ObjectiveTo investigate the epidemiological situation of pre-hospital emergency elderly and non-elderly patients in Chengdu and explore the characteristics of pre-hospital care in the city.MethodAll pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group (≥60 years old) and the non-elderly group (<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared.ResultsA total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for 29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61% (7 043 cases); the mortality rate was 11.74%, with sudden death (28.70%), cardiovascular diseases (25.95%), and respiratory diseases (16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases (35.41%), sudden death (unknown cause of death) (25.33%), and cardiovascular diseases (17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December; while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime (08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak (20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the non-elderly group was in the early morning (00:00 to 04:59) and night (20:00 to 23:59).ConclusionsThe number of pre-hospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.
目的 研究汶川地震后精神傷害對院前急救的影響。 方法 對2010年10月1日－2012年10月31日院前急救患者的地震后家庭成員狀況、精神傷害情況及病情程度進行回顧性病例對照分析。共有446例患者納入研究，男278例，女188例；年齡（41.4 ± 2.8）歲。依據家庭成員遇難狀況分3組，A組（家庭成員在地震中遇難）25例，B組（家庭成員在地震中受傷，無遇難情況）127例，C組（地震家庭成員完好）314例。 結果 各組患者最常見的精神傷害狀況是焦慮（A組96.0%，B組71.7%，C組40.8%）、過度警惕（A組92.0%，B組70.9%，C組50.0%），差異有統計學意義（P＜0.001）。A組患者要求到上級醫院繼續治療率較高（A組56.0%，B組39.4%，C組8.9%），組間差異有統計學意義（P＜0.001）。 結論 地震給人們的精神創傷較重，至今仍然普遍存在，并對患者的就醫活動產生影響。提示在北川縣院前急救工作中需要考慮患者的精神傷害情況。
ObjectiveTo understand the pre-hospital emergency medical staff's knowledge on crush injury and crush syndrome, and the influence of active and effective pre-hospital measures on the prognosis of patients with crush injury. MethodsWe retrospectively analyzed the clinical data of 51 patients with crush injury treated from September 2004 to August 2014, and recorded the number of cases in which pre-hospital emergency medical staff recognized and/or took effective measures to control crush syndrome. Treatment group included those patients who accepted effective prevention and control measures, and the rest of the patients were included in the control group. We compared the two groups of patients in terms of the incidence of serious complications such as crush syndrome and amputation. ResultsTwenty-five cases (49.0%) of crush injury were recognized before the patients were admitted into the hospital, among whom 20 (39.2%) accepted effective preventive and control measures. The mangled extremity severity score between the two groups of patients had no significant difference (6.69±1.96 vs. 7.23±3.54, P>0.05). After being admitted into the hospital, the treatment group had one complication case of crush injury, while the control group had 10 complication cases including 7 of crush injury and 3 of amputation. The complication rate of the treatment group (5.0%) was significantly lower than that of the control group (32.3%, P<0.05). ConclusionActive and effective prehospital preventive and control measures are very important in the treatment of crush syndrome and reduction of morbidity, but the pre-hospital emergency personnel's knowledge of crush injury and crush syndrome is not enough.
【摘要】 目的 分析地市級急救中心院前急救中損傷患者臨床特點，科學地指導院前急救診斷處置及急診外科資源配置。 方法 回顧性分析2009年1-12月份自貢市急救中心出診的全部有效病例中損傷患者出診資料，分析其疾病譜、季節、月份、時刻分布特點。 結果 全年院前急救損傷患者共1 922例，排名前5位的分別為:頭部損傷，涉及身體多個部位的損傷，膝和小腿損傷，腹部、背、腰椎和骨盆損傷，髖和大腿損傷，所有分類構成比男性均多于女性；損傷季節分布以冬季較多（Plt;0.05）；分布以1、11、12月份為多；時刻分布以凌晨0:00~6:00為出診最少時段。 結論 國際疾病分類（ICD-10）為規范院前急救疾病譜提供參考，根據損傷類疾病譜可確定急診外科工作及發展重心，依據季節、月份及時刻分布特點能指導急救資源合理配置。【Abstract】 Objective To provide scientific guidance of assistances for patients sustaining injuries and of effective resource allocation of emergency surgery by analyzing the pre-hospital features of injuries in urgent rescue centers at the local or city level. Methods All cases of injuries in pre-hospital emergency care during the year of 2009 were studied. The spectrum of diseases, and the seasons, the months, and the time points of the diseases were analyzed. Results There were totally 1 922 patients of pre-hospital emergency care in the whole year. Based on the International Classification of Diseases 10th Revision (ICD-10), top five classifications were injuries to the head, injuries involving multiple body regions, injuries to the knee and lower leg, injuries to the abdomen, lower back, lumbar spine and pelvis, and injuries to the hip and thigh. For all kinds of injuries, the number of male patients was more than that of the female. The cases in winter were more than those in other seasons (Plt;0.05). The cases in January, November and December were more than those in other months. The cases between 0:00 am and 6:00 am were less than those at other time points. Conclusion ICD-10 could provide reference for standardizing the spectrum of diseases in pre-hospital care. The focus of emergency surgery may be guided by the spectrum of injuries. The features of the season, the month, and time point of diseases can offer practical help for resource allocation in pre-hospital care.
目的:通過分析2007年自貢市急救中心院前急救反應能力，探討其影響制約因素及解決方法。方法：回顧性分析2007年1～12月份自貢市急救中心院前出診的全部有效病例呼救時間、出車時間、到達現場時間及出診距離，計算出車準備時間、車輛行駛速度、應急反應時間、急救半徑。結果：全年院前出診共3336例，出車準備時間（2.06±0.93） min，車輛平均行駛速度32.17 km/h，應急反應時間（12.51±10.87） min，急救半徑（5.60±5.35） km。結論：我市急救中心目前取得一定成績，需采取多種措施進一步提高急救反應能力。
目的 調查在院前急救中醫患雙方對留置針使用的滿意度，并就留置針在急救中應用的合理性進行研究。 方法 將我院急診科2011年6月－8月院前急救的患者，按出診順序分為兩組，觀察組患者使用留置針穿刺建立靜脈通道，對照組則采用一次性靜脈輸液針，并調查患者或親屬、穿刺操作護士就兩種穿刺方法的滿意度。 結果 觀察組留置針一次穿刺成功者達198例（94.29%），對照組一次穿刺成功者為206例（88.79%），兩組比較差異有統計學意義（P＜0.05）；護士對留置針使用滿意度明顯高于一次性靜脈輸液針；患者及家屬對留置針在保持靜脈通道通暢、輸液肢體舒適的滿意度較一次性靜脈輸液針高。 結論 靜脈留置針在院前急救中能提高醫患雙方的滿意度，值得推廣使用。
目的:探討使用院前指數(Prehospital Index, PHI)及格拉斯哥昏迷評分(Glasgow Coma Score, GCS)兩種創傷評分法對院前急救中急性酒精中毒合并外傷性顱內出血患者的評估價值。方法: 納入68例院前急救中酒精中毒合并頭外傷患者,院前均進行PHI及GCS兩種創傷評分,隨訪至出院,以頭部CT掃描及隨訪結果作為標準以判斷患者是否伴有顱內出血。計算兩種創傷評分的敏感度、特異度、陽性似然比、陰性似然比、陽性預測值、陰性預測值及Youden指數,并作出受試者工作特征曲線(ROC曲線),以正態離差值Z檢驗兩種評分法ROC曲線下面積的差異。 結果: 院前指數以6分作為診斷界值,敏感度為94.7%,特異度為71.4%;格拉斯哥昏迷評分以9分作為診斷界值,敏感度為98.8%,特異度為30.6%,PHI及GCS的ROC曲線下面積分別是0.881和0.678,其差異有統計學意義。結論: 在對急性酒精中毒合并頭外傷患者是否伴有顱內出血的院前評估中,院前指數較格拉斯哥昏迷評分更有價值。