Objective:To investigate the clinical effect of Shenqi Dihuang Decoction and Xiaochengqi Decoction enema combined with hemodialysis in the treatment of qi deficiency, blood stasis and dampness and turbidity in chronic kidney disease (CKD) stage 5.Methods:Randomized controlled trial. A total of 102 elderly CKD stage 5 patients with Qi and Yin deficiency and turbid poison inherent type were selected from May 2021 to January 2022 of the Beijing Longfu Hospital. The patients were divided into two groups by random number table method. Control group (51 cases) received hemodialysis treatment for 4 weeks, and the observation group (51 cases) received Shenqi Dihuang Decoction and Xiaochengqi Decoction enema combined with hemodialysis treatment for 4 weeks. The levels of BUN, SCr and β2-microglobulin (β2-MG), and K +, Ca 2+, P 3- content, hemoglobin were detected by automatic blood cell analyzer, and serum CRP and IL-6 levels were detected by latex enhanced immune scattering turbidimetry. The adverse reactions during the treatment and evaluate the clinical efficacy were observed and recorded. Results:During the treatment, 2 patients in the observation group withdrew from the study due to severe diarrhea, and other patients completed the study. There were significant differences in total response rate between observation group and control group [91.84%(45/49) vs. 74.51%(38/51); χ2=5.32, P=0.002]. After treatment, scores of lumbar and knee acerbity, tiredness and fatigue, edema, dizziness and tinnitus, fear of cold and warm, yellow face, dry stool and total score in observation group were significantly lower than those in the control group ( t=8.38, 13.44, 15.14, 13.09, 7.12, 7.73, 11.16, 11.45, P<0.01); the scores of SF-12-PCS and SF-12-MCS were significantly higher than those in the control group ( t=3.24, 4.22, P<0.01). After treatment, levels of serum BUN [(15.02±2.35)mmoL/L vs. (18.02±3.65)mmoL/L, t=4.87], SCr[(155.26±23.65) μmol/L vs. (184.49±35.49) μmol/L, t=4.83], β2-MG[(7.12±1.27)mg/L vs. (9.56±2.14)mg/L, t=6.90] and P 3-[(1.51±0.10) mmol/L vs. (2.02±0.19) mmol/L, t=16.70], K +[(3.65±0.54) mmol/L vs. (4.21±0.63)mmol/L, t=4.76] in observation group were significantly lower than those in the control group ( P<0.01); Ca 2+[(1.86±0.36)mmol/L vs. (2.35±0.42)mmol/L, t=6.25] was significantly higher than that of the control group ( P<0.01). No adverse reactions occurred during the treatment in the two groups ( P>0.05). Conclusion:Shenqi Dihuang Decoction and Xiaochengqi Decoction enema and hemodialysis can improve renal function, correct electrolyte disorder, reduce the level of inflammatory factors, improve the quality of life, and improve the therapeutic effect of the patients with CKD stage 5 and Qi and Yin deficiency and turbid poison inherent pattern.

Hepatoma-derived growth factor (HDGF) expression is associated with poor prognosis in non-small cell lung cancer (NSCLC); however, whether HDGF affects gefitinib resistance in NSCLC remains unknown. This study aimed to explore the role of HDGF in gefitinib resistance in NSCLC and to discover the underlying mechanisms. Stable HDGF knockout or overexpression cell lines were generated to perform experiments in vitro and in vivo. HDGF concentrations were determined using an ELISA kit. HDGF overexpression exacerbated the malignant phenotype of NSCLC cells, while HDGF knockdown exerted the opposite effects. Furthermore, PC-9 cells, which were initially gefitinib-sensitive, became resistant to gefitinib treatment after HDGF overexpression, whereas HDGF knockdown enhanced gefitinib sensitivity in H1975 cells, which were initially gefitinib-resistant. Higher levels of HDGF in plasma or tumor tissue also indicated gefitinib resistance. The effects of HDGF on promoting the gefitinib resistance were largely attenuated by MK2206 (Akt inhibitor) or U0126 (ERK inhibitor). Mechanistically, gefitinib treatment provoked HDGF expression and activated the Akt and ERK pathways, which were independent of EGFR phosphorylation. In summary, HDGF contributes to gefitinib resistance by activating the Akt and ERK signaling pathways. The higher HDGF levels may predict poor efficacy for TKI treatment, thus it has the potential to serve as a new target for overcoming tyrosine kinase inhibitor resistance in combating NSCLC.

目的 调查北京地区急诊护理技术项目开展及护士临床实践能力现状.方法 通过北京护理学会急诊专业委员会便利,调查了北京地区37家医院急诊科共1474名护士,采用自制问卷调查护理操作技术开展、护士临床实践能力、技术准入项目及制度现状等.结果 60项护理操作技术在37家医院急诊科平均开展41项,开展率为68.7％.不同级别、不同性质医院的急诊科开展技术操作有差别(P<0.05).护士自评的护理技术临床实践能力整体较低,鼻导管吸氧86.78分,心肺复苏(CPR)85.86分.护士对操作技术准入制度的建立态度非常积极.结论 北京地区急诊护理技术项目开展情况基于不同医院等级及急诊专科特色.建议管理者应全面梳理护理操作技术项目,基于操作难度与风险程度分级,建立护理技术分层培训标准与准入体系,以全面提高护士临床技术实践能力,促进北京地区急诊护理专业发展与同质化提升,保障急危重症患者的安全.

Hyperactivation of Wnt signaling is crucial in tumor formation. Fully elucidating the molecular details of how the cancer-specific Wnt signaling pathway is activated or contributes to tumorigenesis will help in determining future treatment strategies. Here, we aimed to explore the contribution of CUEDC2, a novel CUE-domain-containing protein, to the activation of Wnt signaling and the tumorigenesis of triple-negative breast cancer (TNBC) and to determine the underlying mechanisms. TNBC patient samples and disease-free survival (DFS) data were used to determine the association between CUEDC2 and TNBC progression. The effects of CUEDC2 on TNBC were examined in TNBC cells in vitro and in subcutaneous xenograft tumors in vivo. Gene knockdown, immunoprecipitation plus liquid chromatography–tandem mass spectrometry, pull-down, co-immunoprecipitation, localized surface plasmon resonance, and nuclear translocation analysis were used to uncover the mechanisms of CUEDC2 in regulating Wnt signaling and TNBC development. CUEDC2 is sufficient to maintain the hyperactivation of Wnt signaling required for TNBC tumorigenesis. The contribution of CUEDC2 plays a major role in determining the outcome of oncogenic Wnt signaling both in vitro and in vivo. Mechanistically, the CUE domain in CUEDC2 directly bound to the ARM (7–9) domain in β-catenin, promoted β-catenin nuclear translocation and enhanced the expression of β-catenin targeted genes. More importantly, an 11-amino-acid competitive peptide targeting the CUE domain in CUEDC2 blocked the interactions of CUEDC2 and β-catenin and abrogated the malignant phenotype of TNBC cells in vitro and in vivo. We observed that TNBC patients who exhibited higher levels of CUEDC2 showed marked hyperactivation of the Wnt signaling pathway and poor clinical outcomes, highlighting the clinical relevance of our findings. CUEDC2 promotes TNBC tumor growth by enhancing Wnt signaling through directly binding to β-catenin and accelerating its nuclear translocation. Targeting the interactions of CUEDC2 and β-catenin may be a valuable strategy for combating TNBC.

Background Relatively little is known about the effect of traditional Chinese medicine (TCM) on prognosis of non-small cell lung cancer (NSCLC). Methods In this nationwide, multicenter, prospective, cohort study, eligible patients aged 18-75 years with radical resection, and histologically confirmed stage II-IIIA NSCLC were enrolled. All patients received 4 cycles of standard adjuvant chemotherapy. Patients who received Chinese herbal decoction and (or) oral Chinese patent medicine for a cumulative period of not less than 6 months were defined as TCM group, otherwise they were considered as control group. The primary endpoint was DFS calculated using the Kaplan–Meier method. A time-dependent Cox proportional hazards model was used to correct immortal time bias. The secondary endpoints included DFS in patients of different characteristics, and safety analyses. This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800015776). Results A total of 507 patients were included (230 patients in the TCM group; 277 patients in the control group). The median follow-up was 32.1 months. 101 (44%) in the TCM group and 186 (67%) in the control group had disease relapse. The median DFS was not reached in the TCM group and was 19.4 months (95% CI, 14.2 to 24.6) in the control group. The adjusted time-dependent HR was 0.61 (95% CI, 0.47 to 0.78), equalling to a 39% reduction in the risk of disease recurrence with TCM. the number needed to treat to prevent one patient from relapsing was 4.29 (95% CI, 3.15 to 6.73) at 5 years. Similar results were observed in most of subgroups. Patients had a significant improvement in white blood cell decrease, nausea, decreased appetite, diarrhea, pain, and fatigue in the TCM group. Conclusion TCM may improves DFS and has a better tolerability profile in patients with stage II-IIIA NSCLC receiving standard chemotherapy after complete resection compared with those receiving standard chemotherapy alone. Further studies are warranted.

[目的]分析肿瘤患者在入院时、住院期间及出院时的症状分布及患者日记管理工具在疾病管理中的可行性.[方法]选取全国17家医院的恶性肿瘤患者,向其发放患者日记,指导其如何填写,嘱其每日认真填写日记.通过第三方研究者问询获得并分析患者在住院时、住院期间及出院时的相关症状,通过患者对日记满意度调查与主管医生对日记认可度调查分析患者日记工具的可行性.[结果]共纳入符合要求的152例患者,调查发现肿瘤患者入院时排名前10位的症状分别是疲乏、食量下降(近1周)、疼痛、体重下降(近1个月)、睡眠不好、厌食、胸闷气短、便秘、咳嗽咳痰和心情郁闷;住院期间排名前10位的症状分别是便秘、恶心呕吐、厌食、食量下降(近1周)、腹胀、疼痛、睡眠不好、疲乏、腹泻和发热.出院时排名10位的症状分别是疲乏、便秘、睡眠不好、胸闷气短、疼痛、咳嗽咳痰、厌食、出汗、小便减少、心情郁闷.肿瘤疾病分期为Ⅳ期的患者,入院时的症状患病率明显高于非Ⅳ期患者.绝大部分患者(91.4％,139/152)认可患者日记,认为该患者日记能帮助医生更好的了解自己,65.1％(99/152)的患者表示自己出院后会继续填写该日记内容,82.2％(125/152)的患者表示填写日记不会造成负担.绝大部分主管医生(77.6％,118/152)认为患者日记设计合理,77.0％ (117/152)的主管医生认可患者日记并愿意继续使用,75.7％(115/152)的主管医生认为患者日记实用性很强,72.4％(104/152)主管医生认为患者日记能够帮助自己全面了解患者症状,64.4％ (98/152)的主管医生认为患者日记能够提高查房效率.[结论]Ⅳ期肿瘤患者相关症状发生率明显高于非Ⅳ期患者,需重点监测和管理.肿瘤患者临床症状在住院期间部分会得以改善,但治疗相关的不良反应使出院时症状又有升高,需要主管医生引起重视并加强出院后随访及症状管理.患者日记工具能够使患者重视肿瘤所有相关的症状的监测,能提高医护工作人员的查房效率,有助于患者及家属在出院后的疾病全程相关症状管理,值得进一步临床研究及使用.

肺结节是指影像学上表现为直径≤3 cm的局灶性、类圆形、密度增高的实性或亚实性肺部阴影,可为孤立性或多发性.肺结节并非一个独立疾病,而是一类疾病的概称,其病因学分类包括肿瘤(良恶性)、炎性、血管性等.随着肺结节的检出率不断增高以及其与肺癌早筛、早诊、早治的密切关联,日益引起医学界的关注.燕京医学论坛围绕这一临床诊疗热点问题,邀请在京专家交流、发微、启新,共同探讨肺结节的中医病机及防治策略.专家们认为肿瘤相关肺结节可以从属于中医学"肺积"范畴,总属本虚标实,总结出其诊疗需遵循早诊早治与动态观察相结合、宏观辨证与微观辨证相结合、辨病与四诊合参分期相结合、解毒散结与扶正调气相结合、针药并施与摄生调护相结合的原则.治疗上或侧重化痰行瘀,或侧重扶正补虚,但总体上一致认为调平衡、维稳态、抑转化是其核心治疗思维.专家们基于中医与西医融合、经典与现代融合、传承与创新融合的的辨治视角对肺结节科研临床一体化等多个问题展开探讨,较为全面地反映了目前肺结节中医临床诊疗的基本方法与方案.

曾经 只要做医生做得足够久,你总会碰到一些治疗没有那么顺利的患者.这是一位外科医生必须经历的过程,也是必须要面临的宿命. 还记得大约12年前,有一位左肺上叶中央型肺癌患者,他40多岁,是蒙古族人,我们成功地为他做了肺大动脉和左主支气管双成型手术,保住了左肺下叶,避免了左全肺切除,但是手术后发生了并发症(吻合口狭窄、下肺不张),导致高烧不退.

目的:通过多中心、随机、对照、非劣效性临床研究,证实草乌甲素的疗效.方法:随机数字表法区组随机筛选病例.病人1:1分入对照组和试验组.三家研究中心共筛选入组轻度癌痛32例(对照组16例,试验组16例),中度癌痛63例(对照组29例,试验组34例).对照组口服布洛芬缓释胶囊或曲马多缓释片、试验组口服草乌甲素片.观察时间7天.结果:每日平均疼痛数字评分法(numerical rating scale,NRS)评分,轻度癌痛病人对照组与试验组之间无差异;中度癌痛病人对照组在第4天低于试验组.中度癌痛病人对照组发生14例次不良反应,试验组发生2例次,有显著性差异.中度癌痛病人生活质量评估试验组情绪功能更佳.结论:轻中度癌痛病人在第一阶梯、第二阶梯药物无效或者不耐受情况下,可以考虑选择草乌甲素片镇痛治疗.

目的 探讨自制凉血愈肤面膜对缓解肿瘤患者应用表皮生长因子受体抑制剂(epidermal growth factor receptor inhi-bitor,EGFRI)所致颜面部皮疹的效果.方法 选取2019年7月至12月北京大学肿瘤医院收治的63例应用EGFRI后出现皮疹的肿瘤患者为研究对象.将2019年7月至9月入院的31例患者纳入对照组,给予常规护理.将2019年10月至12月入院的32例患者纳入面膜组,在对照组护理基础上外用凉血愈肤面膜,2次/d.干预2周后,评价两组患者皮疹缓解率和癌症患者生存质量核心量表(the quality of life questionaire-core 30,QLQ-C30)评分.结果 干预前,两组患者QLQ-C30各维度状评分比较差异均无统计学意义(均P>0.05).干预后,面膜组患者总体健康状况、躯体功能、社会功能、情绪功能评分均显著高于对照组(均P<0.05),疲倦和失眠评分均显著低于对照组(均P<0.01).面膜组患者干预后皮疹缓解总有效率显著高于对照组(P<0.01).结论 凉血愈肤面膜可有效缓解肿瘤患者应用EGFRI后出现的颜面部皮疹,减少皮疹及相关不适症状,促进患者身心健康,提升生活质量.

目的 了解北京市三级甲等医院急诊科护士锐器伤、血液暴露及工作场所暴力3种职业暴露的发生状况及防护行为现状.方法 便利抽取21所北京市三级甲等医院,依据每所医院急诊科排班整群抽取1组护士作为调查对象,采用自制问卷进行调查,问卷内容包括一般资料及锐器伤、采血过程中血液暴露、工作场所暴力的发生现状及防护行为,调查对象匿名填写问卷.结果 共收集问卷1 150份,有效问卷1 102份,有效回收率为95.83％.在过去1年中,急诊科护士至少经历过1次锐器伤、采血中的血液暴露、语言暴力、身体暴力及性骚扰的发生率分别为37.8％、36.4％、68％、12％和5.3％;急诊科不同的工作区域,锐器伤(x2=16.805,P=0.010)、语言暴力(x2=98.509,P＜0.001)、身体暴力(x2=79.916,P＜0.001)发生率不同.在发生职业暴露的护士中,92.8％的护士在发生锐器伤后能够挤血,同时用流动水冲洗并消毒;69.8％的护士在采血过程发生血液暴露后能够冲洗暴露部位并消毒;在工作场所暴力发生时,41.3％的护士耐心解释,30.0％的护士忍让回避.3种职业暴露的上报率均较低(＜30％).结论 急诊科职业暴露发生率相对较高,管理者需要重视急诊科的工作环境建设,加强采血过程和工作场所暴力的职业防护培训,同时增强对3种职业暴露的上报管理.

目的:了解新冠肺炎疫情期间医护人员的防护依从性及自我防护行为满意度,为做好防护管理提供依据.方法 :采用便利抽样法选取北京市某三级甲等医院疫情期间在京工作和支援武汉的623名医护人员,采用统一的语言使用自行编制的防护行为调查表通过微信进行调查.结果 :新冠肺炎疫情期间,医护人员在工作中防护依从性超过60.00％,支援武汉的医护人员生活中的防护依从性优于在京工作人员(P<0.05),支援武汉医护人员的防护满意度为95.83％,支援武汉医护人员的满意度高于在京工作人员(P<0.001).结论 :医护人员在新冠肺炎疫情期间能够遵从双向防护的原则,做好自身防护,保障健康地为患者服务.

目的 探讨中医辨证治疗晚期结直肠癌化疗失败患者循环肿瘤DNA (ctDNA)状态、突变基因及其与预后相关性.方法 收集83例晚期结直肠癌化疗失败患者外周血10 ml,利用定制的覆盖416个肿瘤相关基因探针的Geneseeq One NGS面板进行杂交富集.高效捕获后进行聚合酶链式反应(PCR)扩增,在HiSeq NGS平台(Illumina)上对目标富集的文库进行测序. 结果 在纳入的83例经中医辨证治疗的晚期结直肠癌化疗失败患者中,有54例(65.06％)血浆中检测出肿瘤相关突变基因,共152个基因.根据突变频率筛选出APC、TP53、KRAS、PIK3CA等前20位的基因;ctDNA突变频率、肿瘤突变负荷(TMB)、KRAS、PIK3CA均与预后显著相关(P＜0.05);临床相关因素分析显示,肝转移与多个肿瘤基因不良突变相关(P＜0.05或P＜0.01),脾肾两虚证与ctDNA突变频率、TMB、TP53相关(P＜0.05),八纲辨证中阴证、阳证与TMB相关(P＜0.05). 结论 外周血ctDNA可以较好地反映中医辨证治疗的晚期结直肠癌化疗失败患者分子生物学状态,脾肾两虚证与较低的ctDNA突变频率、较低的抑癌基因突变存在相关性;阴证患者TMB较低,阳证患者TMB较高.

Ethnopharmacological relevance: Marsdenia tenacissima extract (MTE) is the water-soluble part of a traditional Chinese medicine Marsdenia tenacissima (Roxb.) Wight & Arn, and is commercially available in China for treating cancers. MTE has been revealed to be effective in improving gefitinib efficacy in treating non-small cell lung cancer (NSCLC). However, the mechanisms remain to be defined. Aim of the study: To determine the effects of MTE on gefitinib metabolism and accumulation in vivo, and to explore the underlying mechanisms. Materials and methods: MTE or vehicle were intraperitoneally administrated to the H1975 xenograft model, followed by intragastric administration of gefitinib 12 h later. Mice plasma, tumors and liver tissues were harvested for further analysis. Hoechst 33342, a specific substrate of ATP Binding Cassette Subfamily G Member 2 (ABCG2), was used to determine the effects of MTE on activities of ABCG2 in tumor cells. Results: A higher concentration of plasma gefitinib was detected in MTE-treated mice at 24 h after delivery of gefitinib, however, it became insignificant in another 24 h. By contrast, gefitinib levels were continuously higher in MTE-pretreated mice tumor tissues at 12-48 h post gefitinib administration. MTE suppressed plasma levels of gefitinib metabolites (M523595, M608236 and M537194) in the first 24 h after gefitinib delivery, and inhibited activities of liver CYP2D6 and CYP3A4 at early stage (within 6 h) after gefitinib treatment. Strikingly, the activities of ABCG2, the primary drug transporter for gefitinib, were significantly inhibited by MTE in H1975 lung cancer cells. Further, it was identified that tenacissoside H, but not tenacissoside I, may contribute to the ABCG2-suppressive effects of MTE. Conclusions: MTE pretreatment temporarily elevated plasma concentrations of gefitinib via inhibiting CYP450 enzymes. Most importantly, MTE promoted gefitinib accumulation in tumor tissues in a long-lasting manner via decreasing activities of ABCG2, a drug transporter responsible for gefitinib efflux.

目的:探究软组织肉瘤(STS)患者中医体质类型的分布规律,进一步探究体质类型差异对此类患者化学治疗(简称化疗)后发生骨髓抑制的影响.方法:收集北京大学肿瘤医院就诊的STS患者的临床病例,填写调查表并记录患者治疗期间发生骨髓抑制的情况,对此进行归纳整理、统计分析.结果:共收集符合纳入病例81份,STS患者以气虚质最为常见,阴虚质及阳虚质次之.其他体质类型少见;局限期组与晚期组两组各体质类型分布差异有统计学意义(P=0.007).局限期患者的气虚质分布概率高于晚期患者(P=0.012),而晚期患者阴虚质分布概率显著高于局限期患者(P=0.006).不同体质类型患者化疗后骨髓抑制发生率存在差异.阳虚质患者相比气虚质(P=0.013)及阴虚质(P=0.031)更容易出现重度骨髓抑制.结论:STS患者以气虚质、阳虚质及阴虚质为多见,阳虚质患者更需警惕化疗后出现重度骨髓抑制.

氧气疗法(oxygen therapy,简称氧疗)是各种原因引起的低氧血症患者常规和必不可少的治疗方法,具有纠正缺氧、缓解呼吸困难、保护重要脏器功能、促进疾病痊愈的重要作用.氧疗作为一种诊疗方法,既可给患者带来有益的治疗作用,也可能会对患者造成不良影响.2018年4月,发表在Lancet的一篇系统评价[1]指出,对于血氧饱和度正常的患者给予氧气吸入会增加患者的病死率.

文章指出了急诊科岗位设置情况与特点,以及急诊科护士的能级特点,并对N1 ～ N5级护士定义、岗位培训目标、护士学习方法、岗位培训方法、培训内容、考核等方面进行综述.在此基础上,对以能级为基础的急诊科护士岗位培训进行展望,以期为各大医院急诊科护士的岗位培训及护士的职业发展提供参考.

肺血栓栓塞症(pulmonary thromboembolism,PTE)是来自静脉系统或右心的血栓阻塞肺动脉系统为病因的一组疾病或临床综合征的总称,以肺循环和呼吸功能障碍为其主要临床和病理生理特征.其高危因素包括手术、创伤、下肢骨折、制动、卒中瘫痪、妊娠、产褥期、口服避孕药等.积极的溶栓治疗是成功抢救肺血栓栓塞症的关键,可迅速降低肺动脉压,改善右室功能,改善早期生存率.PTE的溶栓时间窗为2周,由于肺组织存在肺动静脉、支气管动脉双重氧供,发生肺梗死的概率不高,6～14d内的溶栓也能起到一定疗效.然而,病人入院时常常存在合并症,如活动性出血,为溶栓禁忌证,临床治疗过程中往往在保证病人最大获益的基础上选择最佳的治疗方案,这也给临床护理提出了严峻的挑战.2016年10月我科成功抢救1例肺血栓栓塞合并子宫功能性出血的病人.现报告如下.

目的:评价并整合预防无创通气设备相关面部压力性损伤的证据.方法:检索加拿大安大略注册护士协会(RNAO)、英国国家卫生与临床优化研究所(NICE)、苏格兰学院间指南网(SIGN)、美国指南网(NGC)、国际指南网(GIN)、医脉通、BMJ最佳临床实践(British Medical Journal Best Practice)、UpToDate、Cochrane Library、Joanna Briggs Institute(JBI)Library、PubMed、荷兰医学文摘数据库(Embase)、中国知网(CNKI)、万方数据库(WanFang Data)、欧洲压疮咨询小组(EPUAP)官网、美国伤口造口失禁护理学会(WOCN)、欧洲呼吸学会(ERS)、明尼苏达医院协会的相关指南、系统评价和专家共识,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对不同类型研究进行文献质量评价及证据级别评定.结果:共纳入6篇文献,其中2篇指南、1篇证据总结、2篇系统评价、1篇专家共识.总结了23条预防无创通气设备相关性面部压力性损伤的证据,包括风险因素和高危部位识别、连接界面的选择、皮肤评估、压力再分布、预防性使用敷料等.结论:医务人员应结合医院的具体情况按照相关级别的循证医学证据,规范无创通气设备的管理,保证患者安全,减少相关压力性损伤的发生.

胸痛中心的建立促进了对高危胸痛患者的快速救治流程,在整个救治流程中需要对患者精致的护理,北京大学人民医院急诊科设计和实施了护理流程的情景模拟演练,为护理人员发现自身知识不足和护理管理者发现护理流程的缺陷提供了可靠依据,促进了胸痛患者的急救护理流程的改进和完善.