子宫切口妊娠是临床妇科常见特殊异位妊娠,且近年来随着剖宫产率上升而呈逐年升高趋势,若终止妊娠不及时,易引发严重休克、出血,危险性较高,会严重威胁孕妇生命安全[1]。目前多采用超声进行影像学检查确诊,传统经腹检测方法易受到肠道...子宫切口妊娠是临床妇科常见特殊异位妊娠,且近年来随着剖宫产率上升而呈逐年升高趋势,若终止妊娠不及时,易引发严重休克、出血,危险性较高,会严重威胁孕妇生命安全[1]。目前多采用超声进行影像学检查确诊,传统经腹检测方法易受到肠道、脂肪等因素影响,且由于与早期妊娠表现具有相似性,会导致误诊、漏诊情况的发生[2]。而经阴道彩色多普勒超声(transvaginal color doppler sonography,TVCDS)能清晰客观显示宫腔、宫颈等部位的形态、回声改变,孕囊与子宫切口关系,明确孕囊周围血源,从而为子宫切口妊娠提供准确诊断依据[3]。本研究选取我院子宫切口妊娠患者87例,旨在探讨TVCDS检查的诊断效果。现报告如下。展开更多
Background:Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threat-ening injuries in children. We recentl...Background:Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threat-ening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care. Methods:A retrospective analysis of trauma alert activity was performed using data from our trauma registry. In March 2003,responsibility for level II alerts was transferred from the pediatric surgeons (PSs) to the Emergency Department (ED)-physicians. We compared the activity in the 18-month period before this change (period 1; n=627) to that afterward (period 2; n=587). Outcome measures included injury severity score,emergency department length of stay,missed injuries,abdominal computed tomography use,and mortality. Data were analyzed using log-rank statistic,χ 2,or t test,where appropriate,with significance level at P < 0.05. Results:During the entire study period,1499 patientsmet the trauma alert activation criteria of which 1214 (81% ) were level II alerts. The mean injury severity score for period 1 (8.5 ± 7.3 SD) was similar to period 2 (9.0 ± 7.1 SD). When ED physicians replaced PS for Level II alerts,ED length of stay increased from 135 minutes to 165 minutes (P < 0.001). In addition,the use of abdominal computed tomography was significantly decreased (53.6% vs 42.6% ; P < 0.001). However,there were no missed injuries and no significant differences in the rate of mortality. Conclusions:When ED physicians replaced PS for Level II alerts,trauma room length of stay was increased,but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.展开更多
文摘子宫切口妊娠是临床妇科常见特殊异位妊娠,且近年来随着剖宫产率上升而呈逐年升高趋势,若终止妊娠不及时,易引发严重休克、出血,危险性较高,会严重威胁孕妇生命安全[1]。目前多采用超声进行影像学检查确诊,传统经腹检测方法易受到肠道、脂肪等因素影响,且由于与早期妊娠表现具有相似性,会导致误诊、漏诊情况的发生[2]。而经阴道彩色多普勒超声(transvaginal color doppler sonography,TVCDS)能清晰客观显示宫腔、宫颈等部位的形态、回声改变,孕囊与子宫切口关系,明确孕囊周围血源,从而为子宫切口妊娠提供准确诊断依据[3]。本研究选取我院子宫切口妊娠患者87例,旨在探讨TVCDS检查的诊断效果。现报告如下。
文摘Background:Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threat-ening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care. Methods:A retrospective analysis of trauma alert activity was performed using data from our trauma registry. In March 2003,responsibility for level II alerts was transferred from the pediatric surgeons (PSs) to the Emergency Department (ED)-physicians. We compared the activity in the 18-month period before this change (period 1; n=627) to that afterward (period 2; n=587). Outcome measures included injury severity score,emergency department length of stay,missed injuries,abdominal computed tomography use,and mortality. Data were analyzed using log-rank statistic,χ 2,or t test,where appropriate,with significance level at P < 0.05. Results:During the entire study period,1499 patientsmet the trauma alert activation criteria of which 1214 (81% ) were level II alerts. The mean injury severity score for period 1 (8.5 ± 7.3 SD) was similar to period 2 (9.0 ± 7.1 SD). When ED physicians replaced PS for Level II alerts,ED length of stay increased from 135 minutes to 165 minutes (P < 0.001). In addition,the use of abdominal computed tomography was significantly decreased (53.6% vs 42.6% ; P < 0.001). However,there were no missed injuries and no significant differences in the rate of mortality. Conclusions:When ED physicians replaced PS for Level II alerts,trauma room length of stay was increased,but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.
