目的 探讨新型冠状病毒肺炎(以下简称新冠肺炎)医疗救治定点医院设置独立预检分诊管理策略对控制疫情传播的有效性.方法 自2020年1月24日重庆市启动突发公共卫生事件一级响应,该院设置相对独立的预检分诊处,严格执行各项防疫措施和工作流程,以集中分流和快速处置疑似病例和感染病例.结果 经过1年的运行和实践,效果显著,就诊患者新冠肺炎筛查效率高、新冠肺炎疑似或确诊病例零漏诊,医务人员零感染,无院内交叉感染发生.结论 在传染病疫情暴发时,设置独立的预检分诊处这一举措值得在医疗机构推广.

目的 对比观察术后静脉推注帕瑞昔布 、曲马朵对腹腔镜胆囊切除术后的镇痛效果.方法 将2017年3月至2018年3月该院肝胆外科收治的180例行腹腔镜胆囊切除术患者采用随机数字表法分为A组和B组,每组90例.A组患者回病房后即刻静脉推注帕瑞昔布40 mg,B组患者回病房后即刻肌内注射曲马朵2 mg/kg,两组患者12 h后均重复给药1次.两组患者术前均采用气管插管全身麻醉,手术结束前均静脉滴注昂丹司琼8 mg.记录两组患者给药后2、4、6、8、12、24 h疼痛视觉模拟评分 、发生不良反应(恶心 、呕吐 、呼吸抑制 、凝血功能异常)和追加哌替啶的情况.结果 两组患者术后2、4、6、8、12、24 h疼痛视觉模拟评分比较,差异均无统计学意义(P>0.05).A组患者恶心 、呕吐发生率[10.0％(9/90)]明显低于B组[40.0％(36/90)],差异有统计学意义(P<0.05);两组患者均未出现呼吸抑制 、凝血功能异常等不良反应.A组患者中术后使用哌替啶3例(3.33％),B组患者中使用哌替啶6例(6.67％),两组患者追加使用哌替啶情况比较,差异无统计学意义(P>0.05).结论 两种方法均具有较好的镇痛效果,静脉推注帕瑞昔布恶心 、呕吐发生率明显低于肌内注射曲马朵.腹腔镜胆囊切除术后患者回病房即刻 、术后12 h静脉推注帕瑞昔布镇痛具有显著的临床意义,值得推广应用.

Objective To observe the effect of parecoxib sodium on relieving acute postoperative pain and inflammatory fac‐tors in laparoscopic cholecystectomy .Methods Totally 96 cases of laparoscopic cholecystectomy were randomly divided into 3 groups :experimental group (group A ,group B) and control group(group C) ,32 cases in each group .Group A received intravenous infusion of parecoxib sodium 40 mg (diluted to 5 mL ) intravenously at the induction of general anesthesia and intravenous injection of 5 mL normal saline 15 min before surgery .In group B ,anesthesia induction ,15 minutes before surgery were given 5 mL of normal saline ,parecoxib sodium 40 mg (diluted to 5 mL) intravenously .In group C ,5 mL of normal saline was given intravenously at the time of general anesthesia induction and 15 min before operation .The total number of PCA and the number of effective compres‐sions and VAS scores at 12 h postoperatively ,the levels of serum TNF‐α,IL‐6 and IL‐12 before operation ,immediately after opera‐tion ,at 2 ,12 ,24 h after operationwere compared .Results The PCA press times and effective press times of patients in group A within 12 hours after the operation were much less than those in group B ,C(all P<0 .05) .The VAS scores of group A at 1 ,2 ,4 ,6 , 8 and 12 h were lower than those in group B and C (P<0 .05) ,but there was no significant difference between group A and group B after 24 h(P>0 .05) .The changes of serum IL‐6 ,TNF‐αlevel in three groups of patients at the end of the operation ,2 ,12 ,24 h after operationwere :group A < group B < group C .While the changes of serum IL‐12 were:group A > group B > group C . Conclusion Parecoxib sodium has a good analgesic effect of laparoscopic cholecystectomy in the induction of general anesthesia than before the end of the operation and application effect is better ,and its analgesic effect can reduce the production of inflammato‐ry factors IL‐6 and TNF‐α,and increase the level of IL‐12 ,which is beneficial to postoperative recovery .