Objective:To investigate the clinical features and risk factors of infection in patients with heat stroke (HS).Methods:The patients with HS who were admitted to the emergency departments of seven hospitals, including West China Hospital of Sichuan University, the Second Affiliated Hospital of Chengdu Medical College and so on, between July 01, 2020 and September 30, 2022 were retrospectively analyzed. The basic characteristics and laboratory test results of the patients were collected. The patients were divided into infected group and non-infected group according to the etiological results, and the differences in clinical characteristics between the different groups were compared. Multivariate logistic regression was used to screen variables, and the predictive model was established and ROC curve was performed to compare the predictive efficiency with SOFA score.Results:During the study period, a total of 183 patients with HS were included, and 156 patients were finally included for analysis according to the inclusion and exclusion criteria. Among them, 58 cases (37.2%) were in the infected group. The mortality of infected group was significantly higher than that of non-infected group (41.4% vs. 25.5%, P < 0.05). Compared with the patients in non-infected group, the infected gourp serum procalcitonin, direct bilirubin, alanine transaminase (ALT), creatinine, lactate dehydrogenase (LDH), creatine kinase isoenzymes, myoglobin, activated partial thromboplastin time (APTT) and respiratory support ratio at admission were significantly higher and albumin level was lower in infected group (all P < 0.05). Multivariate logistic regression analysis showed that myoglobin, ALT, APTT and respiratory support required at admission were independent risk factors for HS co-infection. A prediction model was constructed based on these four indicators, and the area under ROC curve of the prediction model was 0.846, which was better than SOFA score (0.732, P < 0.05). Conclusions:The prognosis of patients with heat stroke complicated with infection were obviously poor. Myoglobin, ALT, APTT and need for respiratory support at admission are risk factors for HS complicated with infection. The prediction model based on these four indicators is better than SOFA score for the early identification of the HS patients with infection.

Objective The aim of this study was to construct a risk prediction model for nosocomial death in cirrhotics with portal hypertension and esophagogastric variceal bleeding（EVB）. Methods A retrospective cohort study was conducted on the clinical data of 107 patients with cirrhotic portal hypertension and EVB who were admitted to our hospital between June 2018 and June 2020. All patients received transjugular intrahepatic portosystemic shunt（TIPS） therapy. The Logistic regression analysis was performed to screenindependent risk factors influencing the prognosis of patients with cirrhotic portal hypertension and EVB. A risk prediction model for nosocomial death was constructed based on these independent factors, and its predictive efficacy was verified by the area under receiver operating characteristic curve（AUC）. Results 25 patients（23.4%） died and 82 patients survived in our series; the univariate Logistic regression analysis showed that Child class, portal vein diameter, the sites of bleeding, the incidence rates of hepatic encephalopathy and hemorrhagic shock in died patients were significantly different compared to in survivals（P＜0.05）, and the multivariate Logistic regression analysis demonstrated that the portal vein diameter（OR=2.201, 95%CI: 1.544-3.139）, hepatic encephalopathy（OR=3.093, 95%CI: 1.731-5.524） and hemorrhagic shock（OR=1.101, 95%CI: 1.040-1.165） were the independent risk factors for nosocomial death（P＜0.05）; the C-index of the constructed nomogram model we built up by internal verification for predicting nosocomial death of patients with cirrhotic portal hypertension and EVB was 0.937（95%CI: 0.734-0.879）, witha good discrimination, and the AUC was 0.896（95%CI: 0.796-0.958, P＜0.001）, with the sensitivity and specificity of the prediction model were 91.3% and 88.1%, respectively. Conclusion The early recognition of risk factors of nosocomial death in patients with cirrhotic portal hypertension and EVB is important for appropriate management of patients, and the risk prediction model we constructed might have a good predictive efficacy.

目的 观察自拟益气活血汤联合西药对急性心肌梗死患者的临床观察.方法 选择100例急性心肌梗死患者随机分为两组,每组50例,对照组予西医常规治疗,观察组在对照组基础上口服自拟益气活血汤,对比两组临床疗效、心功能、中医证候评分、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(1L-6)、N末端心房利钠肽(NT-proANP)、N末端前脑利钠肽(NT-proBNP)、血清超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)]水平.结果 观察组总有效率为92.00％,显著高于对照组的78.00％(P＜0.05);观察组心功能各指标较对照组显著改善(P＜0.05);两组中医证候评分均显著降低于治疗前(P＜0.05),观察组下降幅度更大(P＜0.05);两组患者血清中TNF-α、IL-6、NT-proANP、NT-proBNP表达均明显降低(P＜0.05),观察组炎性因子均显著低于对照组(P＜0.05);治疗后,观察组血清SOD、NO表达显著高于对照组,MDA表达显著低于对照组(P＜0.05),观察组较对照组改善更为显著(P＜0.05).结论 自拟益气活血汤联合西药对急性心肌梗死患者临床疗效确切,改善心功能及中医证候评分,降低炎症反应,缓解氧化应激状态.

目的 观察黄芪白及粉治疗上消化道出血的疗效.方法 挑选出80例上消化道出血患者,将其以随机分组法为实验组与参照组,两组全部予西医常规用药治疗措施,实验组加用黄芪白及粉口服,比较最终疗效.结果 治疗组止血效果优于对照组,P<0.05.结论 在西医常规治疗基础上加用黄芪注射液在用于上消化道出血的治疗上疗效显著.

目的 调查新型冠状病毒肺炎(简称新冠肺炎)疫情下急诊科医护人员的心理应激压力状况.方法 2020年2月26日至3月1日,采用方便抽样法,通过网络发放问卷,对四川省达州市新冠肺炎疫情发生以来坚守在急诊工作岗位的医护人员进行心理应激压力调查,比较急诊医生与护士的应激感受量表-10(PSS-10)评分;根据性别、婚姻状况、学历及职称等对不同群体医护人员进行亚组分析,并分析急诊医护人员心理应激压力的来源.结果 截至2020年3月1日24:00,共回收问卷160份,排除既往有焦虑、抑郁等心理疾病的调查者的问卷1份和填写时间不足180 s的问卷2份,有效问卷共计157份,有效率98.1％.在157名有效完成问卷的医护人员中,男性70名,女性87名;平均年龄(35.89±9.27)岁;医生80名,护士77名,医生与护士的性别、年龄、学历及婚姻状况差异均有统计学意义(均P<0.05).急诊医生和护士的PSS-10总分均较高,且医生组和护士组间PSS-10总分比较差异无统计学意义(分:16.98±5.73比17.56±6.43,P>0.05).对不同性别、婚姻状况、学历及职称的医护人员进行亚组分析,结果显示,不同性别、学历及职称医护人员间PSS-10总分差异均无统计学意义(均P>0.05);在不同学历人群中,本科以下医护人员PSS-10中应对能力知觉评分明显高于本科及以上者(分:9.24±2.43比8.26±2.72),差异有统计学意义(P<0.05);已婚者PSS-10中危机知觉评分、应对能力知觉评分及PSS-10总分均明显低于单身者〔危机知觉评分(分):8.13±5.10比10.13±4.39,应对能力知觉评分(分):8.35±2.75比9.58±2.05,PSS-10总分(分):16.48±6.90比19.71±5.38〕,差异均有统计学意义(均P<0.05).应激心理压力来源调查显示,有87.90％(138/157)的急诊医护人员不同程度地担心自己被感染,其中88.41％(122/138)的人员担心是由对病毒的未知、自我防护不到位引起;91.08％(143/157)的医护人员希望得到家人、配偶的关爱,96.82％(152/157)的医护人员需要获得心理培训及团队的支持.结论 在新冠肺炎疫情下,急诊医护人员普遍存在较大的心理应激压力,尤其是单身的医护人员,因此需关注其心理压力状况,必要时及时干预.

目的 通过回顾性分析地市级三甲医院急诊科1年内的急诊就诊患者信息,分析老年急诊患者就诊规律及临床特点,为明确老年急诊患者救治重点、优化老年急诊患者就诊流程提供数据支撑.方法 通过医院信息系统(HIS)调取达州市中西医结合医院2017年1月1日00:00至12月31日23:59期间急诊就诊老年患者的基本信息及诊断资料.采用描述性统计方法对患者的性别、年龄、就诊时间、疾病种类、是否入院等情况进行分析.结果 在本院全年23?039例急诊患者中,老年患者共计5?073例,占22.02％,老年患者中男性比例稍高于女性,男性:女性=1.02:1.老年急诊患者全年就诊量以春季最低(22.71％),冬季最高(26.30％).就诊量星期时间点波动不明显,周末效应不明显.全天24?h就诊量呈"双峰"型分布,早、晚1?h高峰时段分别为?09:00?-?10:00和20:00?-?21:00,全天4?h高峰时段为18:00?-?22:00.全年老年急诊患者就诊量中前5位?依次为消化系统疾病(19.20％)、神经系统疾病(16.48％)、外伤(15.00％)、呼吸系统疾病(14.13％)、循环系统疾病(10.61％),合计占75.42％;全年老年急诊患者住院率为43.03％,显著高于非老年组(13.29％),差异有统计学意义(χ2=2?201.221,P<0.001);其中神经系统、呼吸系统、循环系统、消化系统疾病、外伤类疾病的住院率依次为73.21％、48.54％、45.17％、44.76％和38.37％.结论 老年患者占总急诊就诊量22.02％,发病季节高峰为冬季,就诊量日高峰时段为18:00?-?22:00,常见病种依次为消化系统疾病、神经系统疾病、外伤、呼吸系统疾病、循环系统疾病,需入院率显著高于非老年患者.建议通过增排高峰时段加强班、加强常见病种诊疗规范培训等方式提高老年急诊医疗服务水平及救治能力,保证老年急诊患者安全.

目的 分析达州市中西医结合医院急诊科就诊患者的疾病谱构成及就诊特点,为进一步明确救治重点、优化急诊流程、优化及合理使用急诊资源提供数据支撑.方法 通过调取达州市中西医结合医院HIS系统2017年1月1日0:00～2017年12月31日23:59急诊就诊共计20856例患者的基本信息及诊断资料,分析患者的性别、年龄、就诊时间、疾病种类、是否住院等情况,采用描述性统计方法进行分析,SPSS 25.0软件进行统计学处理,率的比较采用x2检验.结果 20856例患者中,男性比例高于女性;年龄组以青年组(45.97％)急诊就诊率最高;一年四季中夏季(26.63％)就诊量最多,春季(23.46％)最低;8月(9.58％)为急诊就诊月高峰,4月(7.49％)为低谷期;急诊就诊量星期时间点波动(14.02％～14.59％)不明显,周末效应不明显;急诊全天1小时高峰时段为20:00～21:00时,4小时高峰时段为18:00～22:00时;疾病谱中以外伤(23.30％)、消化系统(21.25％)、其他类(14.29％)为前三位病种.全年急诊就诊患者住院率明显高于同期门诊患者住院率.结论 该医院急诊患者就诊有一定的规律性,医院可考虑根据该规律提前增排加强班.急诊科医护人员应加强对排名前位系统疾病的诊治流程进行优化及学习,并加强急诊外科建设.

Objective To explore the characteristics of patients visiting emergency department by different ways of transportation.Methods The medical information of 23 039 patients visiting emergency department from January 2017 to December 2017 was obtained through the Hospital Information System (HIS).There were 20 856 patients visiting emergency arranged by themselves (self-visiting group),and 2 183 patients sent by ambulance (ambulance group).The characteristics of two groups were compared.Results The proportion of young patients in the self-visit group was the highest (45.97％,9 587/20 856),and the proportion of elderly patients in the ambulance group was the highest (40.04％,874/2 183).Throughout the year,the number of patients who came to the hospital by themselves was the highest in the summer,that by ambulance was the highest in the winter,while that was the lowest in spring for both groups.There was no significant fluctuation in the number of patients who came to the hospital during the week.In the self-visited group,the daily peak hours were 18:00-02:00 at night and the ambulance group were 10:00-18:00.The number of visits for top 5 system diseases were trauma,digestive system,other diseases,respiratory system and urinary system diseases in self-visiting group;and were nervous system,trauma,digestive system,respiratory system and circulatory system diseases in ambulance group.The hospitalization rates of self-visiting group and ambulance group were 14.41％ (3 006/20 856) and 76.64％ (1 564/2 183),respectively.Conclusion The emergency patients with different visiting modes have different characteristics.The information would be useful for rationally allocate emergency resources,optimize the treatment process,improve the emergency capacity and ensure the safety of patients.

将74例DKA患者分为观察组和对照组,每组37例,观察组患者在此基础上给予中药治疗,连续治疗3d,结果观察组治疗总有效率为91.89％,高于对照组的70.27％ (P ＜0.05);观察组血糖恢复正常时间、尿酮体消失时间均短于对照组,胰岛素日均用量少于对照组(P＜0.05).结论 中西医结合治疗DKA疗效优于单纯西医治疗.

目的：探讨急性有机磷中毒患者的急诊救治方法及救治时机。方法：选取2012年1月至2015年1月在我院就诊的急性有机磷中毒患者90例作为临床研究对象，根据救治时间对患者进行分组：0.5-1.0 h 组47例，1-2 h 组43例。所有患者均予以常规急救措施和血浆置换治疗。比较两组患者的救治效果。结果：与1-2 h 组患者相比，0.5-1.0 h 组患者的昏迷时间、血液胆碱酯酶活性恢复时间、住院时间明显更短，抗胆碱能药物用量明显更低，治愈率明显更高，组间结果对比差异显著（P＜0.05）。两组患者的并发症发生率比较无明显差异性（P＞0.05）。结论：常规急救措施加血浆置换是急性有机磷中毒患者的有效救治方式，而把握救治时机、尽早实施急救是提高治愈率、降低死亡率的关键。

目的：探讨依达拉奉联合高压氧治疗一氧化碳中毒迟发性脑病的临床疗效。方法：选取2012年12月至2016年3月在我院住院治疗的一氧化碳中毒迟发性脑病患者60例作为临床研究对象。随机分组：对照组30例，采用高压氧疗法；观察组30例，采用依达拉奉联合高压氧进行治疗。比较两组患者的治疗效果。结果：观察组患者的治疗总有效率明显高于对照组，治疗后的蒙特利尔认知评估量表评分（MoCA）和简易智能精神状态检查量表评分（MMSE）均明显高于对照组，结果对比具有明显差异性（P＜0.05）。结论：依达拉奉联合高压氧治疗一氧化碳中毒迟发性脑病的临床效果良好，值得推广使用。

Objective To investigate the clinical treatment effect of early mechanical ventilation on patients with severe organo -phosphosphate poisoning with respiratory failure and to provide reference information for clinical treatment .Methods 38 cases of pa-tients with organophosphosphate poisoning in our hospital from June 2013 to June 2014 were included for observation group ( early intu-bation group ) , 37 cases of patients with organophosphosphate poisoning from June 2012 to June 2013 were included for control group ( routine intubation group ) .At the beginning of admission , patients of observation group were treated with endotracheal intubation , ventilator-assisted breathing immediately .Patients of control group were treated with re -intubation , ventilator -assisted when breathing respiratory failure occurred .The cure rate, the mortality rate, PaO2 , PaCO2 , SaO2 , duration of mechanical ventilation , length of stay , re-intubation and aspiration pneumonia , the number of cases occur were observed and compared between the two groups.Results The cure rate of observation group was 96.7%, significantly higher than that in control group (73.0%), the differ-ence was statistically significant (P<0.05).PaO2, SaO2 were significantly lower in control group before intubation than that in obser-vation group (P<0.05), compared with observation groups, there was no significant difference in PaO2(P>0.05); the two groups after intubation, PaO2, SaO2 were significantly higher than those before treatment , PaCO2 significantly lower than that before treatment , the differences were statistically significant (P<0.05);PaO2, PaCO2 difference was not statistically significant after intubation (P>0.05), SaO2 in control group was significantly lower than that in observation group (P<0.05).The length of mechanical ventilation and hospital stay in observation group was significantly shorter than those in control group , and the difference was statistically signifi-cant (P<0.05).Aspiration pneumonia in observation group was lower than that in control group , the difference was statistically sig-nificant (P<0.05).The different of reintubation rate was not statistically significant (P>0.05).Conclusion Early mechanical ventilation used for acute severe organophosphosphate poisoning could improve the cure rate , shorter hospital stay and duration of me-chanical ventilation , improve the success rate .