目的:通过分析2007年自贡市急救中心院前急救反应能力，探讨其影响制约因素及解决方法。方法：回顾性分析2007年1～12月份自贡市急救中心院前出诊的全部有效病例呼救时间、出车时间、到达现场时间及出诊距离，计算出车准备时间、车辆行驶速度、应急反应时间、急救半径。结果：全年院前出诊共3336例，出车准备时间（2.06±0.93） min，车辆平均行驶速度32.17 km/h，应急反应时间（12.51±10.87） min，急救半径（5.60±5.35） km。结论：我市急救中心目前取得一定成绩，需采取多种措施进一步提高急救反应能力。
Objective To observe the expression of molecules on surface of dendritic cells (DC) in retinoblastoma (RB) patients, and investigate its relationship with immune function. Methods The peripheral blood of 50 normal subjects (control group) and 18 RB patients (RB group) were collected to proliferate the DC.The mixed lymphocyte reaction was performed on DC of the control and RB group to detect the antigen-presenting ability. The DC of control group was cultured in the supernate of SO-RB50 with the different concentration of 25% (group A), 50% (group B) and 75% (group C). Then the expression of HLA-DR, CD54 and CD80 on surface of DC were detected by flow cytometry (FCM). Results The Results of MLR showed that DC antigen-presenting ability was gradually enhanced with the increase of stimulation of the cell. And the DC antigen-presenting ability of the control group was superior to that of the RB group (P＜0.05). The expression of HLA-DR, CD54 and CD80 on surface of DC in the control group (12.14plusmn;2.52, 34.89plusmn;5.12, 10.93plusmn;3.1) were significantly higher than that in the RB group (7.33plusmn;2.20, 25.28plusmn;4.54, 7.89plusmn;3.75) (t=4.07, 3.96, 2.59; P＜0.05). The expression of HLA-DR, CD54 and CD80 on surface of DC in the group A, B and C (HLA-DR: 9.95plusmn;2.55, 6.48plusmn;1.82, 3.11plusmn;1.47; CD54: 34.75plusmn;4.92, 21.25plusmn;3.44,15.41plusmn;3.52; CD80: 9.15plusmn;2.18,5.05plusmn;2.01,2.90plusmn;1.10) were reduced in varying degrees compared with the control group; and with the increase of the concentration of supernate SO-RB50, the reduction was more evident (F=8.96,13.62, 20.72; P＜0.05). Conclusions The expression of molecules on surface of DC in RB patients is lower than that in the normal subjects. It is closely related to the functional deficiency of DC.
Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy. Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015. There were 102 males and 63 females at average age of 67.9±8.3 years. Results The operation time was 275.3±50.2 min. The intraoperative blood loss was 230.0±110.5 ml. The number of lymph node dissection was 18.1±6.5. The volume of drainage in thoracic cavity was 750±550 ml on the third day after operation. Thoracoscopic esophagectomy surgeries were successful except that 13 patients (7.8%) converted to open operation including 6 patients (4.2%) with severe pleural adhesion, 2 patients (1.2%) with hemorrhage, 2 patients (1.2%) with arrhythmia, and 3 patients (1.8%) with abnormal oxygenation. There were 17 patients (10.8%) were with intraoperative complications including 2 patients (1.2%) with arrhythmia, 3 patients (1.8%) with abnormal oxygenation, 7 patients (4.2%) with hemorrhage caused by vascular injury, 4 patients (2.4%) with thoracic duct injury, 1 patient (0.6%) with recurrent laryngeal nerve injury. Moreover, 46 patients (27.8%) experienced postoperative complications including 23 patients (13.9%) with pulmonary infection, 6 patients (3.6%) with hoarseness, 4 patients (2.4%) with anastomotic leakage, 3 patients (1.8%) with incision infection, 2 patients (1.2%) with tracheoesophageal fistula, and 2 patients (1.2%) with pneumothorax. Unexpectedly, five patients underwent re-operation due to chylothorax (n=3, 1.8%) and hemorrhage (n=2, 1.2%). One patient (0.06%) died of acute pulmonary embolism. Conclusion Serious adhesion in abdominal cavity, abnormal of lung and heart. And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy. Lung infection, hoarseness, and anastomotic leakage of neck are the most common postoperative complications. And acute pulmonary embolism is the main cause of postoperative death. Proper precautions to decrease the morbidity of complication are necessary.
Objective To investigate the impact of optimized preoperative fasting scheme for gynecological day surgery with general anesthesia. Methods We retrospectively selected 639 patients undergoing gynecological day surgery with general anesthesia between June 2021 and August 2021 in the day surgery department of West China Second University Hospital of Sichuan University as the control group, and 920 patients undergoing gynecological day surgery with general anesthesia in the same hospital between November 2021 and February 2022 as the observational group. The patients in the control group were treated with routine preoperative fasting scheme, and the ones in the observational group were treated with optimized preoperative fasting scheme. The differences in preoperative duration of water deprivation, intraoperative and postoperative incidences of aspiration, and postoperative first anal exhaust time between the two groups were compared. Results The preoperative duration of water deprivation in the control group was longer than that in the observational group [(12.49±2.63) vs. (6.69±2.76) h, P<0.05]. The incidences of intraoperative and postoperative aspiration were both 0. The postoperative first anal exhaust time in the control group was later than that in the observational group [(11.51±6.58) vs. (8.19±4.13) h, P<0.05]. Conclusions For patients undergoing gynecological day surgery with general anesthesia, the implementation of the optimized preoperative fasting scheme can effectively shorten the preoperative duration of water deprivation, without increasing the risk of anesthesia. It can accelerate the recovery of intestinal function for gynecological laparoscopic day surgery with general anesthesia, promote the implementation of enhanced recovery after surgery, and improve the efficiency of day surgery.
The May 12 8-magnitude earthquake caused damage to 87.7% of the health systems in the worst-hit Mianyang areas with 326 casualties and the direct economic loss of RMB 3 124 billion. Within 30 minutes after the earthquake, the Mianyang headquarters for earthquake disaster relief and the Mianyang public health headquarters for medical rescue and treatment were organized. Five medical teams were sent to Beichuang County, the worst-hit Mianyang area within four hours after the earthquake. A total of 22 947 wounded and sick were delivered to local hospitals after simple triage and rapid treatment through three station. By June 30, the Mianyang medical organisation had received 379 600 person times and admitted 21628 inpatients in total, including 2 772 severely-wounded (including 146 with limbs amputated and 846 dead during the stay). Since May 17, 3381 wounded had been transferred to 14 provincial and city-level hospitals across China. On June 20, the Mianyang Rehabilitation Center for wounded and sick people was established and received 156 rehabilitation inpatients and cured 32 ones. Together with the medical team for psychological intervention, they provided psychological support for victims for over 70 000 person times. Within two hours after the earthquake, the Mianyang Organisation for Health and Epidemic Control and Prevention launched the emergency response plan for major natural disasters, prepared and improved the technical scheme for disease prevention after the earthquake. The organisation rapidly sent out emergency teams for disease control and prevention and completed the following tasks: disinfection and burial of corpses and disposal of carcasses, monitoring of the water quality and epidemics, disinfection of environmental ruins, epidemic control in resettled areas, precaution of the secondary disasters caused by the earthquake and conduction of large-scale health education. The emergency command system for medical rescue and disease control and prevention in the worst-hit Mianyang areas after Wenchuan Earthquake integrated resources, carried out the unified command and responded rapidly. Moreover, the headquarter of medical relief coordinated and orderly unified the governmental and non-governmental organizations, which achieved good performance for both medical relief and anti-epidemic. The experience of earthquake medical relief will benefit the post-disaster reconstruction, as well as the establishment of national and regional emergency response systems.
The Wenchuan Earthquake caused severe injuries and deaths as well as subsequent serious potential risks to public health and hygiene in the worst-hit areas. There were 16 casualties in the Mianyang CDC system and the township amp; county CDC networks were destroyed in the worst-hit counties after the earthquake. The Mianyang CDC quickly launched its emergency response plan for major natural disasters within two hours after the earthquake, prepared and improved the technical guide for disease prevention after the earthquake and rapidly sent out quick response team. With the help of CDC aid teams across the country, Mianyang CDC successfully disinfected and buried 6,767,568 corpses, and disposed of millions of animal carcasses.They also disinfected and sterilised an area of 932.595 million square metres, eradicating 3,514,166 fly and mosquito breeding places and treating 5,254,228 cesspit times. By June 30, they had examined 11,092 water supply units and carried out disinfection of 319.7997 million cubic metres of drinking water. Besides, dynamic monitoring for water quality in the four worst-hit areas in Mianyang urban areas. They organised hygienic enforcement supervisors to develop food safety inspection, regulated catering services of the centralised settlements, destroyed spoiled and expired food and vegetables. The authorities prevented the masses from eating dead poultry or meat from carcasses to ensure no occurrence of food poisoning after the earthquake. Standard administration of the 170 settlements of the earthquake-afflicted people and 132 settlements of evacuated people was carried out in accordance with the rules of "Six Provisions and Four Reinforcements" and this would ensure no recurrence of public health events in the settlements. On Day 3 (May 15) after the earthquake, they established a real-time monitoring and report network of the epidemic situation after the earthquake and monitored diseases and symptoms of the people in the resettled region to ensure no occurrence of major epidemic cases. The monitoring results showed that the number of infectious disease cases was comparable to that in the previous years. Moreover, they carried out intensive vaccination with hepatitis A vaccine in children 41196 person times, stored 100,000 person oral cholera vaccine and monitoring for new sexually transmitted diseases. A total of 10.1265 million copies of publicity materials were organised printed and distributed. They developed large-scale health education and a massive patriotic health campaign by means of the media and organised the masses to engage in sanitation and hygiene as well as controlling flies, mosquitoes and rats in the temporary earthquake-proof places. Under the unified command of the Mianyang emergency response headquarters, the centers for health and epidemic control and prevention at various levels of disaster relief continued to dispose of carcasses and disinfect and bury corpses as well as monitor water quality, so as to ensure the secondary disasters could be prevented in advance.