is 16,and area of ROC'S curve:Az=0.8653,U=4.2115,P=0.0000, Sen=85.10%, Spe=76.00%.The cut-off of MEWS grade is 3.Az=0.8255, U=3.8424,P=0.0001.Sen=85.71%,Spe=75.71%.They all show midium intensity of forecasting value.Conclusion It is proved that the APACHE Ⅱ and MEWS show forecast value on an equal basis,but MEWS is proved to have more simple grading structure and own the advantage of time-saving as well as economical.Therefore,the MEWS is more suitable to popularize in the prognosis forecast of brain-injured at emergency room.

腰椎间盘突出和腰椎管狭窄是腰腿痛、坐骨神经痛最常见的原因[1].我院从1990年1月以来共收治腰椎间盘突出合并腰椎管狭窄病例108例,取得一些治疗经验,现总结如下.