本文介绍了电子健康档案平台应具备的功能和包含的内容构想,从身份识别、共享应用两方面讨论了如何保障信息安全与患者权利,介绍了建设国家级电子健康档案平台在地区层面具体推进执行的思路,同时也探讨了居民拥有主动完善健康档案的权利,以及地方管理机构在保障患者权益方面应承担的责任,为"健康中国2030"背景下规范建设标准化的电子健康档案平台提供了参考与建议.

AIM:To investigate the neuroprotective effect of hydrogen sulfide ( H2 S) after cardiopulmonary re-suscitation in rats with cardiac arrest ( CA) , and to explore the effects of H2 S on neuron autophagy.METHODS:The CA model was established through asphyxia.Male Wistar rats were randomly divided into sham group, model group and NaHS group.The levels of beclin-1 and LC3 II/I were measured by Western blot at 2 h, 4 h, 12 h and 24 h after the restoration of spontaneous circulation (ROSC).At 12 h after ROSC, the formation of autophagic vacuole with LC3 dots was deter-mined by immunohistochemical ( IHC) method.The phenomenon of neuron autophagy was observed under transmission electron microscope.The numbers of apoptotic neurons were counted by TUNEL staining at 72 h after ROSC.The neurolo-gic deficit score ( NDS) was used to evaluate the neurologic function after ROSC.RESULTS: The level of beclin-1 was gradually increased in model group, but it was increased and then gradually recovered in NaHS group ( P<0.05 ) .The conversion of LC3 II in the cerebral cortex was the same as beclin-1.The results of IHC showed that LC3-positive nuclei in model group were more than those in NaHS group ( P<0.05) .The number of autophagic vacuole in model group was more than that in NaHS group (P<0.05).The number of the TUNEL-positive cells in model group was more than that in NaHS group (P<0.05).The NDS of the animals in NaHS group after ROSC was lower than that in model group(P<0.05). CONCLUSION:H2 S inhibits neuronal autophagy, decreases apoptosis and improves neurologic function in CA rats after ROSC.

Objective To evaluate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on survival and neurological function in adult patients with cardiac arrest.Methods The PubMed and Web of Science were searched to collect relevant literature from Jan 1980 to Nov 2015,and two reviewers strictly distinguished the studies,assessed the quality of studies and picked up the valuable data for statistical analysis by using RevMan 5.0.Results A total of 8 studies involving 27 18 patients were included in our review.Of them,462 patients were treated with ECPR and 2 256 patients were cared with CCPR.The meta analysis showed that the survival discharge rate (OR =2.92,95％ CI:2.24-3.81,P ＜ 0.01),long-term survival rate (OR =2.97,95％ CI:2.11-4.19,P＜0.01) and neurological function status (OR=3.50,95％CI:2.36-5.81,P＜ 0.01) of ECPR (n =182) were better than those of CCPR (n =182).In 4 studies,propensity score matching was used to minimize bias and heterogeneity.The meta analysis also showed that the rate of ROSC,survival discharge rate,long-term survival rate and neurological function status in ECPR were superior over CCPR.Conclusions ECPR would be the excellent measures to improve ROSC rate,survival discharge rate,long-term survival rate and neurological outcome in adult victims with cardiac arrest.

ObjectiveTo explore the clinical characteristics, diagnosis, and pathogenesis of acute aortic dissection (AD) complicated with acute pancreatitis (AP) so as to improve the diagnosis process.MethodsA case of acute AD complicated with AP was analyzed. Nine cases with the same diagnosis, including this case, were collected from the recent literatures and analyzed together. ResultsThe first clinical manifestation of this case was severe epigastric pain and the diagnosis was based mainly on imaging and laboratory results. This patient discharged voluntarily and was lost to follow-up. Of the 9 cases, 6 cases were DebakeyⅢ acute AD, 2 were DeBakeyⅠ acute AD, and one case was unknown type. All the patients were diagnosed by imaging studies and serum analyses. ConclusionsAcute AD complicated with AP is uncommon and easy to be misdiagnosed. AP may cause AP via different pathogeneses.

Objective To design and develop a cardiopulmonary?cerebral resuscitation (CPCR) events data recorder independently,and to evaluate the performance of the recorder by stimulating on?the?spot resuscitation. Methods The CPCR events data recorder and background data acquisition system were designed and produced. The process of CPCR was stimulated. Thirty technicians were divided into the memory group and the timer group(using CPCR events data recorder)to record the time of stimulated?CPCR events out of hospital,during emergency transit,and inside hospital. Stopwatches were used for standardized timing by technicians. After the experiment,all the operation time in the memory group was recalled by the technicians. The display,extraction and storage of the data in the timer group were achieved by background operating system. The data and standard time in the timer group and memory group were compared. Then,the error and correlated factors in each group were analyzed. Results The CPCR events data recorder and background data acquisition system were designed and produced. The process of CPCR was stimulated. Thirty technicians were divided into the memory group and the timer group(using CPCR events data recorder)to record the time of stimulated?CPCR events out of hospital,during emergency transit,and inside hospital. Stopwatches were used for standardized timing by technicians. After the experiment,all the operation time in the memory group was recalled by the technicians. The display,extraction and storage of the data in the timer&nbsp;group were achieved by background operating system. The data and standard time in the timer group and memory group were compared. Then, the error and correlated factors in each group were analyzed. Conclusion CPCR events data recorder can significantly reduce the errors in collecting and recording time. It can also reduce the errors caused by extended operating time and items,which favors improving the operability of Utstein?style CPCR registry.

目的：探讨早期动脉血乳酸清除率（LCR）在评估严重脓毒症患者预后中的价值。方法回顾性分析河源市人民医院重症监护病房68例严重脓毒症患者的临床资料。计算出患者治疗前后6 h的乳酸清除率、24 h内APACHEⅡ评分，监测ScvO2、CVP、MAP和尿量。分别比较存活组和死亡组、MODS组和NMODS组、EGDT达标组和EGDT未达标组、CBP组和NCBP组的6 h乳酸清除率，以及其与ScvO2的相关性。结果存活组6 h乳酸清除率显著高于死亡组（ P＜0.05）。 NMODS组、EGDT达标组及CBP组的动脉血乳酸清除率分别高于MODS组、EGDT未达标组及NCBP组（均P＜0．05）；且前者的死亡率明显低于后者（均P＜0．05），EGDT达标组治疗6 h后患者ScvO2、CVP、MAP、尿量明显改善，差异均有统计学意义（ P＜0．05）。动脉血乳酸清除率与ScvO2呈显著正相关（r＝0．90，P＜0．05）。结论早期动态检测严重脓毒症患者的动脉乳酸清除率可评估其严重程度及预后，而通过积极的EGDT、CBP等治疗明显提高早期动脉血乳酸清除率，从而改善严重脓毒症患者的预后。

AIM: To investigate the effect of cobalt chloride (CoCl2) on the apoptosis of neural stem cells (NSCs) and the expression of microRNA-26a (miR-26a) in vitro, and to explore the mechanisms of NSC apoptosis in-duced by CoCl 2 .METHODS:NSCs were exposed to CoCl 2 at different doses (200~600μmol/L) for 24 h.The cell via-bility and apoptosis were measured by CCK-8 assay and TUNEL method.The expression of miR-26a-3p, miR-26a-5p, GSK-3β, caspase-3, Bcl-2 and Bax was examined by real-time PCR.The protein levels of Bcl-2 and Bax were detected by Western blotting .RESULTS: The cell viability was inhibited and the apoptosis of NSCs was increased significantly by CoCl2 in a dose-dependent manner (P<0.05).CoCl2 at concentration of 400μmol/L for 24 h was used to induce apopto-sis and the expression of miR-26a was down-regulated compared with control (P<0.05).Exposure to CoCl2 at concentra-tion of 400μmol/L up-regulated the expression of GSK-3β, caspase-3 and Bax , down-regulated the expression of Bcl-2 and Bcl-2/Bax (P<0.05).CONCLUSION:CoCl2 at concentration of 400μmol/L induces the apoptosis of NSCs obviously . CoCl2 may induce the NSC apoptosis by mitochondrial apoptotic pathway .Declining miR-26a may be related to NSC apopto-sis.

Objective To assess the value of video laryngoscope for tracheal intubation in prehospital settings.Methods Databases including Pubmed and Embase were searched for controlled trails about tracheal intubation, which were accomplished by using video laryngoscope and direct laryngoscope in prehospital settings.Data in these trials were analyzed by Revman5.1 software.Results Four trials were identified including altogether 1794 patients.There was no difference between video laryngoscope and direct laryngoscope in ultimate success of intubation [WMD=1.00, 95% CI (0.98, 1.02 ), P =0.99 ].Many intubation failed with video laryngoscope, then switch to the direct laryngoscope to complete intubation [WMD =51.46, 95% CI (10.39, 254.79), P <0.001]. Conclusion Despite its many advantages seen in other settings, the video laryngoscope did not show superior to direct laryngoscope in prehospital settings, large sample of clinical researches are needed to confirm its value.

目的 比较血循环中心肌特异性miR-133a与肌钙蛋白T(cTnT)在急性心肌梗死(AMI)早期诊断中的价值.方法 收集67例AMI患者和32名非AMI对照者的血浆标本,通过定量逆转录聚合酶链反应(qRT-PCR)测定血浆中miR-133a水平,同时通过电化学发光法检测血浆cTnT的变化.结果 AMI患者血浆中miR-133a水平较非AMI对照者明显升高(P<0.01),而当这些AMI患者康复出院时miR-133a水平已回落到基线.MiR-133a水平的波动与研究对象的自身特征无相关性(P>0.05).受试者工作特征曲线(ROC)分析表明,miR-133a在早期诊断AMI方面具有显著的心肌特异性和敏感性,但并不优于cTnT.结论 血浆miR-133a可作为AMI早期诊断的标志物,但在诊断价值上并不优于cTnT.

Objective To investigate the changes in perfusion-weighted magnetic resonance imaging (MRI) in canine models of cardiac arrest (CA) and cerebral hemodynamics following return of spontaneous circulation (ROSC).Methods Six beagle dogs underwent PWI scanning prior to CA (baseline)and at 4 (day 1),28 (day 2) and 52 (day 3) after ROSC,respectively.This was followed by comparison on mean arterial blood pressure (MAP),right common carotid artery flow(MQ) and intracranial microcirculation (HEAD).Results There was no significant difference for MAP at all time points(P＞0.05).MQ was mostly reduced at day 1 and differed statistically with that at baseline and day 3 (both P＜0.05).A most significantly reduced level of HEAD was recorded at day 1 and differed considerably with that at baseline and days 2 and 3 (all P＜0.05).The lowest ratio of time to peak(TTP) to baseline level recorded at day 1 (0.93±0.05) was markedly reduced (P＜0.05) as compared with that at baseline and day 2.The ratio of mean transition time (MTT) to baseline increased impressively at day 1 (2.30±0.33) as compared with that at other time points (P＜0.05).A considerable increase in the ratio of relative cerebral blood volume (RCBV) to baseline (1.80±0.60) recorded at day 1 appeared statistically different from that at baseline(P＜0.05).Furthermore,the most markedly reduced ratio of relative cerebral blood flow (RCBF) to baseline (0.69±0.13) at day 1 differed statistically with that at other time points (P＜0.05).Conclusion Cerebral microcirculation is significantly disrupted at day 1 during recovery,in which PWI may be employed to determine the cerebral hemodynamic changes.

目的 观察增强型体外反搏(EECP)干预心脏骤停(CA) 犬后血清内皮素-1(ET-1)、一氧化氮(NO)及颅内微循环的变化,探讨其对血管内皮功能的影响.方法 采用心外膜电致颤诱发16只比格犬CA,经心肺复苏(CPR)至自主循环恢复(ROSC)后随机选8只行3次1 h EECP干预,8只为对照(Con)组.各时间点采血,用ELISA法测血清ET-1、NO浓度,并观察颅内微循环.结果 血清ET-1浓度、ET-1/NO比值在ROSC后EECP组比Con组低(P<0.05或P<0.01),血清NO浓度EECP组比Con组高(P<0.05或P<0.01).反搏后颅内微循环灌注量EECP组比Con组升高(均P<0.01).结论 EECP可升高CA-ROSC犬血清NO浓度和降低血清ET-1浓度,降低ET-1/NO比值,改善内皮舒缩功能,增加颅内微循环灌注量.

Objective To evaluate the status of support service for community Methadone Maintenance Treatment(MMT)in Guangdong and its impact on patient discharge rate.Methods During November 20,2008 to December 10,2008,a census was conducted to collect and analyze the status of support service in 45 MMT clinics,which were opened before September 30,2008 in Guangdong.Discharge reports of patients were collected from national MMT management system,and discharge rate was used to evaluate effectiveness of support service.Results Support services in different clinics were conducted with different types,contents and organizational forms.The types of support service carried out in Guangdong included counseling,testing,encouragement,treatment of diseases and recreational activities.Counseling was used widely(in 45 of 45 hospitals,100.0%),while treatment of diseases was used at least(in 4 of 45 clinics,8.9%).Five themes including knowledge,psychological consult were run irregularly in counseling.Material rewards were given to individual by encouragement system.Discharge rate was related to support service implementation,and the rates were lower in those clinics where encouragement,treatment of diseases and recreational activities were carried out(P<0.05).Conclusion Several types of support service were conducted in MMT clinics in Guangdong,but the types,contents and forms should be further developed.Service ability,contents and forms should be improved for support service on MMT in future.

目的:探讨急诊胃镜在上消化道出血诊治中的价值.方法:回顾性分析2009年1月至2011年12月因上消化道出血在中山大学附属第一医院急诊科就诊的502例患者的临床资料,根据检查的时间段分为急诊胃镜组和延迟胃镜组,其中溃疡性上消化道出血患者420例(急诊胃镜纽299例,延迟胃镜组121例),静脉曲张性上消化道出血患者82例(急诊胃镜组49例,延迟胃镜组33例),比较分析两组患者的住院日、输血量、主要止血药物使用情况、是否进行外科止血和出院存活情况.结果:溃疡性上消化道出血和静脉曲张性上消化道出血的两组患者生长抑素使用率和输血量比较差异有统计学意义,P＜0.05;急诊胃镜可降低溃疡性消化道出血患者外科手术治疗的风险(8/299∶13/121,P=0.001)和缩短溃疡性消化道出血患者的住院天数[急诊胃镜组8(1,64)d,延迟胃镜组11(1,102)d,P=0.015]；降低死亡率(溃疡性出血:2/299∶9/121,P=0.001；静脉曲张性出血:1/49∶4/33,P=0.023).生存分析表明急诊胃镜提高上消化道出血患者30 d的生存率,x2=17.840,P＜0.001.结论:急诊胃镜治疗可显著减少上消化道出血患者长抑素类药物的使用,减少输血量,降低溃疡性出血患者外科手术治疗的风险和缩短住院天数,提高上消化道出血患者的总体生存率.

Objective To investigate the situation of abuse of methamphetamine substances in the patients with methadone maintenance treatment(MMT) and to analyze the relevant factors.Methods 126 voluntary opioid-dependent men who received MMT from July 1st,2010 to September 30th,2010 were recruited from the methadone maintenance clinic of Guangzhou Brain Hospital of Liwan District.Urine tests were conducted in the patients by the way of LC/MS in order to check whether they ever took MA.Logistic regression models were examined for each of the demographic variables,medication-related variables and MA abuse.Results In 126 patients,urine MDNA positive had 11 patients(the positive rate was 8.7%);the patients who were transferred for treatment from other clinics were more likely to take MA than the local patients(β = 4.177,P 0.001),employed men were more likely to abuse MA than unemployed men(β = 1.907,P = 0.008),the longer time of the patients for MMT treatment,the smaller risk of abusing MA they had(β =-0.048,P =0.033).Conclusions It is the common phenomenon of abusing MA in MMT patients.The indices such as occupation,duration of treatment,transferring treatment from other clinics or not shall be concerned for the decrease of substance abuse behavior.

目的 为检验自主研发的心肺脑复苏计时器在复苏过程中的性能,模拟心肺脑复苏现场,通过对照实验,探讨心肺脑复苏计时器相比传统回忆计时法在提高Utstein登记模式数据采集的实用性和优越性.方法 熟悉Utstein复苏登记模式,掌握登记的时间点;模拟心肺脑复苏现场并记录过程,由工作人员专门计时采集标准时间,30名参加模拟复苏的人员分别采用计时器计时和通过人脑回忆计时两种方法 采集Utstein各操作点的时间信息,并与标准时间相比较,得出各自的误差值,分析各组的误差值和相关影响因素.结果 回忆组误差为(21.5±22.7)s,计时器组误差为(3.36±4.28)s,两组比较差异有统计学意义(P<0.05);回忆组的误差值随操作时间延长而增大,相关系数为0.538,计时器组也存在类似趋势,相关系数为0.286,Z检验的结果 表明,两者差异有统计学意义(Z=2.41,P<0.05);回忆组的误差值随着操作项目的 增多而增大,相关系数为0.523,计时器组也存在类似趋势,相关系数为0.218,Z检验的结果 表明,两者差异有统计学意义(Z=2.59,P<0.05).结论 相比回忆的方法,心肺脑复苏计时器能减少在数据采集过程中因回忆产生的误差,并能减小因为操作时间延长和操作项目增多导致的误差.

Objective To discern the demographic and treatment characteristic of patients who have taken methadone maintenance treatment for more than 3 years.Methods 46 opioid-dependence who have taken methadone maintenance treatment for more than 3 years,were recruited from the methadone maintenance clinic of Guangzhou brain hospital.Analyzing their demographic,pre-treatment and post-treatment characteristics by means of descriptive statistics.Results The patients are predominantly male,their average age(39.93 ± 8.10) years;mostly with secondary and higher education;living with their family,relatives or friends and having good family relationships.Pre-treatment,93.48% of the patients unemployed,97.80% had addicted in heroin for 10 years or more,the average time(17.78 ± 3.75) years;majority spent 100-500 yuan per day for drugs.Post-treatment,82.6% spent 30 minutes or less in journey to clinic;most patients taking a dose of 20-80mL.The median of treatment participation rate,urine test participation rate and urine positive rate were 91.72%,1.72% and 14.12%,respectively.Conclusion Monitoring the demographic,pre-and post-treatment characteristics of the patients during the medication,and taking appropriate measures for them is beneficial for their therapeutic time and effect.

目的 了解影响广东省部分地区社区美沙酮维持治疗(methadone maintenance treatment,MMT)患者依从性的因素.方法 采用个案访谈法,对广东省部分地区4家MMT门诊的在治患者、家属以及门诊工作人员进行深入访谈,归纳总结影响患者维持治疗依从性的因素.结果 影响患者治疗依从性的因素主要包括:(1)渴望彻底脱离毒品;(2)对美沙酮的成瘾性表示堪忧;(3)治疗期间出现不良反应;(4)经济困难无法长期坚持;(5) MMT便捷性问题;(6)患者对司法部门监控的担心;(7)社会支持不足.结论 应加大MMT政策及相关知识的宣传力度,为患者提供良好的家庭、社会支持,针对广东省MMT中存在的问题采取针对性的解决措施,提高患者的依从性.

目的 建立可以实时观察颅内微循环变化的犬室颤心脏骤停(CA)模型.方法 6只比格犬开颅后采用交流电诱发室颤,同时观察犬诱发室颤前、自主循环恢复(ROSC)后2 h内动脉内平均压(MAP)、右颈总动脉平均流量(Q)、耳及颅内微循环灌注量.结果 犬全部诱发室颤,无干预3 min后开始心肺复苏,6只比格犬均复苏成功.ROSC 30 min颅内微循环最高均值,与其余各时点差异均有统计学意义(P<0.05).ROSC 5 min MAP低值与ROSC 105 min高值差异有统计学意义(P<0.05).经相关分析表明CA前MAP与Q呈负相关(r=-0.941,P=0.005).ROSC后,耳与颅内微循环正相关(r=0.269,P=0.049);而耳微循环与MAP(r=-0.454,P=0.001)、Q(r=-0.440,P=0.001)呈负相关;MAP与Q呈正相关(r=0.297,P=0.029).结论 开颅窗比格犬CA模型,可动态观察颅内微循环变化,为心肺脑复苏(CPCR)提供更直接更可靠的观察手段和方法.颅内微循环在复苏后30 min时存在高灌注.复苏后2 h内耳与颅内微循环灌注量正相关.

目的:为提高手足口病(hand-foot-mouth diseases,HFMD)的诊治水平,对国内报道的该疾病的临床表现及治疗作荟萃分析.方法:根据关键词检索找到相关文献后进行荟萃分析.结果:1～3岁的患儿占65.51％.手部皮疹出现率为94.52％,足91.78％,口77.61％,肛周约32.49％.29.79％病例有胸片改变.标准量和大剂量激素冲击对减少重症病例死亡率并无显著差异.结论:1～3岁儿童是发病的主体,皮疹是早期诊断依据,肺部损伤可能是最常见的并发症；对于重症者大剂量激素冲击并不能提高生存率.

目的 通过检测大鼠海马组织bcl-2和bax表达来探讨硫化氢(H2S)在心脏骤停(cardiac arrest, CA)后脑细胞凋亡中的作用.方法 雄性SD大鼠160只,初始选择108只随机均分为三组,建立CA/CPR模型.①第1组(36只):在自主循环恢复(ROSC)后予以NaHS干预;②第2组(36只),在自主循环恢复(ROSC)后予以羟胺干预;③第3组为常规复苏组(36只).上述三组根据观察终点又均分为1、3和7 d三个亚组,每个亚组再等分两组分别做相关凋亡的免疫组化和RT-PCR检测.结果 ①三组经历CPR大鼠死亡及备用鼠使用的差别无统计学意义(P>0.05);②在CPR后,三组之间大鼠血清H2S浓度变化的差异有统计学意义(F=189.917,P=0.000),在CPR后各时点上三组之间血清H2S浓度的差异均有统计学意义(P=0.000);③在CPR后,三组之间大鼠海马组织CA1区bax和bcl-2蛋白表达累积光密度变化的差异有统计学意义(P<0.05),在CPR后各时点上三组之间海马组织CA1区bax和bcl-2蛋白表达累积光密度的差异均有统计学意义(P<0.01);④在CPR后,三组之间大鼠海马组织bax和bcl-2 mRNA相对表达量变化的差异有统计学意义(P=0.000),在CPR后各时点上三组之间海马组织bax和bcl-2 mRNA相对表达量的差异有统计学意义(P<0.01).结论 在CPR后,H2S可能通过促进bcl-2和抑制bax表达来影响bcl-2/bax的平衡而参与神经细胞凋亡.