院外心脏骤停（out-of-hospital cardiac arrest, OHCA）患者的生存率与第一目击者立即心肺复苏（cardiac pulmonary resuscitation, CPR）、自动体外除颤仪（automated external defibrillator, AED）快速除颤、院前急救系统的响应时间与高级生命支持的质量、院内救治效率等密切相关 [1,2,3,4]。本文报道由120调度员指导第一目击者对1例OHCA患者CPR及AED除颤、救护车急救人员现场恢复患者自主循环（return of spontaneous circulation, ROSC），院内多学科合作，在静脉-动脉体外膜肺氧合（vein-artery extracorporeal membrane oxygenation, VA-ECMO）与机械通气的支持下，植入支架1枚，患者康复出院。

目的 调查青岛市急救中心"互联急救"APP急救志愿者服务情况,并探讨其服务效率影响因素与保障需求.方法 通过调取 2021 年 1 月 1 日—2022 年 6 月 6 日青岛市急救中心"互联急救"APP志愿者接受调派参与OHCA急救数据,运用SPSS 23.0 统计学软件分组进行对比分析.设计调查问卷,运用SPSS 23.0、Stata16 软件进行急救志愿者服务影响因素与保障需求调查分析.结果 青岛市急救中心"互联急救"APP急救志愿者中有207 人次响应(7.89%),154 人次到达OHCA呼救现场(5.87%),先于EMS到达仅 40 人次(1.5%).志愿者响应半径中位数 0.8 km,明显短于EMS响应半径的中位数 2.65 km,差异具有统计学意义,P＜0.05.志愿者响应间期中位数 9 min等于EMS响应间期中位数 9 min,差异无统计学意义(P＞0.05).多重响应频数、回归分析等显示急救知识与技能能够提升志愿者参与危重症急救的信心.APP定位不准确、志愿者自身对地理位置不熟悉、交通阻塞是造成到达现场时间晚于EMS的主要阻力因素.建立全社会协同保障机制,配备必要的急救设备、用品均是志愿者迫切的保障需要.结论 建立完善的志愿服务社会保障机制,加强志愿者急救技能培训,并为志愿者配备必要的急救设备、用品等,是激励急救志愿者广泛参与,提高急救志愿服务效率,推动急救社区化体系建设发展的必要途径.

Objective:Intravenous thrombolysis (IVT) in patients with acute ischemic stroke is strongly time-dependent.The purpose of this study was to investigate whether the transfer of ischemic stroke patients to hospital through emergency medical service (EMS) could shorten onset to needle time (ONT),onset to door time (ODT), door to imaging time(DIT), door to needle time(DNT) and improve the clinical outcomes of intravenous thrombolysis patients.Methods:We retrospectively collected the clinical and time data of acute ischemic stroke(AIS) patients who received IVT in the Affiliated Hospital of Qingdao University on Laoshan campus from September 2021 to August 2022 were retrospectively collected. Patients were divided into EMS group and Non-EMS group according to patients whether transferred by ambulance. The baseline characteristics, length of each period and differences in clinical outcome were compared. Good prognosis was defined as modified Rankin Scale score of 0-2 at 3-months.Results:A total of 175 patients aged (66.1 ±12.3) years were selected, including 63 females (36.0%) and 53 patients (30.3%) were transferred by EMS. Compared with the Non-EMS group, the patients in the EMS group were older, the baseline NIHSS score was higher, ODT and ONT were shorter (all P< 0.05), but there were no significant difference in DIT and DNT between the two groups. Binary Logistic regression model showed that after adjusting for age, sex, baseline NIHSS score, bridging therapy, history of atrial fibrillation, history of hypertension, the number of previous diseases and intracranial hemorrhage, EMS was independently associated with good prognosis of patients with acute ischemic stroke [odds ratio ( OR) 0.376, 95% confidence interval ( CI) 0.144~0.890, P=0.027). Conclusion:EMS could improve the clinical outcomes of acute stroke patients by shortening the ODT and ONT in patients with acute ischemic stroke.

Objective To observe the effect of acupuncture and pricking therapy on intractable hiccups in stroke.Methods Forty five patients were enrolled and randomly divided into two groups:Treatment group (n=23)treated with acupuncture and pricking therapy,and control group (n=22)treated with conventional western medicine.Results Hiccupsi improvement scores in treatment group were higher than that in control group (P<0.05).Conclusion Pricking with acupuncture therapy was effective for stroke hic-cups.

目的 观察水针配合电针次髎穴治疗中风后尿失禁的疗效.方法 将40例患者随机分为治疗组和对照组,每组20例.对照组单纯针刺百会,中极、关元、三焦俞,膀胱俞、三阴交治疗,留针30 min.治疗组在对照组基础上加用次髎穴水针配合电针治疗,予维生素B12注射液穴位注射,并电针次髎穴.每日1次,15 d为1个疗程,两个疗程后评价疗效.结果 治疗组总有效率85%,对照组总有效率65%,两组比较疗效有统计学意义.结论水针配合电针次髎穴治疗中风后尿失禁疗效显著.

The utility model relates to a medicine taking device for acupuncture point application therapy and aims at solving the problem that small-area pasty medicine or ointment is inconvenient to apply and the medicine amount is difficult to control. The medicine taking device for the acupuncture point application therapy comprises an outer barrel, a pushing rod and a piston, wherein the piston is arranged inside the hollow outer barrel, one side of the piston is connected with the pushing rod, and scales are marked on the outer barrel. An applying area adjustor is installed at the position of a medicine outlet of the medicine taking device for the acupuncture point application therapy and comprises the hollow cylindrical wall, the annular bottom wall and a hollow handle, wherein the handle is connected onto the bottom wall. The diameter of the wall can be adjusted as required so as to meet different sizes of acupuncture point application pastes. The medicine taking device for the acupuncture point application therapy is low in cost, convenient to use, even in applying, capable of accurately controlling the using amount of medicine to be applied and suitable for pasty medicine or ointment application on various specifications of acupuncture point application pastes.

<正>类风湿关节炎(rheumatoid arthritis,RA)是一种慢性、系统性、自身免疫性疾病,主要表现为对称性多关节炎,亦可累及脏腑、神经、血管等系统。RA在中医学中没有对等病名,根据其临床表现,属于"尪痹"、"痹病"等范畴,在中医文献中也有"鹤膝风"、"痛风"、"历节"、"白虎历节风"等病名类似。本文在我科承担青岛市卫生局科技支撑项目"青岛地区类风湿关节炎中医辨证分型的临床研究"的基础上,对2010年10月l日至2012年1月1日期间就诊于我科门诊及

Objective Combined with the patients arthritis symptoms and signs,TCM syndrome differentiation of rheumatoid arthritis was undertaken to investigate TCM syndrome distribution.Methods A total of 656 patients of rheumatoid arthritis from October 1st 2010 to January 1st 2012 hospitalized in Shandong Qingdao Combine Traditional Chinese and Western Medicine hospital were untaken TCM syndrome differentiation according to their symptoms and signs.Results The main syndromes of rheumatoid arthritis patients were cold-dampness blockage syndrome and liver and kidney deficiency syndrome,followed by cold-wind blockage syndrome,deficiency of Qi and blood syndrome,and dampness-heat blockage syndrome.The highest scores of ESR and C reactive protein appeared in dampness-heat blockage syndrome group,with ESR being (56.23 ± 13.87) ram/h,CRP being (69.49± 21.56) mg/L.These values showed significant difference than other syndrome group (P ＜ 0.05).There was no significant difference of rheumatoid factor,immunoglobulin IgG,IgA,IgM values among these syndrome groups (P＞0.05).Comparison of age,course of disease showed the liver and kidney deficiency syndrome group (age was 59.3± 12.15,duration was 7.98 ± 3.76)and Qi and blood deficiency syndrome group (age was 52.5± 11.5,duration was 6.56±3.12) were significant higher than cold-dampness blockage syndrome,damp-heat blockage syndrome group and cold-wind blockage syndrome group with the age of (46.2± 11.12) and (45.8± 11.60),(43.5± 12.50) respectively and course of (5.56±2.76),(5.78±2.98),(5.12±2.32) respectively (P＜0.05).Conclusion The main TCM syndromes of rheumatoid arthritis patients in Qingdao area were cold-dampness syndrome,liver and kidney deficiency syndrome,followed by cold-wind blockage sydrome,Qi and blood deficiency syndrome,damp-heat blockage syndrome.Among all syndromes,relatively high age and disease course of patients appeared in liver and kidney deficiency syndrome and Qi and blood deficiency syndrome.

目的总结不同治疗方法对CKD-5D期脑出血患者的预后的影响。方法通过回顾青岛中西医结合医院2005-2012年收治的21例次CKD-5D期合并脑出血患者的治疗,总结间断肾脏替代治疗(间断血液透析和间断血液滤过)与每日血液透析治疗CKD-5D期合并脑出血的临床效果。结果每日血液透析组患者的总体好转率、死亡率好于间断肾脏替代。结论每日血液透析是治疗CKD-5D期合并脑出血的较理想的方法。

目的:总结治疗脑出血合并急性肾损伤的血液透析治疗方案.方法:通过回顾青岛中西医结合医院1年收治脑出血合并急性肾损伤患者的治疗过程,总结每日血液透析治疗脑出血合并急性肾损伤的可行性.结果:6例患者全部存活,其中一例发展为慢性肾脏病,2例Scr＞350μmol/L的患者,1例Scr降至基础值,一例进入维持性血液透析治疗.结论:每日血液透析是治疗脑出血合并急性肾损伤的有效方法.

目的 总结不同治疗方法对CKD-5D 期脑出血患者的预后的影响.方法 通过回顾青岛中西医结合医院2005-2012 年收治的21 例次CKD-5D 期合并脑出血患者的治疗,总结间断肾脏替代治疗(间断血液透析和间断血液滤过)与每日血液透析治疗CKD-5D 期合并脑出血的临床效果.结果 每日血液透析组患者的总体好转率、死亡率好于间断肾脏替代.结论 每日血液透析是治疗CKD-5D 期合并脑出血的较理想的方法.

非酒精性脂肪性肝病(NAFLD)是遗传-环境-代谢应激相关性疾病,包括非酒精性单纯性脂肪肝(NAFL)及由其演变的非酒精性脂肪性肝炎(NASH)和脂肪肝性肝硬化三种类型.近年来,由于生活方式的改变,环境因素的影响,糖尿病、高脂血症、肥胖的发病率升高,NAFL和NASH相继增多,本文就46例NASH的临床特点报告如下.

外伤后急性弥漫性脑肿胀(PADBS)是指外伤后数小时内脑组织广泛性肿胀,病情进展快,预后差.1998年9月至2003年9月我院共收治PADBS患者41例,保守治疗17例、手术治疗24例,死亡23例.现将治疗体会介绍如下.

Objective To observe micro-anatomic structure endoscopically via suboccipital retrosigmoid approach, and provide the morphologic basis for surgical localization. Methods Thirty adult cadavers heads soaked in formalin were studied microscopically and endoscopically via suboccipital retrosigmoid approach. The major structures of this region were investigated; the distance between star spot and the important operative corridor marks were measured; and the angle between the approach and the sagittal plane depicted. Results The longitudinal incision was (3.5±0.5)cm long, the superior extremity being the star spot. The skull window was located posterior to star spot, which was (2.5±0.5)cm in diameter. The operative corridor was between the subdura and epiarachnoed space, which was located posterior to the petrous bone, anterolateral to the cerebella, and anterior to flocculus. The angle between the approach and sagittal plane was 45.0°±2.5°. Although the pathway was narrow , the operation field was greater, which could reach the abduens nerve superiorly, and jugular foramen inferiorly. Conclusion The key to a successful operation lies in the knowledge of the related anatomic structures and skillful technique of endoscopy.

神经外科正朝着微创的方向迅猛发展,它要求最大程度地解除病人的病变,最大程度地保留病人的生理功能,保持手术的精确性和微创性.近年来科技高速发展,产生了具有高度可视性、可操作性的多种型号的神经内镜,神经外科锁孔手术逐渐发展起来,开始了具有真正意义的内镜经锁孔入路神经外科手术[1～6].现将内镜经锁孔手术入路的神经外科进展综述如下.

肠易激综合征(IBS)是一种临床常见的肠道功能性疾病,临床表现为慢性反复发作的腹痛、腹胀和排便习惯改变,但无器质性病变的肠道功能紊乱症状群.2003年4月～2004年3月我们应用斯巴敏、贝飞达联合治疗IBS195例,疗效满意.现报告如下.

颅脑损伤双瞳散大病人的病死率很高,有国内报道高达80%[1],国外报道为57%～100%[2].我院自1990年6月～1997年7月共收治此类病人68例,死亡52例,死亡率76%.现将本组病人死亡因素分析报道如下.