目的 调查影响急诊危重患者预后的危险因素,构建急诊危重患者预后预测模型并对其应用效果进行验证,以期为急诊患者病情危重程度评估提供科学依据.方法 采用便利抽样法,选取2019年9月至2020年8月于苏州大学某附属医院急诊科就诊的危重患者为研究对象.按患者在急诊的预后(是否死亡)进行分层随机抽样,分配70％为建模组(3737例),30％为验证组(1601例).将建模组患者分为存活组与死亡组,采用单因素分析与Logistic回归方程分析筛选影响急诊危重患者预后的独立危险因素并建立预测模型,采用Hosmer-Lemeshow检验预测模型的拟合优度,受试者工作特征曲线(receiver operat-ing characteristic curve,ROC)检测模型的预测效能.结果 Logistic回归分析显示,年龄、收缩压、脉搏、呼吸、体温、血氧饱和度(peripheral oxygen saturation,SpO2)、AVPU评分[即A(alert)为意识清醒、V(responds to voice)为对声音有反应、P(responds to pain)为对疼痛有反应、U(unrespondsive)为无反应]、入院方式等8项是急诊危重患者预后的独立危险因素,根据各独立危险因素对应的危险积分值构建急诊危重患者预后快速评分工具,形成急诊危重患者预后预测模型.Hosmer-Lemeshow检验结果显示,P=0.863,ROC曲线下面积为0.876,Youden指数为0.585,敏感度为0.810,特异度为0.775,实际应用正确性为80.5％,提示模型具有较好的拟合效果及鉴别效能.结论 基于影响急诊危重患者预后危险因素建立的预测模型,有利于尽早识别有死亡风险的急诊危重患者,为医护人员有针对性并及时对有死亡风险急诊危重患者采取预防性护理措施提供指导.

目的比较快速急性生理评分、快速急诊内科评分和改良早期预警评分在急诊危重患者预后预测中的应用价值.方法回顾性分析苏州市某医院2019年9月-2020年8月于急诊科就诊的534例危重患者资料,收集患者入急诊时的相关数据并计算快速急性生理评分、快速急诊内科评分和改良早期预警评分得分,比较RAPS、REMS和MEWS预测危重患者预后效果,同时,对3种工具在急诊的应用进行评价.结果最终纳入的5 344例危重患者中,急诊死亡156例.随着3种评分分值的升高,急诊危重患者的死亡率增加.ROC曲线分析显示,快速急性生理评分、快速急诊内科评分和改良早期预警评分预测急诊危重患者预后的ROC曲线下面积分别为0.737、0.785和0.795,说明3种评分对其预后均具有一定的预测价值.3种工具的应用评价结果显示,改良早期预警评分的计算耗时低于快速急性生理评分和快速急诊内科评分,计算准确度和满意度均高于快速急性生理评分和快速急诊内科评分.结论快速急性生理评分、快速急诊内科评分和改良早期预警评分均可预测急诊危重患者的预后,改良早期预警评分的预测效能最高.综合考虑预测效能及临床实用性,改良早期预警评分更适用于急诊危重患者的预后评估.

Objective:To construct the prognostic prediction model and scoring tool by using severe trauma patients’ physiological indicators on admission, and to verify the clinical application effect and provide a reference for the early evaluation of severe trauma patients.Methods:This study was a retrospective study which adopted cluster sampling. Patients who met the inclusion and exclusion criteria in the emergency department of the First Affiliated Hospital of Soochow University from September 2019 to November 2020 were included. Patients were randomly assigned into the modeling group and the validation group in a ratio of 7:3 based on their outcome in the emergency department. Logistic regression analysis was performed to construct a prediction model, which was simplified as a scoring tool. The model was verified by using validation group and two months’ prospective validation. The efficiency of the simplified scoring tool was compared with that of the revised trauma score (RTS) and the injury severity score (ISS).Results:Totally 863 patients were included in this study, including 604 patients in the modeling group and 259 patients in the validation group. The model included systolic blood, SpO 2 and AVPU score. The AUC for predicting the death of severe trauma patients was 0.938. The AUC of the prediction model was 0.933, the best cut-off point was 5, the sensitivity was 86.7%, the specificity was 94.2%; the AUC of the validation was 0.885, the sensitivity was 83.3%, the specificity was 93.7%; and the AUC of prospective validation was 0.919, the sensitivity was 100%, and the specificity was 76.7%. The AUC of the RTS and ISS were 0.800 and 0.833, respectively. The AUC of RTS was lower than that of the simplified scoring tool constructed in this research. Conclusions:The prediction model and simplified scoring tool are better than RTS in predicting the outcome of emergency severe trauma patients, which are convenient for emergency medical staff to evaluate the severity of trauma patients.

目的：探讨CBL引导的急诊急救医护合作实践培训教学模式及意义。方法对我校护理本科专业学生实习前开展了CBL引导下的，由来自临床的医生、护士、临床医学生及护生组成合作团队，通过急诊急救案例引导进行贴近临床的仿真实训，搭建“医生为主导、护士为主体”的仿真平台。结果 CBL引导的急诊急救医护合作模式开展后，从“护生”到“医学生”再到“医护专家”，形成了教学链，得到了“护生融入平时团队学习”、“医学生案例精细，分工明确”、“医护专家正反引导，组内互补”的反思结果。结论该培训模式帮助护生在实习前感受真实的临床情境，在急诊急救的医护合作中培养了他们发现问题、解决问题的能力、评判与创新思维能力、主动学习能力、沟通合作能力及临床决策能力，促进实习护生尽快与临床无缝对接。

目的探讨急性主动脉夹层的急诊预检分诊、急救与护理方法。方法对30例急性主动脉夹层的急诊预检分诊及护理经验进行总结。结果 30例患者均通过快速预检分诊送至抢救室,其中1例分诊错误,其余29例均分诊正确;30例患者中,1例在入院后1小时内死亡(此例分诊正确),2例转上级医院,其余均安全转入病区治疗(8例保守治疗好转出院,19例手术治疗好转出院)。结论准确分诊,协助医生早期明确诊断,密切观察病情变化、控制血压、降低心率、减轻疼痛,做好心理护理是抢救成功率提高的关键。