《黄帝内经》中认为"心脏骤停"病因总属内外二因,并受特定外部环境影响;各种致病因素的发病机制不同,但总体病机不外乎"阴阳隔绝,阴衰阳竭";以"扶正祛邪,补虚泻实"为治疗原则,对于具体治法又灵活运用;心前区疼痛是其发病时最常见的症状表现,多提示病情危重且预后较差.

目的 探讨基于休克指数(SI)评估的急救护理措施应用于严重创伤合并失血性休克(HS)患者的抢救效果.方法 回顾性分析南华大学衡阳医学院附属第二医院急诊科2019年1～10月收治的53例严重创伤合并HS患者为对照组,实施常规抢救护理措施;2019年11月至2020年8月收治的53例患者作为观察组,开展基于SI评估的急救护理措施.对比2组的就诊情况,包括急诊抢救时间、院内失血量、输血量、血液指标和抢救效果.结果 观察组的急诊抢救时间短于对照组,院内失血量和输血量均少于对照组(P均<0.05).2组在抢救12 h、24 h和48 h后的血液指标水平均较入院时更优,且每一时间点的指标水平均较前一时间点更优,观察组的指标均优于同期对照组,组间和组内差异均有统计学意义(P均<0.05),2组间7 d病死率的差异无统计学意义(P>0.05),观察组的抢救成功率高于对照组(P<0.05).结论 基于SI评估的急救护理措施可有效缩短严重创伤合并HS患者的抢救时间,减少院内失血量和输血量,改善血液指标,提高抢救效果,但对降低7d病死率的效果不明显.

目的 探析清气凉营汤对脓毒症(Sepsis)患者HMGBL、sRAGE及免疫功能的影响.方法 收集本院2019年8月至2020年2月急诊留观室、ICU收治的Sepsis患者60例,单盲试验原则,数字标注法随机分组,对照组30例,采用西医标准治疗方案,清气凉营组30例,在标准方案基础上联合清气凉营汤用药.比较两组治疗前、治疗7d血清HMGB1与血浆sRAGE水平、CD4+、CD8+水平及急性生理学及慢性健康状况评分系统(APACHE Ⅱ)评分,记录28 d病死率.结果 两组治疗7d后APACHE Ⅱ评分、血清HMGB1与血浆sRAGE水平显著低于治疗前(P＜0.05);且清气凉营组治疗7d后APACHE Ⅱ评分、血清HMGB1与血浆sRAGE水平改善幅度显著优于对照组(P＜0.05).两组治疗7d后CD4+、CD8+均明显高于治疗前(P＜0.05),且清气凉营组改善幅度显著优于对照组(P＜0.05).清气凉营组患者治疗28 d死亡率显著低于对照组(P＜0.05).结论 清气凉营汤治疗脓毒症效果良好,能降低患者HMGB1、sRAGE水平,抑制炎症因子过表达,调节机体免疫功能,促进自身免疫系统恢复稳态,减低病死风险.

现代医学对复发性口腔溃疡病因及发病机制尚不明确,亦无特效药治疗.李俊教授认为复发性口腔溃疡经久不愈,红肿不显,多伴少气、纳差、便溏、脉虚等症,多属"脾虚证",故在治疗上以培护中土为本,结合疡科"托""补"及外治之法,内外合用,可有力促进口疮愈合,收效良好.附验案1则以佐证.

目的 探讨血行感染脓毒症患者的阴阳证候分布规律及其与预后的关系.方法 回顾性分析2017年4月至2019年6月于广东省中医院住院的172名血行感染脓毒症患者的临床资料,其中阴证组58例,阳证组114例,包括一般资料、检验指标和序贯器官功能衰竭评分(SOFA评分)、急性生理学和慢性健康状况评分系统Ⅱ评分(APACHEⅡ评分)、病死率等指标.结果 采用二分类Logistic回归评估各项指标与血行感染脓毒症阴阳证型的相关性,获得的方程具有统计学意义(x2=12.358,P=0.002),其中尿素氮(Urea)≥11 mmol/L与阳证血行感染脓毒症呈负相关(OR-0.501,95％CI[0.256,0.981]),白蛋白(ALB)≥32 g/L与阳证血行感染脓毒症呈正相关(OR=2.598,95％CI[1.327,5.084]).回归模型评估血行感染脓毒症患者的病死率,校正后的模型显示年龄(OR=1.040,P=0.026,95％CI[1.005,1.076])和SOFA评分(OR=1.347,P＜0.001,95％CI[1.174,1.546])增加与病死率呈正相关(x2=28.993,P＜0.001).亚组分析中,阴证组血行感染脓毒症患者的格拉斯哥昏迷评分(GCS评分)(OR=0.797,P=0.003,95％CI[0.687,0.924])与病死率呈负相关(x2=9.010,P=0.003).结论 阴证血行感染脓毒症患者比阳证患者感染更重,器官功能状态和营养状态更差.年龄、SOFA评分和GCS评分是影响血行感染脓毒症患者预后的重要因素.

目的 观察传统的板书配合课件教学模式在《中医急诊学》课堂中对中医本科生急诊思维培养的影响.方法 连续2年对广州中医药大学境外班2014级与2015级共224位学生,随机对不同章节应用板书+课件教学(板书组)或课件教学(课件组)的教学模式,设置相关期末试卷考核,选取板书组与课件组对应的题目得分率进行配对比较.结果 2014级、2015级板书组与课件组之间总得分率差异均存在统计学意义(P＜0.05);在2014级单选题、多选题、问答题中,两组得分率差异具有统计学意义(均P＜0.05),其中板书组在简答题有优势,课件组在客观题有优势.结论 两种教学模式在考核中有各自的优势.多媒体课件教学适用传递大量信息,板书教学适用培养中医本科生急诊思维.我们需要在《中医急诊学》课堂教学中运用传统的板书配合课件教学有机结合的教学模式,从而提高中医本科教学质量.

In clinical treatment, it is difficult to carry out effective bone tissue transplantation and anti-inflammatory treat-ment at the same time due to bone defects and osteomyelitis where the tissue is contaminated or infected. As a downstream target of TNF-α, NF-κB has an inhibition effect on the proliferation and differentiation of cells surrounding the lesion. As a negative effect, it leads to slowing of bone growth and development. In this study, the small molecule NBD polypeptide and bone conduction matrix Sr-CaS are microsphere-formed to prepare Sr-CaS, NBD drug-loaded sustained-release micro-spheres, in order to achieve a Sr-CaS/NBD peptide drug-loaded sustained release microsphere scaffold material (SP-Sr-CaS/NBD). We prepared the microspheres and optimized the production process to obtain particles with stable morphologi-cal properties and sustained release properties. In vitro experiments demonstrated that SP-Sr-CaS/NBD can reduce TNF-α-induced cell growth inhibition, caspase-3 activity and NF-κB transcriptional activation as the function of continuous NBD peptide dosing regimen. Also, the introduction of Sr-CaS matrix potentiate microspheres to promote cell proliferation and provides a basis to become a hopeful used 3D bone scaffold material in the future.

Background: High morbidity has been reported regarding Achilles tendon (AT) injuries, and the upward trend has accelerated since the mid-1990s. A chronic Achilles tendon rupture usually results from a neglected or misdiagnosed acute rupture, and about one-fifth of acute AT ruptures are missed and lead to chronic AT rupture. Although many techniques have been described, there is no gold standard in the treatment of chronic AT ruptures. Hypothesis: Endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle flexor hallucis longus (FHL) tendon would result in improvement of the overall function, with a low rate of wound complications. Study Design: Case series; Level of evidence, 4. Methods: Between May 2015 and November 2016, a total of 19 consecutive patients were enrolled and treated using endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle FHL. The operative assessment comprised the Achilles Tendon Total Rupture Score, the American Orthopaedic Foot & Ankle Society score, the Victorian Institute of Sports Assessment–Achilles score, and a postoperative questionnaire. All postoperative complications were recorded. Results: The mean follow-up time for all patients was 31 months (range, 20-42 months). According to the postoperative questionnaire, the result of surgery was excellent in 8 (42%) of 19 patients, good in 10 (53%), and fair in 1 (5%). All clinical outcome scores (mean ± SD) improved significantly after surgery: Achilles Tendon Total Rupture Score, 23.3 ± 10.3 vs 98.3 ± 9.2 (postoperatively vs preoperatively); American Orthopaedic Foot & Ankle Society, 52.1 ± 12.4 vs 97.5 ± 18.9; and Victorian Institute of Sports Assessment–Achilles, 23.4 ± 11.2 vs 95.7 ± 17.1 ( P < .05). No complications with regard to wound healing or infection were noted. Twelve relatively young patients returned to preinjury activity levels, such as playing basketball or badminton, and the older patients were able to meet their daily needs, such as walking up stairs and jogging. Conclusion: Chronic AT ruptures were successfully treated via minimally invasive reconstruction using a double-bundle FHL, which provided excellent functional improvement. It is best suited for patients with complex requirements who are at high risk for wound complications.

目的 观察益气泻浊活血法对急性肺损伤(ALI)高危患者的有效性及安全性并探讨其作用机制.方法 59例患者随机分为观察组29例与对照组30例.对照组予西医常规治疗,观察组在西医治疗基础上联合益气泻浊活血法中药汤剂.比较两组治疗前后呼吸、血氧分压、动脉血氧饱和度、氧合指数及炎症、免疫等指标变化情况.结果 观察组治疗后呼吸、血氧分压、血氧饱和度(SaO2)、氧合指数均较治疗前改善(均P＜0.05或P＜0.01),对照组治疗前后呼吸、血氧分压、SaO2、氧合指数比较,差别均不大(均P＞0.05).两组治疗后呼吸、血氧分压、SaO2、氧合指数指标比较,差别均不大(均P＞0.05).两组治疗后白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)均较治疗前改善善(均P＜0.01),但两组治疗后上述指标比较,差别均不大(均P＞0.05).两组治疗后血IgA、血C3、CH50均较治疗前改善(均P＜0.05或P＜0.01),且观察组治疗后血C3、CH50高于对照组(均P＜0.05).两组治疗后ALI发生率、28 d生存率、住院总天数及住院总治疗费用比较,均差别不大(均P＞0.05).结论 益气泻浊活血法虽未改善ALI高危患者的住院7 d ALI发病率与28 d生存率,但无负性影响;益气泻浊活血法对ALI高危患者免疫功能具有一定改善作用,可改善患者呼吸、氧合情况,从而改善短期内病情,可能是ALI高危患者一个潜在有效的中医切入方案.

Background. Sepsis is a global major health problem with high mortality rates. More effective therapy is needed for treating sepsis. Acupuncture has been used for various diseases, including severe infection, in China for more than 2,000 years. Previous studies reported that acupuncture at Zusanli (ST36) might be effective in treating sepsis, but the efficacy and the quality of evidence remain unclear since there is no systematic review on acupuncture at ST36 for sepsis. Methods. Seven databases were searched from the inception of each database up to May 2019. Ultimately, 54 studies using acupuncture at ST36 for the treatment of experimental sepsis were identified in both English and Chinese literature with systematic review procedures. Results. Acupuncture might be useful in reducing injuries induced by sepsis in cardiac, lung, kidney, liver, gastrointestinal tract, and immune system. Its potential mechanisms for antisepsis might include reducing oxidative stress and inflammation, improving microcirculatory disturbance, and maintaining the immune balance mediated by dopamine. However, the positive findings should be interpreted with caution due to poor methodological quality and publication bias. Conclusion. Acupuncture at ST36 might be a promising complementary strategy for controlling sepsis inflammation, yet further studies are needed.

目的 观察木豆叶总黄酮/α-半水硫酸钙(α-calcium sulfate hemihydrate,CaS)复合材料在大鼠颅骨临界性骨缺损模型中的修复效果,积累基础实验数据.方法 50只SD大鼠进行颅骨临界性骨缺损造模,随机分为5组,植入不同材料:空白对照组(无植入)、CaS组(无木豆叶总黄酮)、低剂量复合材料组(木豆叶总黄酮与CaS质量比=20 mg:1000 mg)、中剂量复合材料组(木豆叶总黄酮与CaS质量比=40 mg:1000 mg)及高剂量复合材料组(木豆叶总黄酮与CaS质量比=80 mg:1000 mg),每组10只.动物实验后4周、8周、12周进行评价,包括苏木素-伊红(HE)染色、Masson染色及Micro-CT定性及定量评价.结果 Micro-CT三维重建影像、HE染色及Masson染色均证实空白对照组大鼠颅骨骨缺损虽有部分组织新生,但其中骨组织含量极少,骨质无法修复,说明造模成功,其余四组骨缺损均得到了修复,但修复质量CaS组较差,高剂量复合材料组最佳.骨矿物质密度(bone mineral density,BMD)和骨体积/组织体积(bone volume/total volume,BV/TV)趋势一致,在术后12周时,CaS组、低剂量复合材料组、中剂量复合材料组及高剂量复合材料组均显著优于空白对照组(P<0.05),而中、高剂量复合材料组明显优于CaS组和低剂量复合材料组(P<0.05).结论 中、高剂量木豆叶总黄酮/α-半水硫酸钙复合材料的促成骨作用明显优于单纯的 α-半水硫酸钙,可以缩短骨修复时间,是一种良好的新型骨替代材料.

Neovascularization is important for bone repair, vascularization, and ossification during bone repair. Ginsenoside Rg1 (G-Rg1), which is the main extract of ginseng, has been shown to promote therapeutic angiogenesis. It has been studied in the field of biomaterials, but there is no relevant report in the field of bone substitute materials. In this study, we successfully prepared the bone substitute material combining calcium sulphate (Sr-CaS) with G-Rg1 on the basis of previous research work. In vitro experiments were carried out to verify the ossification of composites by using mouse bone marrow mesenchymal stem cells (BMMSCs) and the ossification was quantified by western blot. The related proteins in the key signaling pathways for the different concentrations of G-Rg1/Sr-CaS composite extract were studied to determine whether there was receptor competition and to find the optimal ratio parameters. The vascularization of the composite was verified in the human umbilical vein endothelial cells (HUVECs) model, and finally the coordination of pro-vascularization and ossification was evaluated in the mouse critical bone defect model. The results indicated that G-Rg1/Sr-CaS composites contributed to ossification in the mouse BMMSC model and vascularization in the HUVEC model. The G-Rg1/Sr-CaS composites resulted in significantly greater bone mineral densities and bone volume/total volume of the defect group compared to the control group. Histological analysis showed that the G-Rg1/SrCaS was resorbable with satisfactory biocompatibility. The doped strontium ions enhanced the bone repair performance of G-Rg1/Sr-CaS in the mouse model and the new substitute demonstrated promising results for clinical use.

目的 探讨距舟楔关节融合治疗Müller-Weiss病的临床疗效.方法 回顾性分析2012年1月至2015年11月于我院行距舟楔关节融合治疗的Müller-Weiss病患者19例,22足的术前及术后资料.患者术中在足内侧柱得到复位重建后,凿除舟骨外侧部分并进行清理,取适当大小的髂骨骨块进行植骨,足背侧进行锁定钢板固定,轴向予空心螺钉固定.术前及术后的疼痛模拟评分(visual analog scale,VAS 评分)和美国矫形外科足踝协会踝与后足评分(American Orthopaedic Foot and Ankle Society,AOFAS评分)进行比较.结果 所有患者均获得随访,平均随访时间为28个月(13～57个月),平均融合时间为15周(13～17周),4例严重的跟骰关节炎患者行骨赘清理手术,1例患者术后15个月时出现螺钉松脱,予内固定拆除.术后疼痛模拟评分及AOFAS评分均较术前明显改善(P=0.000).结论 距舟楔关节融合结合自体髂骨取骨植骨治疗Müller Weiss病疗效可靠,足内侧柱的复位重建对于恢复足部的解剖形态及术后功能具有重要意义.

目的 了解中医院住院医师规范化培训医生(规培生)在急诊科轮科的疲劳情况.方法 调查2017年3月至9月期间,广东省中医院规培生在急诊科轮科前后的疲劳评定量表14评分(FS-14),进行自身前后对照.结果 研究共纳入111名受访者,轮科前后的FS-14配对样本t检验有统计学差异(P＜0.05);女性受访者以及普通规培轮科前后的FS-14存在统计学差异(P＜0.05).专硕规培、普通规培之间的轮科前后FS-14比较无明显差异(P＜0.05).结论 急诊科轮科导致的规培生轮科的疲劳度增加无法避免,需要我们予以重视.资源的优化、合适的培养模式可能是减低规培生疲劳度的有效策略.

目的 探讨磁共振引导聚焦超声术(MRgFUS)消融症状性子宫肌瘤的疗效.方法 选择行MRgFUS治疗的症状性子宫肌瘤患者22例,记录治疗情况、不良反应.治疗后3个月复查盆腔MRI及血红蛋白浓度,治疗后3、6、12个月复查症状严重程度评分(SSS)和健康相关生命质量(HRQL)评分.结果 22例患者均完成MRgFUS治疗,共消融41个肌瘤,完成率95.3％ (41/43).非灌注体积比率57.9％ ～ 99.2％,平均(84.2±13.8)％.治疗后轻度不良反应发生率为18.2％ (4/22),无严重不良反应.治疗后3个月肌瘤体积平均缩小(49.1±9.0)％,贫血者血红蛋白较治疗前升高(P＜0.05).MRgFUS治疗后3、6、12个月SSS评分均较治疗前降低,HRQL评分则较治疗前升高(P＜0.05).除治疗后6个月HRQL评分较治疗后3个月升高(P＜0.05)外,其余不同随访时间的SSS和HRQL评分差异无统计学意义(P＞0.05).结论 MRgFUS是治疗症状性子宫肌瘤安全、非侵入性的方法,短期疗效较显著.但长期疗效还需要进一步观察.

目的探讨舒筋洗药配合手法按摩对关节镜下前交叉韧带重建术后早期功能康复的疗效.方法回顾性分析2015年2月-2017年7月我院61例关节镜下前交叉韧带重建术患者,其中30例术后行单纯康复训练,31例在康复训练的基础上配合舒筋洗药外用熏洗加手法按摩,比较两组患者术后2周、4周、8周VAS疼痛评分及康复目标达成率,并于术后8周比较两组患者Lysholm膝关节功能评分.结果观察组在第2周、第4周和第8周的VAS疼痛评分均低于对照组,差异有统计学意义(P＜0.05),观察组各阶段康复目标达成率均高于对照组,且在、第4周时有统计学意义(P＜0.05),术后8周两组患者膝关节评分优良率无明显差异(P＜0.05),但观察组Lysholm评分明显优于对照组,差异有统计学意义(P＜0.05).结论舒筋洗药配合手法按摩可有效减轻前交叉韧带重建术后患者疼痛,促进患者早期功能康复,临床值得推广.

Objective To investigate the influence of different prompt measures on the quality of cardiopulmonary resuscitation (CPR) chest compressions in the standardized training of residents in Chinese medicine hospitals. Methods There were 84 participants who were the first year standardized training residents recruited from Guangdong Provincial Hospital of Chinese medicine during July to August 2016, and eleven of them were excluded because of incomplete chest compression data collected from the feedback system. Finally, 73 participants being volunteers were enrolled. They were divided randomly into phone metronome group (n = 16), music metronome group (n = 15), depth display group (n = 22), and blank control group (n = 20). In phone metronome group, a mobile phone metronome was applied in the duration of CPR, with a frequency of 110 beats per minute, beat 2/4; in the music metronome group, it was accompanied by the music Staying Alive during the compression period, with frequency of 107 beats per minute, beat 4/4; in depth display group, a model electronic displayer was used in the duration of the compressions to feedback the real time compression depth and its rebound situation in CPR; there was no any intervention measure in blank control group. Each participant performed 5 cycles of CPR on a manikin. A chest compression feedback device was placed on the pressing point, on which the participants places the hand for CPR. The chest compression fraction 1 (CCF1), compression depth, compression rate, too slow frequency, too fast frequency, too shallow frequency, the total times of compressions, the correct times of compressions, correct rate, and the rate of compression retention were record as preliminary evaluation data by using the dual sensor and the pressure sensor built in the chest compression feedback device. At the same time, the correct compression ratio, correct ventilation ratio, the chest compression fraction 2 (CCF2) displayed on the human electronic displayer of the manikin were used as the review criteria. The quality of chest compression among the four groups of volunteers was compared. Results The compression rate and the too fast frequency in the depth display group were significantly higher than those in the music metronome group [compression rate (bpm): 140.59±17.90 vs. 124.27±21.43, the too fast frequency (times): 134.18±49.88 vs. 95.40±53.76, both P < 0.05], and the total compression times in depth display group were significantly higher than either in music metronome group or in blank control group (times: 152.73±27.05 vs. 135.60±10.38, 144.60±12.56, all P < 0.05), the rate of compression retention in depth display group was significantly higher than that in blank control group [37.50% (4.75%, 88.25%) vs. 12.00% (2.75%, 47.00%)]. Consistency detection of two sets of feedback systems for chest compression showed that the chest compression ratio in music metronome group evaluated by the chest compression feedback device was obviously lower than that assessed by the analog human electronic displayer [(53.60±9.87)% vs. (58.20±28.17)%], and it was suggested that the chest compression ratio in depth display group evaluated by the chest compression feedback device be markedly higher than that assessed by the analog human electronic displayer [(56.32±7.77)% vs. (43.86±27.63)%, P < 0.05], and it was shown that the correct rates of chest compression assessed by the chest compression feedback device were significantly lower than those evaluated by the analog human electronic displayer in metronome, music, depth and blank control groups [phone metronome group: 0.00% (0.00%, 60.75%) vs. 38.50% (24.25%, 92.00%), music metronome group: 0.00% (0.00%, 7.00%) vs. 60.00% (32.00%, 89.00%), depth display group: 0.00% (0.00%, 0.25%) vs. 34.00% (20.75%, 68.25%), blank control group: 0.00% (0.00%, 1.75%) vs. 61.50% (30.75%, 84.25%), all P < 0.05], suggesting that the consistency of this two feedback systems be poor and their degrees of reliability low. Conclusion The effects of intervention measures on the quality of chest compressions vary from person to person, and the quality of chest compressions can be really elevated only by systematic training and repeated practice.

Objective To evaluate the effect and mechanism of ginsenoside-Rg1 on foot wound healing in Sprague-Dawley rat models with diabetic ulcer. Methods 96 SD rats were divided into 3 groups: diabetes mellitus group (DM group),ginsenoside-Rg1 group (G-Rg1 group) and positive control group. After the diabetic rat models were established by a single intraperitoneal injection of streptozotocin (STZ) in DM group and G-Rg1 group, 3 mm×7 mm full-thickness skin defects were created on the feet of all rats. Normal wound healings were acquired in positive control group with no intervention. G-Rg1 saline solution was administrated by gavage at a dosage of 40 mg· kg～(-1) · d ～(-1) in G-Rg1 group. Correspondingly, the rats were given normal saline of the same quantity in DM group. Wound tissue samples were obtained and evaluated on 3 days,7 days and 14 days after the interventions respectively. Results The diabetic rat models were successful. Histologically, HE and Masson staining results indicated that well-connected epithelium was observed in G-Rg1 and positive control groups, besides,new collagen fibril and tubular construction in G-Rg1 and positive control groups were more than those in the DM group. PCR results revealed that the expression levels of Col-1,Col-3 and VEGF mRNA in the G-Rg1 and positive control groups were considerably up-regulated compared with those in the DM group at different time points (all P＜0.05). The same trend was also observed in the protein expression of these cytokines detected by Western blot. Specifically,the expression level of Col-3 protein in the positive control group was significantly superior to that in the G-Rg1 and DM groups(P＜0.05), however, there is no significant difference between the two groups (P＞0.05 ). Conclusion G-Rg1 administration could accelerate wound healing, promote angiogenesis and collagen fibril neogenesis by up - regulating the expression levels of VEGF, Col-1 and Col-3 in rat models with diabetic ulceration,the repairing effect was similar to the normal healing.

目的:了解中医院住院医师规范化培训医生(规培生)在心肺复苏(CPR)过程中的疲劳情况.方法:观察2017-03-2017-09期间广东省中医院规培生在2 min CPR前后的生理数据、自认劳累分级量表(RPE)评分、疲劳评定量表14(FS-14)评分,进行自身前后对照.结果:研究共纳入146例受试者,剔除16例数据不完整者.130例受试者CPR前后的生理数据、RPE、FS 14进行配对样本t检验,受试者按压前后的心率、呼吸、血氧饱和度、RPE、FS-14差异均有统计学意义(P＜0.01).男女受试者按压前后的心率、呼吸、血氧饱和度、RPE、FS14差异无统计学意义.结论:规培生在2 min的CPR后,躯体疲劳抑或脑力疲劳都无法避免.我们需通过日常科学的训练,加快施救者轮换来提高复苏的质量.

目的 回顾性分析踝关节支具辅助旋后外旋型Ⅳ度骨折术后早期功能康复的疗效.方法 选取2016年1月-2017年12月收治的旋后外旋型Ⅳ度踝关节骨折脱位患者34例,所有患者均行切开复位内固定术,其中18例术后佩戴可调节踝关节支具辅助功能锻炼,16例常规石膏外固定保护下功能锻炼,术后每月定期随访,并于术后第1个月比较两组患者踝关节跖屈、背伸活动度及VAS疼痛评分,术后第6个月比较两组患者足踝AOFAS评分情况,以期评价支具辅助踝关节旋后外旋型Ⅳ度骨折术后早期功能康复的效果.结果 所有患者随访资料完整,术后第1个月支具组VAS疼痛程度评分低于石膏组,但两组比较无统计学意义(P＞0.05),支具组踝关节背伸、跖屈活动范围均优于石膏组,两组比较有统计学意义(P＜0.05).术后6个月两组患者踝关节评分优良率虽无显著差异,但支具组AOFAS评分为(86.9±6.95)分,明显优于石膏组的(80.6±9.26)分,两组比较有统计学意义(P＜0.05).结论 支具可安全有效地促进踝关节旋后外旋型Ⅳ度骨折术后早期功能的康复,临床值得推广.