Objective: To analyze the risk factors for hospitalized death in patients with acute aortic dissection（AAD） after operation and set up risk prediction models. Methods: The clinical data of 256 patients with AAD were collected. Univariate and multivariate logistic regression analysis were used to screen the related factors of postoperative death in Stanford type A and type B patients. The mortality risk prediction model was established and evaluated. Results: The in-hospital mortality of AAD patients was 12.11%（31/256）. Multivariate analysis showed that sinus involvement and acute renal failure were independent risk factors for postoperative hospital death in type A patients, older age and acute renal failure were independent risk factors for postoperative hospital death in type B patients, and higher fibrinogen（FIB） was an independent protective factor for type B patients. Furthermore, the nomogram prediction model was constructed and tested by Homser-Lemeshow statistics. The fitting effect of type A prediction model（χ~2=0.383, P=0.536） and type B prediction model（χ~2=7.292, P=0.505） were both good. The areas under the receiver operating characteristic curve of type A and type B prediction models were 0.722（P＜0.01） and 0.938（P＜0.01）, respectively. Conclusion: The risk prediction models of postoperative in-hospital death in patients with ADD, including Stanford type A based on sinus involvement and acute renal failure, as well as Stanford type B based on age, acute renal failure and FIB, both have good prediction performance.

Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.

Objective:To explore the application effect of the problem-originated clinical medical curriculum (PCMC) and problem-based learning (PBL) on teaching interns in the department of emergency.Methods:A total of 71 interns received in the department of emergency from January 2018 to January 2020 were selected and divided into an observation group ( n=38) and a control group ( n=33) according to different teaching methods. Among them, the control group received traditional teaching, the observation group took PCMC combined with PBL teaching method. The comprehensive ability scores and teaching quality of the two groups of interns were observed, and their satisfaction with teaching and the patient's evaluation on them were recorded. SPSS was used for t test. Results:There was no significant difference in the theoretical test scores, case analysis ability, and operational skills scores between the two groups before the teaching. After teaching, they were all improved, and the improvement effect of the observation group was significantly better than that of the control group [(92.30±4.37) vs. (83.75±3.98); (90.24±5.31) vs. (85.35±4.57); (91.33±5.28) vs. (86.49±4.42), all P<0.05]; the scores of basic job mastery, work attitude, adaptability and doctor-patient communication of the two groups were all improved, and the observation group was higher than the control group ( P<0.05); the satisfaction of the interns and the evaluation results of patients in the observation group were better than those of the control group ( P<0.05). Conclusion:PCMC combined with PBL used in the teaching of interns in the department of emergency can not only stimulate the interns' interest in learning, increase their theoretical knowledge, improve their learning ability and practical ability, but also improve the quality of teaching and improve their clinical resilience.

目的 探讨导师制结合反思性教学在重症医学科实习护士带教中的作用.方法 将2019年3月至10月在重症医学科实习的21名护士设为对照组,另将2019年12月至2020年7月实习的21名护士设为研究组.对照组采取传统带教,研究组采取导师制结合反思性教学.对比两组带教前后理论和技术操作考核成绩、带教前后职业自我效能感及带教前后临床综合能力.采用SPSS 26.0进行t检验和卡方检验,等级分布采用秩和检验.结果 带教后两组理论和技术操作考核成绩等级分布对比差异均有统计学意义(P＜0.05),研究组理论和技术操作考核成绩优良率均高于对照组(P＜0.05);带教前两组护生职业自我效能感量表中工作职责和教育要求评分以及临床综合能力(观察病情能力、沟通能力、健康教育能力、人文关怀能力、应急能力、专业知识、准确执行医嘱能力、与医生配合能力)评分差异均无统计学意义(P＞0.05),带教后两组护生职业自我效能感量表评分、临床综合能力评分均升高(P＜0.05),研究组带教后实习护生职业自我效能感量表评分、综合能力评分均高于对照组(P＜0.05).结论 在重症医学科实习护生带教中采用导师制结合反思性教学,可提高实习护生职业自我效能感,提升教学效果,并可提高实习护生临床综合素质.

热射病(heat stroke,HS)是中暑最严重的类型,由高温引起人体体温调节功能失调,体内热量过度积蓄,从而引发神经器官受损.通常发生在夏季高温、高湿的天气,核心体温可超过40℃.该病发病急,进展迅速,主要临床表现为高热、口干、血压升高、皮肤干热无汗等,严重时可出现休克、昏迷、消化道出血、肝肾功能不全甚至出现多器官功能衰竭综合征(MODS)、弥散性血管内凝血(DIC),死亡率高达50％～80％[1].本研究对2012年7月～2015年8月我院救治的18例热射病患者临床资料进行回顾性分析,总结其治疗特点与体会.

目的：探讨急性重度有机磷中毒导致呼吸衰竭的治疗方法。方法对45例急性重度有机磷农药中毒住院患者的治疗效果与转归进行回顾性分析。结果39例患者存活，占86.67%，2例患者临床死亡，占4.44%，自动出院4例，占8.89%。结论尽早达到阿托品化以及积极应用呼吸机可以明显降低病死率，改善患者预后。

目的:探讨早期激素干预对一氧化碳(CO)中毒迟发性脑病的预防作用.方法:收集2011-01-2013-12我院急诊科收治的70例CO中毒患者的临床资料进行统计分析,按照随机分组原则分为高压氧组和联合治疗组,每组各35例,高压氧组采用高压氧等传统综合措施进行治疗,联合治疗组则在高压氧组治疗的基础上早期加用地塞米松治疗,治疗结束后比较2组患者的治疗效果及迟发性脑病的发生率.结果:2组患者的症状均有不同程度的缓解,联合治疗组的总有效率为91.42％,显效率为85.71％;高压氧组的总有效率为71.43％,显效率为62.86％;联合治疗组的显效率和总有效率明显高于高压氧组,差异有统计学意义(P＜0.05).联合治疗组发生迟发性脑病者3例,占8.57％;高压氧组发生迟发性脑病者10例,占28.57％;联合治疗组的发生率明显低于高压氧组,差异有统计学意义(P＜0.05).联合治疗组1例患者死亡,占2.86％;高压氧组4例患者死亡,占11.43％,差异无统计学意义.2组患者中均无激素相关并发症的发生.结论:高压氧与激素早期联合应用可有效治疗CO中毒,效果满意;早期使用激素可有效降低CO中毒迟发性脑病(DEACMP)的发生,且不增加发生激素相关并发症的风险,但目前尚不能证实早期使用激素可降低患者病死率.

目的探讨综合治疗急性重度有机磷中毒临床疗效。方法对2010年1月~2013年1月收治45例ASOPP住院患者的治疗效果进行回顾性分析。结果39例患者存活,占86.67%,2例患者临床死亡,占4.44%,自动出院4例,占8.89%。结论早期积极综合治疗急性重度有机磷中毒能够明显降低死亡率,提高救治率。