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find Author "刘纪宁" 4 results
  • 危重患者院内转运实践及策略探讨

    目的探讨综合性医院危重患者院内转运的重要性及转运中应注意的问题及转运策略。 方法总结分析2012年1月-2014年1月期间20 352例危重患者的急救及院内转运的实践及资料,探讨转运中的医疗人员组成、急救设备、转运流程、转运风险的评估、应对方案。 结果20 352例危重患者中,除136例因病情危重在抢救室抢救无效死亡,5 756例因抢救后病情相对平稳由抢救室转送急诊科留观室留观治疗或暂因患方及医院主客观原因不能转送专科住院治疗由抢救室转送急诊科监护室治疗,其余14 460例危重患者经抢救病情相对稳定后全部实现院内安全转送。 结论合理的救治医疗人员组成、积极对危重患者的救治、作好病情评估、把握好转运的时机是实现危重患者院内转运安全的保障。

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  • 急诊医疗纠纷分析及防范措施

    目的探讨急诊医疗纠纷发生的原因及影响因素,以便制定相应的防范对策。 方法对2008年1月-2013年12月由医疗纠纷处理部门正式受理的与急诊相关的22起医疗纠纷案例进行原因分析和评估。 结果医疗纠纷发生的主要原因为知情告知不充分9例(占40.9%),服务态度不满意6例(占27.3%),医疗技术不满意4例(占18.2%),违反规章制度、风险意识淡薄、急诊流程不满意及收费不满意共3例(共占13.6%)。 结论医疗纠纷的发生是多重因素导致的结果,涉及医疗单位、医务工作者、患者及社会因素。其中坚持以患者为中心,尊重患者,提高医疗技术水平及沟通技巧,提升服务态度是减少医疗纠纷发生的主要途径。

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  • Clinical Effect of Noninvasive Positive Pressure Ventilation on Severe Acute Pancreatitis Combined with Acute Lung Injury in Emergency

    ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P<0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P<0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P<0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.

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  • Chang and predictive efficacy of new biomarkers for acute kidney injury in the early stage of multiple trauma

    Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury (AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission (20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs. (11.13±3.41) d], rate of renal replacement therapy (35.0% vs. 0.0%), and 28-day mortality rate (25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group (P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group (P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98 (0.96, 1.00), 0.92 (0.83, 1.00), and 0.87 (0.78, 0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.

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