Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Analysis of the Role of Problem-Based Independent Learning Model in Teaching Cerebral Ischemic Stroke First Aid in Emergency Medicine

Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.

An overview of the construction of emergency and pre-hospital first aid platform

To further improve the ability of pre-hospital and in-hospital collaborative treatment, strengthen emergency multidisciplinary cooperation and construct a scientific, rational and efficient emergency system, under the support of former chairman Yu Xue-zhong, Dr. Li Chun-sheng and numerous colleagues in the industry, the Emergency Medicine Society of the Chinese Medical Association appeal to us to draft Construction of Emergency and Pre-hospital Platform. Based on this background, the platform of emergency and pre-hospital first aid helps to build a 'one horizontal and one Longitudinal' treatment model, using the horizontal and longitudinal patterns to integrate emergency medical resources to satisfy the automatic information integration and intelligent analysis sharing, realizing the emergency management visualization and medical information digitization, simplifying the medical process and establishing a perfect standard for the emergent diseases, thereby ultimately achieving efficient diagnosis and scientific treatment.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

OBSERVATION ON THE THERAPEUTIC EFFECT OF CT-AIDED SURROUNDING NEEDLING IN THE TREATMENT OF ISCHEMIC STROKE AND CHANGES OF PLASMA CATECHOLAMINE LEVEL

In this study, 61 cases of ischemic stroke patients are randomly divided into surrounding needling group (n=31) and scalp acupuncture group (n=30). The ischemic focus of the brain is determined by CT examination. For patients of the surrounding needling group, Gauge 29-30 stainless steel filiform needles are inserted into the surrounding scalp of the focal projection region one by one, with the needle tips toward the center of the focal projection area, and combined with other body acupoints according to syndrome differentiation. For patients of scalp acupuncture group, Motor Area (MS 6) and Sensory Area (MS 7) of the contralateral side of the focus are used. The treatment is performed once daily in both groups, with 30 sessions being a therapeutic course. After one course of treatment, in surrounding needling and scalp acupuncture groups, 20 and 11 cases are cured basically, 10 and 15 have a marked improvement, 1 and 4 are effective, the therapeutic effect of the former group is significantly superior to that of scalp acupuncture group. After treatment, plasma epinephrine (E) and norepinephrine (NE) levels of the two groups decrease considerably compared with pre treatment of each group (P<0.01), and the effects of surrounding needling on E and NE are more evidently than those of scalp acupuncture (P<0.05). Results suggest that the therapeutic effect of acupuncture may be related to the decline of plasma E and NE levels.

基于德尔菲法的《脑卒中“病脉证并治”临床辅助决策方案》条目筛选

目的对《脑卒中“病脉证并治”临床辅助决策方案》进行条目筛选,为方案制定和完善提供参考。方法采用德尔菲法,通过问卷星平台于2022年7、8月分别向全国60位脑病学或神经病学方向专家发放两轮问卷,对方案的病名概述、病因病机、证候特点、治则治法、代表方、针灸及其他疗法与预防调护具体条目问卷结果进行统计学分析。结果两轮调查分别回收42、50份有效问卷。专家对病因病机、治则治法、针灸及其他疗法、预防调护条目重要性达成共识。证候特点删除了与证型相关度低或引起歧义的要素,代表方删除现代已弃用或同名异方。同时,对证型、治则治法的名称进行统一规范化处理。结论《脑卒中“病脉证并治”临床辅助决策方案》条目基本得到专家认同,但仍存在局限性,有待进一步研究探讨。

基于有限时机理论的急诊绿色通道护理流程用于急性脑卒中患者救护中的实践

目的 探索基于有限时机理论的急诊绿色通道护理流程用于急性脑卒中患者救护中的实践。方法 对厦门市中医院2022年9月至2023年10月救治的78例急性脑卒中患者展开研究,按照随机投掷法将患者分为两组,即观察组(39例,采取基于有限时机理论的急诊绿色通道护理流程)和对照组(39例,采取常规急诊处理)。比较两组急救时效性、神经功能缺损程度[临床神经功能缺损评分标准(CSS)]、意识状态[格拉斯哥昏迷评分(GCS)]、不良事件的发生情况。结果 观察组急救时效性相比对照组较短(P<0.05);干预1周后,观察组CSS评分相比对照组较低(P<0.05);干预6 h后,观察组GCS评分相比对照组较高(P<0.05);两组不良事件发生率无统计学意义(P>0.05)。结论 急性脑卒中患者的救护中应用基于有限时机理论的急诊绿色通道护理流程进行干预,不仅能保障急救时效性,减轻意识障碍,降低神经功能缺损程度,还能最大限度帮助患者争取良好预后。

基于血浊理论与援药理论的卒中后癫痫辨治初探

卒中后癫痫(PSE)是指卒中前无癫痫病史,卒中后出现的痫性发作,西医目前对其发病机制认识尚为不足,治疗手段有限且不良作用明显。根据王新陆教授提出的血浊理论与援药理论,PSE的中医病机责之于过食肥甘,血失常度,痰瘀互结,酿生血浊。清化血浊法是治疗PSE的有效方法,化浊行血汤可作为防治PSE的基础方剂。

智慧医疗介入脑卒中急救系统设计研究

通过智慧医疗对脑卒中病人进行远程监测、主动报警、主动上门溶栓救治,实现脑卒中救治黄金期的目标。降低致残率和致死率,提升救助质量。通过梳理现有脑卒中救治流程中的痛点,将智慧医疗与脑卒中院内急救纳入院前急救环节结合,提出了运用搭载智慧医疗技术的主动式脑卒中急救车进行施救的路径。本系统整合了智慧医疗技术、系统集成、工业设计与服务设计等领域,建立了从主动发现到上门诊断,再到远程救治的脑卒中救助服务系统。该系统借助智慧医疗大数据分析及远程监测与协同操作等优势,依托脑卒中急救车院前施救,压缩不必要的等待期难点,保证救治时间窗口。实现了越早发现、越早报警、越早检查、越早诊断、越早治疗的目标。

计算机辅助认知康复训练对脑卒中患者总体认知功能改善的Meta分析

目的:评价计算机辅助认知康复训练对脑卒中后认知损害患者总体认知功能的改善效果。方法:计算机检索Pubmed、EMbase、万方和CNKI数据库,搜集关于计算机辅助认知康复训练对脑卒中后认知损害患者总体认知功能改善效果的随机对照研究,时限为建库到2022年5月。文献的筛选、资料的提取和评价纳入研究的偏倚风险由2名研究者独立完成,最后采用RevMan5.3软件进行Meta分析。结果:共纳入9个RCT研究,包括467例患者。Meta分析结果显示,MMSE的效应值是1.97[0.52,3.42],MoCA的效应值是3.24[2.41,4.07]。在认知功能改善方面,计算机辅助认知康复训练效果优于人工认知康复训练。结论:4周及以上计算机辅助认知康复训练在改善脑卒中患者总体认知功能方面存在优势,临床上可根据不同患者、不同医院的具体情况制定康复方案,使认知功能得到有效的改善。受纳入研究数量和质量的限制,结论尚待更多高质量研究予以验证。

移动卒中单元在急性缺血性脑卒中院前急救中的应用现状

目的对移动卒中单元的发展及其在急性缺血性脑卒中院前急救的应用现状进行综述,以期为完善我国急救体系、促进医疗模式的转变提供新思路和新方向。方法检索国内外相关文献,对移动卒中单元的发展历史、在急性缺血脑卒中院前急救的应用现状及应用发展的难点问题进行分析和总结。结果移动卒中单元可缩短患者静脉溶栓时间、降低院前延误、提升院前急救质量。结论移动卒中单元对缺血性脑卒中院前急救有重大意义,但其应用与发展仍有不足,未来可开展进一步研究,以完善移动卒中单元的应用。

面向脑卒中患者助行辅具的情感化设计研究

以脑卒中患者的生理、心理需求为导向,分析助行辅具产品对于患者的价值,从而提出情感化的设计方法,有利于患者在使用过程中获得正向的情感认知。以情感化设计理论为出发点,通过对患者特征、康复痛点和助行辅具功能痛点进行分析,获取患者需求,并采用访谈调研总结出重点需求。将患者需求与情感化设计转化,进行助行辅具产品的设计实践。针对脑卒中患者的助行辅具情感化设计可以满足患者锻炼需求及情感价值等。助行辅具的情感化设计有相当高的社会意义,能够满足患者对助行辅具情感化需求。所以,需要设计师结合患者的生理、心理特征,以情感化设计理论为基础,将助行辅具的功能、情感价值发挥到最大化,给予患者最好体验。

缺血性脑卒中患者康复训练决策辅助工具的构建

目的构建缺血性脑卒中康复训练决策辅助工具,为患者决策提供结构化指导与支持。方法基于文献回顾和半结构式访谈,初步拟定缺血性脑卒中康复训练决策辅助工具,采用德尔菲专家函询法对15名专家进行2轮专家函询。结果2轮专家函询的问卷回收率及有效率均为100%,表明专家的积极性高;2轮函询的专家权威系数分别为0.88、0.89,表明专家的权威程度高;2轮专家函询的肯德尔协调系数分别为0.298、0.398(P<0.001),表明专家意见的一致性较高;最终形成的缺血性脑卒中康复训练决策辅助工具包括4项一级指标、9项二级指标和25项三级指标。结论本研究构建的缺血性脑卒中康复训练决策辅助工具兼具科学性和实用性,有助于改善患者的决策质量。

基于时间节点为导向的院内急救干预在急性脑卒中患者中的应用效果

目的:探讨基于时间节点为导向的院内急救干预在急性脑卒中患者中的应用效果。方法:根据随机数表法将2022年6月—2023年6月晋江市医院晋南分院急诊收治的120例急性脑卒中患者分为对照组和观察组,每组60例。对照组给予常规院内急救干预,观察组给予基于时间节点为导向的院内急救干预。比较两组患者的急救时间和神经功能、吞咽功能和生活质量评分及预后。结果:观察组入院至接诊、入院至CT报告获取、入院至溶栓的时间均短于对照组,差异有统计学意义(P<0.05)。出院时两组患者神经功能评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。出院时两组患者吞咽功能评分和心理功能、生活功能、环境适应3个维度的评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。出院时,观察组无明显功能障碍、轻度残疾例数均多于对照组,明显残疾例数少于对照组,差异均有统计学意义(P<0.05)。两组患者死亡例数比较,差异无统计学意义(P>0.05)。结论:基于时间节点为导向的院内急救干预可缩短急性脑卒中患者的急救时间,有利于神经功能和吞咽功能的恢复,可改善预后,提升生活质量。

急救护理路径在急性缺血性脑卒中护理中的应用价值

目的分析急救护理路径在急性缺血性脑卒中护理中的应用价值。方法方便选取2022年8月—2023年8月邹城市人民医院收治的103例急性缺血性脑卒中患者为研究对象,采用随机数表法分为对照组(n=52)和观察组(n=51)。对照组采取常规护理,观察组采取急救护理路径。比较两组呼救至急救时间、出诊反应时间、急诊入院时间和生活质量评分。结果观察组的呼救至急救时间为(22.41±2.38)min,出诊反应时间为(1.34±0.29)min,急诊入院时间为(2.13±0.34)h,明显短于对照组的(30.59±6.73)min、(2.09±0.34)min、(3.34±0.57)h,差异有统计学意义(t=8.192、12.034、13.052,P均<0.05)。护理后,两组生活质量各维度评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论急性缺血性脑卒中患者护理中采用急救护理路径,临床效果较好。

基于脑卒中急救护理小组的系统化急救护理对急性缺血性脑卒中患者急救效率的影响

目的探讨基于脑卒中急救护理小组的系统化急救护理对急性缺血性脑卒中(Cerebral Ischemic Stroke,CIS)患者急救效率的影响。方法回顾性选取临朐县人民医院2022年1月—2023年12月收治的85例CIS患者的临床资料,按护理方法不同分为两组。对照组(43例)实施传统急救护理,观察组(42例)实施基于脑卒中急救护理小组的系统化急救护理。对比两组急救效率、短期预后[Barthel指数(Barthel Index,BI)评分、脑卒中专用生活质量量表(Stroke Specific Quality of Life Scale,SS-QOL)评分]、护理满意度。结果观察组接诊至确诊时间(19.78±2.55)min、确诊至治疗时间(20.59±3.08)min、接诊至CT检查时间(16.61±2.40)min,均短于对照组的(26.85±3.93)min、(31.40±5.57)min、(22.08±3.45)min,差异有统计学意义(P均<0.05)。出院时,观察组BI、SS-QOL评分高于对照组,差异有统计学意义(P均<0.05)。观察组护理满意度(92.86%)高于对照组(74.42%),差异有统计学意义(P<0.05)。结论基于脑卒中急救护理小组的系统化急救护理能够缩短急救流程时间,提高急救效率,改善CIS患者预后和护理满意度。

链式管理对经脑卒中溶栓绿色通道治疗病人急救效率、预后及神经功能的影响

目的:探讨链式管理对经脑卒中溶栓绿色通道治疗病人急救效率、预后及神经功能的影响。方法:选取我院2020年9月—2021年9月收治的88例急性脑卒中病人为研究对象,将2020年9月—2021年2月收治的44例病人列为对照组,将2021年3月—9月收治的44例病人列为观察组。对照组采用常规溶栓绿色通道模式,观察组在此基础上给予链式管理,观察并比较两组急救时间、预后及神经功能。结果:实施链式管理后,观察组急救时间短于对照组(P<0.05);观察组致残率、致死率、并发症发生率及护患纠纷率低于对照组(P<0.05);观察组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组(P<0.05)。结论:链式管理应用于脑卒中溶栓绿色通道中可提升病人急救效率,改善预后,降低神经功能损害。

基于循证的急救护理路径在急性缺血性脑卒中患者中的应用效果

目的探究基于循证的急救护理路径在急性缺血性脑卒中患者中的应用价值。方法选择2019年2月至2021年5月我院收治的150例急性缺血性脑卒中患者为研究对象,按照护理方法不同将其分为对照组和观察组,各75例。对照组接受常规急诊护理,观察组在对照组基础上加施基于循证的急救护理路径。比较两组的干预效果。结果观察组的分诊时间、就诊至静脉采血时间、就诊至溶栓时间及住院时间短于对照组(P<0.05)。干预后,观察组的动态阻抗(DR)、脉搏波速(Wv)及外周阻力(R)低于对照组(P<0.05)。干预后,观察组的格拉斯哥昏迷量表(GCS)评分高于对照组,急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分低于对照组(P<0.05)。观察组的血管再通率高于对照组(P<0.05)。结论基于循证的急救护理路径可有效提高急性缺血性脑卒中患者的急救效率、血管再通率,改善脑部血流动力学,缓解昏迷程度,提高健康状态,值得推广。

医疗团队资源管理模式在急性缺血性脑卒中患者中的应用

目的探讨在急性缺血性脑卒中(AIS)患者急救绿色通道中采取医疗团队资源管理模式的作用。方法回顾性分析许昌市中心医院2020年1月至2022年2月收治的72例AIS患者的临床资料。2020年1月至2021年1月急诊科采取常规急救绿色通道期间收治的AIS患者36例作为对照组[女17例,男19例,年龄(60.56±3.89)岁];2021年2月至2022年2月急诊科采取医疗团队资源管理模式期间收治的AIS患者36例作为观察组[女16例,男20例,年龄(60.59±3.91)岁]。比较两组急救效率、神经功能、日常生活能力、致残率、生活质量以及患者满意度。采用t检验、χ^(2)检验进行统计比较。结果观察组急诊分诊时间为(3.68±1.15)min、急诊滞留时间为(39.42±3.18)min、就诊至溶栓时间为(55.23±5.40)min,均高于对照组的[(5.09±1.23)min、(46.24±3.25)min、(64.79±5.53)min](t=5.024、8.999、7.421,均P<0.001);观察组出院时美国国立卫生研究院卒中量表(NIHSS)评分为(6.51±1.50)分、日常生活能力量表(ADL)评分为(21.35±2.16)分,均低于对照组[(8.93±1.54)分、(25.50±2.19)分](t=6.754、8.095,P<0.001);观察组致残率为2.78%(1/36),低于对照组的16.67%(6/36)(χ^(2)=3.956,P=0.047);观察组出院时脑卒中生活质量量表(SS-QOL)评分为(140.84±6.83)分,高于对照组的(119.92±6.64)分(t=13.177,P<0.001);观察组患者满意度中急救方式为(21.26±1.18)分、安全管理为(21.85±1.23)分、人文关怀为(21.96±1.25)分、护理态度为(21.80±1.43)分、总分为(84.43±3.34)分,均高于对照组[(18.98±1.13)分、(19.94±1.20)分、(18.54±1.16)分、(19.06±1.30)分、(75.54±3.26)分](t=8.373、6.669、12.033、8.507、11.429,均P<0.001)。结论AIS患者急救绿色通道中采取医疗团队资源管理模式,可提升急救效率,改善患者神经功能,促进其日常生活能力提升,有效改善预后,从而提升患者满意度。