2022年2月20日，举世瞩目的北京第二十四届冬季奥林匹克运动会圆满落下帷幕，秉持贯彻"绿色可持续"的办奥理念和"节俭办奥"的原则，经北京冬奥组委运动会服务部医疗服务处组织，由首都医科大学宣武医院互联网医疗诊治技术国家工程研究中心（下称"国家工程研究中心"）牵头，首都医科大学附属北京世纪坛医院（下称"北京世纪坛医院"）具体承担，联合国内多家单位研发的5G移动CT救治单元圆满完成北京冬奥会五棵松冰球场馆医疗保障任务。国际奥委会医疗代表Dr. Bruce Forster特别指出五棵松冰球场馆配备的小型移动CT救治单元，是有史以来奥运会医疗装备史上的第一次，实现了从"0到1"的突破。现就本次医疗保障的组织方式及保障经验报道如下。

Objective:To compare and analyze the effectiveness of mobile stroke unit (MSU) and conventional treatment mode of acute ischemic stroke (AIS).Methods:Sixty patients with AIS were selected from Encephalopathy Department of Nanshi Hospital Affiliated to Henan University from October 2019 to January 2020. The patients were randomly divided into MSU group (30 cases) and routine group (30 cases). In the MSU group, MSU equipped with 16-slice mobile CT was used to evaluate the neurological function, brain mobile CT scanning diagnosis and recombinant tissue-type plasminogen activator alteplase (rt-PA) intravenous thrombolysis for AIS. The patients in the routine group under routine treatment mode were initially treatment by first aid on site and transported to the hospital by 120 ambulance. The neurological assessment, brain CT scanning were performed in the Emergency Department. The diagnosis was determined in stroke experts. Then the patients were admitted to the stroke center for rt-PA intravenous thrombolysis. The initial contact time, CT scan time, rt-PA thrombolytic time, and the degree of neurological deficit before and after thrombolytic therapy were compared and analyzed between the two groups.Results:The total effective rate of MSU group was higher than that of routine group, the difference were statistically significant (P<0.05). The time from the first medical contact to the completion of head CT examination in MSU group was significantly less than that in routine group (the average time was shortened by 28.72 min), and the time from the first medical contact to the start of intravenous thrombolysis was significantly less than that in routine group (the average time was shortened by 34.81 min). The difference between the two groups was statistically significant (P<0.05). The change of NIHSS score in MSU group was better than that in routine group (P<0.05).Conclusion:The use of MSU mode for AIS can significantly shorten the time of brain CT scanning and rt-PA intravenous thrombolysis for the treatment of rt-PA intravenous thrombolysis, which resulted in significant improvement of neurological function and clinical efficacy of AIS patients.

目的 探讨国产16排移动CT在救护车运载条件下进行头部扫描成像的可行性.方法 选取陆军某部训练基地的志愿者健康官兵95人,随机分为3组:Ⅰ组(77人),救护车在停止行驶状态下进行头部扫描;Ⅱ组(11人),救护车在行驶状态下进行头部扫描;Ⅲ组(7人),设置电磁波干扰环境.分析对比3组受检者在不同状态下,移动CT扫描成像质量、运动伪影、数据采集及信息传输情况.结果 骨窗成像:3组受检者颅骨、眼眶、鼻蝶窦等成像清晰.脑组织窗成像:3组受检者均可清晰显示眼球、视神经、脑干、脑皮质及脑白质等结构,但颅底部分层面均存在不同程度的运动伪影,其中Ⅰ组16.88%(13/77)受检者有较轻微的线状运动伪影,Ⅱ组81.82%(9/11)受检者有较明显的运动伪影;Ⅲ组14.29%(1/7)受检者有轻微线状运动伪影.经χ2检验,Ⅰ组、Ⅲ组分别与Ⅱ组比较,差异均有统计学意义(χ2=21.645、7.901,均P＜0.05);Ⅰ组与Ⅲ组比较,差异无统计学意义(χ2=0.031,P＞0.05).在电磁干扰状态下,移动CT数据采集及信息传输正常,3组辐射剂量CTDIvol均为36.27 mGy.结论 16排移动CT在救护车行驶及电磁干扰状态下扫描成像稳定安全,数据采集及信息传输正常.

目的 多中心临床应用对比分析8排及16排移动CT的成像质量及性能特点、检查耗时、人工成本及辐射剂量值等.方法 解放军总医院第七医学中心神经外科自2010年8月至2020年7月应用8排移动CT行头部扫描90059例次,解放军总医院第七医学中心神经外科联合多家医院自2017年3月至2020年7月应用16排移动CT行头部扫描10969例次,分别采集患者头部扫描成像、检查时间、人工成本(人员累计耗时),以及辐射剂量值:CT剂量指数(CTDIvol)、剂量长度乘积(DLP)、有效剂量(ED).另外随机选择同期60例次64排大型CT检测值作为对比.结果 (1)成像分析:8排移动CT头部扫描90059例次,其中急诊室82843例次(91.99％)、ICU 7090例次(7.87％)、手术室126例次(0.14％).16排移动CT头部扫描10959例次,其中急诊室8601例次(78.41％)、ICU 879例次(8.01％)、手术室31例次(0.28％)、车/船/机载头部扫描1458例次(13.29％).2组成像质量基本相同,与8排移动CT组相比较,16排移动CT安装有精密导轨控制扫描和减振器,扫描速度快,运动伪影少,具有平扫+增强、脑血管造影(CTA)和脑灌注成像(CTP)等多种成像功能.(2)扫描时间与辐射剂量:16排、8排移动CT及64排大型CT的扫描时间、人工成本、辐射剂量(CTDIvol、DLP、ED)比较,差异均有统计学意义(P<0.05).结论 16排移动CT成像质量优良,扫描速度快耗时少、人工成本低、辐射剂量低,具有平扫、增强及CTA、CTP多种成像功能.

Objective: To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China. Methods: The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children's Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People's Hospital and Children's Hospital of Zhejiang University School of Medicine. The data of patients' characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test. Results: All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO(2) or SaO(2) before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO(2) and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ(2)=0.615, P>0.05; 4/28 vs. 2/14, χ(2)=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ(2)=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ(2)=0.845, P>0.05; 6/42 vs. 7/50, χ(2)=0.001, P>0.05; 29/19 vs. 38/19, χ(2)=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ(2)=0.775, P>0.05; 32/48 vs. 35/57, χ(2)=0.313, P>0.05; 20/48 vs. 22/57, χ(2)=0.102, P>0.05). Conclusion: With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.