我国灾害事故频繁发生,往往带来无可估计的损失和影响.卫勤保障作为我国坚强柱石,在抢险救灾等应急救援事件中发挥着无可替代的作用.为确保卫勤保障工作高效、安全、有序展开,可积极利用信息化手段进行精细化管理以实现抢险救灾卫勤保障与支撑作用.建模仿真技术以计算机及其软件为工具,能够生成逼真的虚拟环境并进行人机交互,其作为一种有效的测试研究新手段已经在教学、军事、医疗等众多领域获得了应用.本文分析了抢险救灾中卫勤保障的特点,同时分析了建模仿真技术在当前抢险救灾中应用,该技术可有效提高车辆的调度时效、优化医疗卫生资源配置、提高救治训练能力等.本文通过对以上特点及应用实例整理分析和综述,旨在为提高抢险救灾卫勤保障能力提供新的思路.

安徽省地貌类型复杂,洪涝灾害发生率高,军队参与的抗洪抢险任务是非战争军事行动的重要组成部分,军队卫勤部队的救援工作在抗洪救灾工作中发挥了突出作用.该文结合某医疗后勤保障部队医院以往的救灾工作经验,总结军民融合下抗洪抢险医疗队灾害救治特点及存在问题,从制订保障预案、扎实战备训练、充分协调沟通三个方面提出对策与建议.规范灾难救援流程,制定应急保障预案,走军民融合道路,加强军队与地方的紧密合作,是保证卫勤部队高效完成救援任务的重要对策.

目的 研究急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病患者经皮冠状动脉介入(PCI)术后短期预后与平均血糖波动幅度(MAGE)的相关性.方法 选择2018年1月—2021年9月中国人民解放军联勤保障部队第九〇一医院收治的92例行急诊PCI治疗的急性STEMI合并2型糖尿病患者作为研究对象,根据术后1个月内患者是否发生主要心血管不良事件判断患者预后,分为预后良好组(60例)和预后不良组(32例).收集所有患者一般资料,包括性别、年龄、体质量指数(BMI)、有无并发症(高血压、高脂血症、脑卒中)、Killip分级、病变支数、梗死部位.检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、MAGE、最大血糖波动幅度(LAGE)、空腹血糖等指标.以受试者工作特征(ROC)曲线分析LVEF、MAGE、LAGE、FBG水平预测急性STEMI合并2型糖尿病患者PCI术后短期预后不良的价值;采取非条件Logistic逐步回归分析急性STEMI合并2型糖尿病患者PCI术后短期预后不良的危险因素.结果 与预后良好组相比,预后不良组多支病变的患者比例较高,并且预后不良组LVEF水平较低,MAGE、LAGE、FBG水平较高(P<0.05);经ROC分析,LVEF≤57.162％、MAGE≥4.629 mmol/L、LAGE≥2.715 mmol/L、FBG≥9.366 mmol/L是预测急性STEMI合并2型糖尿病患者PCI术后短期预后不良的最佳截断值(均P<0.05);多因素Logistic回归性分析显示,多支病变、LVEF≤57.162％、MAGE≥4.629 mmol/L、LAGE≥2.715 mmol/L、FBG≥9.366 mmol/L是急性STEMI合并2型糖尿病患者PCI术后短期预后不良的危险因素(均P<0.05).结论 急性STEMI合并2型糖尿病患者PCI术后短期预后与MAGE水平呈负相关,此外多支病变、LVEF偏低、高MAGE、高LAGE、高FBG可能是患者PCI术后短期预后不良的危险因素,使用MAGE预测PCI术后短期预后具有较高的敏感度和特异性,可将其作为临床评估患者预后的参考指标.

目的:研究参麦注射液联合西药对急性心肌梗死患者的疗效及机制.方法:选择我院2016年3月～2019年12月收治的101例急性心肌梗死患者,根据随机数字表法分为对照组和观察组.对照组口服替格瑞洛治疗,观察组联用参麦注射液治疗,观察两组治疗的疗效及治疗前后血浆乳酸、脑钠肽(Brain natriuretic peptide,BNP)和血清降钙素原(Procalcitonin,PCT)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)水平及心功能指标变化.结果:观察组的有效率明显高于对照组(P＜0.05);两组治疗前的血浆乳酸、BNP和PCT、hs-CRP水平无明显差异(P＞0.05),治疗后,两组的上述指标明显降低(P＜0.05),且观察组低于对照组(P＜0.05);两组治疗前的左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室舒张期末内径(End diastolic diameter of left ventricle,LVEDd)、CO和左心室收缩末期直径(leftventricular end systolic diameter,LVESd)无明显差异(P＞0.05),治疗后,两组的上述指标明显改善(P＜0.05),且观察组优于对照组(P＜0.05);观察组的药物不良反应率为14.00％(7/50),与对照组的11.76％(6/51)相比无明显差异(P＞0.05).结论:参麦注射液联合替格瑞洛能减轻急性心肌梗死患者体内的炎症反应,改善心功能,可能与其机制有关.

目的:比较不同液体复苏在腹部多发伤导致的失血性休克救治中的临床效果及安全性.方法:选取2017年7月至2019年12月我院救治的因高处坠落、交通事故等意外事件导致腹部多发伤且失血性休克的患者83例,根据入院时间分为2组,对照组(于2017年7月至2018年7月入院治疗)和研究组(于2018年8月至2019年12月入院治疗).在治疗过程中,对照组采用常规充分液体复苏;研究组采用限制性液体复苏.观察和比较两组患者临床治疗效果、血液酸度及其他相关指标.结果:复苏后,两组动脉血氧分压(Partial arterial oxygen pressure,PaO2)均较复苏前显著下降(P＜0.05),对照组PaO2较研究组更明显,在复苏后90 min、120 min,对照组PaO2明显低于研究组(P＜0.05).两组复苏后动脉血二氧化碳分压(Partial pressure of blood carbon dioxide,PaCO2)均呈现先下降后上升的变化趋势,对照组PaCO2均显著高于研究组(P＜0.05).从复苏前到复苏后,两组pH值均呈现先降后升的变化趋势,同时在复苏后90min、120min研究组pH值均显著高于对照组(P＜0.05).与复苏前相比,两组复苏后PT值均显著上升(P＜0.05),研究组复苏后90 min、120minPT值明显低于对照组(P＜0.05),复苏后谷丙转氨酶(Alanine aminotransferase,ALT)、谷草转氨酶(Aspartate aminotransferase,AST)及肌酐水平均明显低于对照组(P＜0.05).对照组共有9例(22.50％)患者出现并发症或死亡,研究组共有5例(11.62％)患者出现并发症,无死亡;不良预后发生率明显低于对照组(P＜0.05).结论:对腹部多发伤失血性休克患者而言,采用早期限制性液体复苏可有效恢复患者血容量,对血液携氧能力、肝肾功能影响较小,安全性高,有利于患者预后恢复.

儿童淡水淹溺指15岁以下的儿童浸没于淡水中,淡水充塞呼吸道及肺泡或反射性引起喉痉挛和(或)呼吸障碍,发生窒息和缺氧的临床状态.本文通过对其发病机制、院前-转送途中-院内一体化的急诊救治以及预防措施进行梳理,提高社会对儿童淡水淹溺的关注和重视.

目的 观察血必净联合乌司他丁辅助治疗脓毒血症的临床效果.方法 选取脓毒血症患者80例,根据随机数字表法将其分为对照组与观察组各40例.两组均接受常规治疗,对照组给予血必净注射液50 mL加入生理盐水100 mL静脉滴注,每日2次;观察组给予血必净+乌司他丁治疗,血必净用药方法同对照组,乌司他丁10万U加入生理盐水100 mL静脉滴注,每日2次.两组均连续治疗10 d.分别于治疗前、治疗8d采用器官功能障碍量表Ⅱ(MarshaⅡ)评分评价患者的器官功能,采用急性生理学和慢性健康状况量表Ⅱ(APACHEⅡ)评分评价患者的健康状况;分别于治疗前及治疗4、8d用全自动血液细胞分析仪检测血常规,用全自动凝血分析仪检测凝血指标,用免疫比浊法、酶联免疫吸附法检测炎症因子;记录两组治疗10 d的生存情况.结果 治疗后两组MarshaⅡ评分、APACHEⅡ评分、血常规、凝血指标、炎症因子水平均较治疗前改善(P均＜0.05),且治疗后观察组以上指标较对照组改善明显(P均＜0.05).治疗10 d观察组生存率高于对照组(P＜0.05).结论 血必净与乌司他丁可协同减轻脓毒血症患者病情,改善其凝血功能、炎症状态,提高患者存活率.

目的 探讨百草枯中毒浓度及中毒严重指数(SIPP)对急性百草枯中毒患者临床预后的影响.方法 收集2015年1月-2018年6月该院急诊内科收治的急性百草枯中毒患者140例,根据中毒21 d转归情况分为存活组(67例)和死亡组(73例).比较两组入院时外周血中百草枯浓度及SIPP,分析其对患者临床预后的影响.结果 死亡组的服毒量、服毒至入院时间、入院时血浆中百草枯浓度、SIPP、心率(HR)、呼吸频率(RR)、动脉血氧分压(PaO2)、pH值、Na+、WBC、格拉斯哥昏迷评分(GCS)、肝肾损伤率、肺纤维化率及多器官功能障碍综合征(MODS)发生率均明显高于存活组(P＜0.05).Logistic多因素分析显示,服毒量、服毒至入院时间、血浆中百草枯浓度、SIPP、急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分、肝肾损伤、肺纤维化、MODS均是影响临床预后的危险因素(P＜0.05).SIPP的ROC曲线下面积(AUC)为0.890,大于血浆中百草枯浓度的0.821 (P＜0.05);SIPP和血浆中百草枯浓度对死亡概率预测的最佳界值为6.15(h· mg/L)和1.23 mg/L,阳性预测值为86.84％和88.73％.结论 血浆中百草枯浓度及SIPP对急性百草枯中毒患者的临床预后有预测价值.

目的 研究高血脂症性急性胰腺炎患者血清细胞因子水平及其与病情严重程度的相关性.方法 回顾性分析200例急性胰腺炎(AP)患者资料,按照患者发病原因分成2组,观察组为高血脂症性急性胰腺炎(HLAP)患者,对照组为非高血脂症性急性胰腺炎(NHLAP)患者.观察2组三酰甘油(TG)、总胆固醇(TC)、谷草转氨酶(AST)、血淀粉酶、内毒素、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)水平情况及其与患者病情严重程度的相关性.结果 2组年龄、性别、高血压、糖尿病、脂肪肝比较差异有统计学意义(P均＜0.05),2组腹痛持续时间及腹痛至入院时间比较差异无统计学意义(P均＞0.05);2组血清CRP水平均呈先升后降的动态变化,在发病第3天达到最高值,然后下降,但观察组各时间点血清CRP水平均明显高于对照组(P均＜0.05);轻型急性胰腺炎患者中,第1天与第7天2组间血清CRP水平比较差异无统计学意义(P＞0.05),在第2-6天观察组均显著高于对照组(P均＜0.05);中型急性胰腺炎患者中,第1-4天2组间血清CRP水平比较差异有统计学意义(P均＜0.05),第5-7天2组间比较差异无统计学意义(P均＞0.05);重型急性胰腺炎患者中,第2-4天2组间血清CRP比较差异有统计学意义(P均＜0.05),在第1天与第5-7天2组间比较差异无统计学意义(P均＞0.05);观察组TG、TC、AST、内毒素、TNF-α、IL-6、PCT水平均明显高于对照组(P均＜0.05),血淀粉酶值显著低于对照组(P＜0.05);ROC曲线分析,观察组第2天的约登指数明显高于第1,3天,对应的CRP临界值为173.12 mg/L,而对照组在第3天的约登指数明显高于第1,2天,血清CRP临界值为198.00mg/L.结论 高血脂症性急性胰腺炎患者血清CRP及血脂水平均明显高于其他原因引起的急性胰腺炎,并且血清CRP会随着病情加重而变化,可为临床上早期诊断高血脂症性急性胰腺炎提供依据.

目的 探讨抗氧化剂N-乙酰-L-半胱氨酸(N-acetyl-L-cysteine,NAC)抑制NLRP3炎性体减轻脂多糖(LPS)诱导的大鼠急性肺损伤(ALI)的作用及其机制.方法 32只6-8周雄性SD大鼠随机分为对照组、急性肺损伤模型组、NAC对照组(NAC预处理对照)和NAC处理组(NAC预处理+急性肺损伤模型),每组8只.模型组和NAC处理组大鼠腹腔注射大肠杆菌LPS(5 mg/kg)诱导急性肺损伤;对照组和NAC对照组腹腔注射等量生理盐水;NAC对照组和NAC处理组于生理盐水或LPS注射前30 min腹腔注射20 mg/kg NAC.造模后24 h采集各组大鼠动脉血、支气管肺泡灌洗液(BALF)和肺组织.测定肺组织湿/干比(W/d);ELISA法测定血清和支气管肺泡灌洗液(BALF)中髓过氧化物酶(MPO)、乳酸脱氢酶(LDH)、肿瘤坏死因子-α(TNF-α)、白细胞介素18(IL-18)水平;Western blot检测各组大鼠肺组织中NLRP3、caspase-1、ASC和IL-1β 的蛋白表达.结果 对照组和NAC对照组各项检测指标比较,差异无统计学意义.与对照组相比,模型组肺组织W/d、BALF和血清中MPO、LDH、TNF-α、IL-18水平明显增加(P<0.01),肺组织NLRP3、caspase-1、ASC和IL-1β的蛋白表达增加(P<0.01).与模型组相比,NAC处理组大鼠肺组织W/d、BALF和血清中MPO、LDH、TNF-α、IL-18水平明显减少(P<0.01),肺组织NL-RP3、caspase-1、ASC和IL-1β的蛋白表达水平也明显下调(P<0.01).结论 LPS诱导大鼠ALI模型中,NLRP3炎性体活化介导的炎症反应增加.NAC通过抑制NLRP3炎性体活化从而减轻LPS诱导的ALI,作用机制与减轻NLRP3介导的炎症反应有关.

目的 比较奥曲肽与生长抑素辅助治疗非胆源性急性中重症胰腺炎的效果及对炎性介质的影响.方法 入选2015年10月～2017年3月解放军第一○五医院收治的118例非胆源性急性中重症胰腺炎患者为研究对象,根据随机数字表法将其分为A组(61例)、B组(57例).在常规治疗的基础上,A组给予奥曲肽方案,B组给予生长抑素方案,疗程7d.比较两组临床指标恢复时间、疗效及并发症发生率.结果 两组患者腹痛、体温、白细胞计数、血清淀粉酶恢复正常时间及平均住院时间比较差异均无统计学意义(P＞0.05).治疗7d,两组急性生理和慢性健康评分(APACHEⅡ)下降数值比较差异无统计学意义(P＞0.05);两组治疗后总有效率比较差异无统计学意义(P＞0.05);两组外周血肿瘤坏死因子α(TNF-α)、白介素(IL)-6、IL-8、超敏C反应蛋白(hs-CRP)下降数值比较,差异均无统计学意义(P＞0.05).两组治疗期间假性胰腺囊肿、肺部感染、消化道出血、呼吸衰竭、胃肠胀气发生率比较,差异均无统计学意义(P＞0.05),A组治疗中低血糖发生率显著低于B组(P＜0.05).结论 奥曲肽、生长抑素辅助治疗非胆源性急性中重症胰腺炎效果相近,均能显著降低炎性介质表达,使用生长抑素低血糖发生率高于奥曲肽.

Objective:To compare the efficacy of hydration combined with 60 mg/day or 40 mg/day atorvastatin on prevention of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods:172 AMI patients were randomly divided into high dose group (88 cases) and low dose group (84 cases).Based on the conventional treatment of PCI,the patients in high dose group after admission to 72 h after PCI were given 60 mg/day atorvastatin orally,and those in low dose group given 40 mg/day atorvastatin orally,at the same time two groups in the perioperative period were given intravenous saline water treatment.The operation associated indexes,variations on biological markers and renal function before and after operation were recorded,and the incidence of CIN and clinical adverse events were noted and compared between the two groups.Results:There was no significant difference in contrast agent dosage,contact time,hydration volume and coronary atherectomy ratio,and mean number of stent implantation per patient (P ＞ 0.05).The decreased values of NT-proBNP,Hs-CRP and MMP-9 in the high dose group at 72 h after PCI as compared with the preoperative values were significantly higher than those in the low dose group [(0.5 ± 0.2) pg/mL vs (0.4±0.2) pg/mL,(7.8±2.4) mg/Lvs (6.3±1.9) mg/L and (27.5 ±9.5) μg/Lvs (23.7±7.7) μg/L] (allP＜0.05).The increased values of Scr and BUN,and the decreased values of eGFR in the high dose group at 72 h after PCI as compared with the preoperative values were significantly lower than those in the low dose group [(11.9 ± 3.5) μmol/L vs (19.6 ± 5.8) μmol/L,(1.5 ±0.5) mmol/Lvs (2.4±0.7) mmol/L,and (5.0±2.2) mL/(min · 1.73 m2) vs (9.2±3.8)mL/(min · 1.73m2)] (P＜0.05).The incidence rate of CIN and the ratio of patients accepting renal dialysis in the high dose group were significantly lower than those in the low dose group [6.8％ vs 16.7％,1.1％ vs 8.3％] (P＜0.05).Conclusion:Atorvastatin combined with conventional hydration during PCI can prevent the occurrence of CIN,and the preventive effect of 60 mg/day atorvastain is better than 40 mg/day.

[Objective] To integrate the damage scores,construct the prognostic survival model of patients with multiple trauma combined with craniocerebral injury,and verify their applicability.[Methods] The patients with multiple trauma combined with craniocerebral injury received by the 105 th Hospital of PLA from October 2014 to January 2017 were selected as the study cohort,the relevant clinical data were collected,the injury scores were completed,and the prognosis of injury after 28 days was observed.According to the clinical scores and prognosis,the severity degree and influence of prognosis survival of patients were evaluated.[Results] A total of 156 patients with multiple trauma combined with craniocerebral injury were involved in the study,9 patients were lost,and 24 patients died within 28 days after injury.①Cox regression analysis showed that the GCS score,APACHE-Ⅱ scale,R-CRMAS scale and TRISS scale were the independent influencing factors of death within 28 days after injury among patients with multiple trauma combined with craniocerebral injury.The APACHE-Ⅱ scale was risk factor,and the other scales were the protective factors;②ROC curve showed that APACHE-Ⅱ ≥40.81 and TRISS ＜0.26 were the critical value of poor prognosis evaluation,which had significant evaluation effectiveness.[Conclusion] The improvement of GCS score,APACHE-Ⅱ scale,R-CRMAS scale and TRISS scale of patients with multiple trauma combined with craniocerebral injury has important clinical value in evaluating prognosis.APACHE-Ⅱ ≥40.81 and TRISS＜0.26 are the critical point for evaluating the prognosis and outcome of patients with multiple trauma combined with craniocerebral injury.

Objective To forecast the risk and severity of subsequent secondary end stage renal disease (ESRD) in patients with chronic obstructive nephropathy (CON). Methods The CON patients who firstly admitted to the 105th Hospital of Chinese PLA from June 2013 to September 2015 were selected as the research subjects, and were followed up to 18 months to confirm the prognosis. With the clinical data and laboratory results of the initial admis-sion,the long-term risk prediction and related risk assessment analysis were carried out based on the follow-up results. Results A total of 274 CON patients were eventually included, and follow-up analysis was completed in 255 patients, of which 69 patients progressed to ESRD during follow-up. Cox regression analysis showed that the risk model of ad-verse prognosis in patients with CON was composed of complete obstruction, urinary neutrophil gelatinase-associated lipo-calin (uNGAL), N-acetyl-beta-D-glucosaminidase (uNAG), and urinary kidney injury molecule-1 (uKIM-1), which were the independent risk factors for secondary ESRD in patients with CON within 18 months after onset. The CON patients with uKIM-1≥137.01 pg/mL or uNGAL≥173.25 ng/mL were more severe and the progress time to ESRD stage was shorter. The critical value of uKIM-1 had a higher risk of evaluation (P<0.05). Conclusion Complete obstruction, uKIM-1, uNGAL, uNAG were risk factors for secondary adverse outcomes in patients with CON, and uKIM-1≥137.01 pg/mL is the critical point to measure the severity of CON.

Objective:To investigate the clinical efficacy of clopidogrel combined with enteric-coated aspirin in the treatment of acute myocardial infarction(AMI).Methods:Ninety-one patients with AMI were randomly divided into the control group(45 cases) and observation group(46 cases).The control group was treated with aspirin on the basis of conventional treatment,and the observation group was treated with clopidogrel combined with enteric-coated aspirin on the basis of conventional treatment.After 3 months of treatment,the total effective rate,improvement of heart function,change of blood coagulation function and complications between two groups were compared.Results:After 3 months of treatment,the total effective rate in observation group(95.65%) was higher than that of control group(80%)(P<0.05).After treatment,the cardiac function in two groups was significantly improved than before(P<0.01),and the improvement of cardiac function in observation group was more obvious than that in control group(P<0.01).The differences of the 4 indexes of coagulation function between before and after treatment in control group were not statistically significant(P>0.05),but the prothrombin time in observation group increased after treatment(P<0.01).After 3 months,the incidence rate of vascular reocclusion in observation group significantly decreased(P<0.05),and the difference of complication between two groups was not statistically significant(P>0.05).Conclusions:The effect of clopidogrel combined with enteric coated aspirin in the treatment of AMI is significant,which can obviously improve the cardiac function and coagulation function of patients,and has important significance in improving the prognosis of patients.

Objective:To investigate the effects of different glucose tolerance status during pregnancy on pregnancy outcome.Methods:One thousand seven hundred and one singleton pregnant women were divided into the gestational impaired glucose tolerance group(GIGT group),gestational diabetes mellitus group(GDM group) and euglycemia group(control group) according to the blood sugar status in pregnancy.The data of patients were retrospectively analyzed.Results:The maternal age in GIGT group and GDM group were significantly higher than that in control group(P<0.01).The pre-pregnancy weight,over weight and obesity rates in GDM group were higher than those in control group(P<0.01 and P<0.05).The pre-pregnancy weight in GIGT group was lower than that in GDM group(P<0.01),but the differences of the prenatal weight and BMI between three groups were not statistically significant(P>0.05).The incidence rates of the premature rupture of membrane and polyhydramnios in GIGT and GDM groups were higher than those in control group(P<0.05),the incidence rates of macrosomia and cesarean in GDM group were higher than those in control group(P<0.05),and the incidence rate of cesarean in GIGT group was lower than that in GDM group(P<0.05).The differences of the incidence rates of postpartum hemorrhage between three groups were statistically significant(P<0.01).The differences of the incidence rates of hypertensive disorders in pregnancy,premature birth and hypothyroidism between three groups were not statistically significant(P>0.05).Conclusions:Both GIGT and GDM can harm the health of mothers and children,which should be emphasized.The proper pregnancy and controlling pre-pregnancy weight can reduce the incidences of GDM and GIGT.

Two male patients(aged 73 and 62 years,respectively)received an intravenous infusion of ertapenem 0. 5 g once daily and 1. 0 g once daily for perianal abscess and intestinal obstruction. On day 5 and 9,the two patients developed neuropsychiatric symptoms,such as seizures,hallucination and sleep-walking. Ertapenem was withdrawn,the neuropsychiatric symptoms did not recur.

目的：探讨以呼吸泵衰竭改善窗（RPFIW）为切换点行序贯通气治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭的临床价值。方法 COPD合并呼吸衰竭患者70例分为2组，RPFIW组（n=35）出现RPFIW时，即撤除气管插管，改用面罩行无创正压通气（NIPPV）治疗，对照组（n=35）出现RPFIW时，仍继续行有创机械通气治疗。比较两组患者出现RPFIW时及RPFIW组患者拔管前后的循环及呼吸相关指标，比较两组患者有创通气时间、总机械通气时间、住ICU时间、住院费用、VAP发生率、再次插管发生率及病死率。结果两组患者发生RPFIW时MAP、HR、pH值、PaO2、PaCO2、辅助呼吸肌动用评分、P0.1、浅快呼吸指数等循环及呼吸相关指标比较差异无统计学意义（P>0.05）；RPFIW组患者拔管前后MAP、HR、pH值、PaO2、PaCO2、辅助呼吸肌动用评分等循环及呼吸相关指标比较差异无统计学意义（P>0.05）；RPFIW组患者有创通气时间、总机械通气时间、住ICU时间、住院费用、VAP发生率、再次插管发生率、病死率均明显少于或低于对照组（P<0.05）。结论以RPFIW作为有创-无创序贯通气的切换点可缩短有创机械通气时间、ICU住院时间，降低VAP发生率及病死率。

Objective To investigate the effect of scenario simulation teaching method on medical interns in emergency department . Methods A total of 80 medical interns were randomly divided into control group and experimental group on average ,respectively trainedby traditional teaching method and scenario simulation teaching method .Two groups of students were tested by theoretical and skills examina-tion,experimental group for evaluation of scenario simulation teaching method .Results Without significant difference between twogroups in theoretical examinations scores (P>0.05),the experimental group was significantly better than the control group in skills examination scores (P<0.05).The survey results showed that more than 90 percent of students were inclined to scenario simulation teaching method .Conclu-sion Compared with the traditional teaching ,scenario simulation teaching method is better for students to master emergency knowledge .

Objective To explore the clinical value of serum procalcitonin ( PCT) detection to guide the an-tibiotics use for acute asthma. Methods 83 patients diagnosed as acute asthma were randomly divided into the PCT group and the control group. Their serum PCT levels were measured 1 h after hospitalization and the 3rd, 5th, and 7th days respectively. While PCT<0. 1μg/L, they would stop taking antibiotics and initiate while PCT≥0. 1μg/L. Antibiotic treatment in the control group was based on guidelines of asthma diagnosis and treatment. Results The duration of antibiotic therapy and hospital stay was respectively 5. 6 ± 1. 5 and 7. 5 ± 2. 4 days in the PCT group, and 7. 9 ± 2. 1 and 10. 0 ± 1. 7 days in the control group (both P<0. 01). The cost of hospitalization and antibiotic thera-py was 3902 ± 493 and 1417 ± 322 yuan in the PCT group, and 5367 ± 438 and 1860 ± 337 yuan in the control group respectively (both P<0. 01). There was no significant difference in the clinical effective rate and the incidence of bronchial asthma with acute exacerbation within 1-month follow-up between the two groups. Conclusion PCT-guided antibiotic treatment can reduce antibiotic use in the treatment of acute asthma.