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The Anxiety Status and Related Factors of H1N1 Patients at the Influenza Peak of Fever Clinics

【摘要】　目的　了解甲型H1N1流感发热病区门诊就诊高峰期患者焦虑状况及相关因素，采取针对性护理措施减轻患者焦虑情绪。　方法　2009年11月上旬-12月上旬采用一般资料调查和Zung′s焦虑自评量表（SAS）对219例患者进行调查分析。　结果　219例患者SAS平均分为（33.70±8.60）分，其中17例SAS总分≥50分，存在焦虑情绪，发生率7.76%。多元回归分析结果显示，在年龄、性别、城乡差异、发热程度等因素中，与焦虑症状有关的主要因素为年龄和发热程度。　结论　甲型H1N1流感发热病区门诊就诊高峰期患者焦虑情绪明显高于常模，应引起重视，在门诊工作中加强心理护理，减轻和尽力消除患者的焦虑情绪，以免对病情产生不利影响，不利于控制流感疫情。【Abstract】　Objective　To investigate the anxiety status and related factors of H1N1 patients at influenza peak of fever clinics,and to take specific measures to reduce anxiety in patients.　Methods　The general information and Zung′s self rating anxiety scale (SAS) were taken to analyze 219 patients from early November to early December 2009.　Results　The average SAS score of the 219 patients was 33.70±8.60, in which there were 17 patients (7.76%) with total scores ≥ 50 and anxiety. Multiple regression analysis showed that the age and temperature were related factors among age, gender, urban-rural differences, and fever.　Conclusion　The survey suggests that the pafients at the H1N1 influenza peak of fever clinics are significantly more anxious than normal anxiety. Out-patient work should strengthen psychological care to reduce and try to eliminate the anxiety of patients, in order to avoid adverse impact which is not conducive to control influenza outbreaks.

Influence of the Infusion Speed of Agkistrodon Halys Antivenin on the Coagulation Function of the Victim Suffering from the Snake-bite

ObjectiveTo explore the use of agkistrodon halys antivenin, and the influence of its infusion time on the coagulation function of the patient bitten by agkistrodon halys. MethodsWe retrospectively analyzed the clinical data of patients suffering from pit viper bites and first diagnosed and treated in the emergency department of our hospital between April 1 and November 30, 2013. According to the allergy test results, patients were divided into two groups: negative and positive. Based on the infusion time, the negative patients were divided into ≤1.5 hours and >1.5 hours groups, and the positive patients were divided into ≤3 hours and >3 hours groups. All patients' gender, age, infusion time, and PT, APTT, TT, FIB, D-DIMER before and after infusion of antivenomous serum were recorded, and blood coagulation indicators before and after infusion of antivenomous serum and the impact of infusion time were compared among different groups. ResultsFor both the negative and positive groups, PT, APTT, TT, FIB, and D-DIMER were statistically improved after infusion of antivenomous serum. The blood coagulation indicators of infusion time ≤1.5 hours group and ≤3 hours group were significantly better than those of infusion time >1.5 hours and >3 hours groups. ConclusionAntivenomous serum can correct coagulation and the faster infusion rate, the more obvious the effect is.

心理干预对注射长效青霉素疼痛的影响

目的探讨心理干预对注射长效青霉素疼痛的影响。 方法选取2012年1月－8月100例肌肉注射长效青霉素的患者，随机分成对照组和试验组，每组各50例。对照组采用常规注射法，干预组在常规注射基础上采用心理干预予以辅助，比较两组疼痛程度和一次性注射成功率。 结果干预组视觉模拟疼痛评分为0～2、3～5、6～8、＞8分的患者分别为22、15、8、5例，对照组分别为5、18、12、15例，干预组疼痛程度轻于对照组，差异有统计学意义（Z=-3.867，P＜0.001）；干预组一次性注射成功率（70.0%）高于对照组（40.0%），差异有统计学意义（χ2=9.091，P=0.003）。 结论心理干预能有效降低患者疼痛程度，且一次性注射成功率高，值得推广。

Administration of Information of Victims in Emergency Department in Wenchuan Earthquake and Yushu Earthquake

目的　总结大型灾害情况下，急诊伤员信息收集流程，为制定大型灾害救援提供证据支持。 方法　回顾性分析汶川地震（2008年5月12日－6月2日）和玉树地震（2010年4月14日－5月1日）伤员信息收集方法，总结两次地震伤员信息收集管理过程中发现的问题及取得的经验。 结果　通过制作地震伤员登记表、调整病历收集与管理模式、分诊提前、伤员信息登记提前，调整急诊功能分区、头像采集技术的使用、成批伤员信息资料袋和分诊信息卡的应用，最大限度地保证了伤员信息收集的完整性。 结论　地震伤员信息资料的准确性、完整性、及时性在伤员的救治、伤员的查找、伤员的转归和各类医疗信息的收集，以及制定大型灾害事故应急预案等方面起着非常重要的作用。

早期干预对缓解急诊危重患者心理危机

【摘要】　目的　通过对急诊重症监护室（emergency intensive care unit，EICU）患者心理干预对照试验，总结早期心理干预在急诊临床中的意义。　方法　将2009年10月－2010年10月入住急诊EICU的46例患者，根据就诊单双号顺序分为对照组和试验组，每组23例。对照组按整体护理常规进行，试验组在常规护理基础上加行心理干预，通过测量两组患者干预前后的焦虑评分值，判断心理干预的效果。　结果　患者入住EICU时试验组、对照组焦虑量表基线评分分别为（19.35±5.83）、（19.69±6.03）分，两组差异无统计学意义（t=0.066，P=0.948）；24 h后评分，试验组、对照组评分分别为（12.00±7.18）、（28.91±9.18）分，两组比较，差异有统计学意义（t=6.959，P=0.000）。试验组的焦虑评分较入EICU评分差异有统计学意义（Plt;0.001）；对照组焦虑评分较入EICU时升高，差异有统计学意义（Plt;0.001）。　结论　早期干预对缓解急诊危重患者心理危机有一定帮助。

Early Oral Care for Paraquat-poisoned Patients

【摘要】　目的　探讨口服百草枯中毒患者口腔护理的方法及早期护理的临床意义。　方法　2009年1月-2010年3月，采用半随机方法将62例白草枯中毒患者按中毒时间的长短分A组（中毒时间lt;3 d，n=32）、B组（中毒时间gt;3 d，n=3），比较两组患者口腔溃疡的治愈率、并发症发生状况，分析早期口腔护理的必要性。　结果　A组患者百草枯所致的口腔黏膜损害明显减轻，并发症发生率降低，为改善预后提供了条件，显示了早期加强口腔护理的成效。　结论　重视百草枯早期口腔护理，能够减轻口腔糜烂溃疡痛苦，减少并发症，提高患者生活质量。【Abstract】　Objective　To investigate the clinical significance of early oral care for paraquat-poisoned patients.　Methods　A quasi-randomized controlled trial was used. A total of 62 paraquat-poisoned patients (from January 2009 to March 2010) were divided into experimental group and control group in order to compare the healing rate of oral ulcer, complications and the necessity of early oral care between the two groups.　Results　The oral mucosa lesions in experimental group obviously alleviated and the complications decreased. The effective early oral care provided the very favorable conditions for better prognosis.　Conclusion　The early oral care for paraquat-poisoned patients could relieve the pain of oral ulcer, reduce the complications and improve patient′s life quality.

灾害急救体系现状

眼镜蛇咬伤致呼吸骤停一例的急救护理体会

The Clinical Usage of Small Dose and Low Pressure Lavage in Gastrointestinal Hemorrhage Induced by Acute Poisoning

ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning. MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores. ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05). ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.

三种胃管固定方法在急诊洗胃中的应用

目的 比较临床上常见的3种急诊洗胃胃管固定方法优劣。 方法 将2010年1月－2014年8月收治的300例急诊洗胃患者随机抽签分为A组（100例）注射器固定胃管，B组（100例）一次性口垫固定胃管，C组（100例）气管导管固定器固定。3组患者一般资料差异无统计学意义（P＞0.05），具有可比性。观察3组洗胃过程中出现的不良反应以及置管时间、洗胃时间。 结果 3组患者在口腔内相关损伤和胃管脱落、咬闭方面，差异有统计学意义（P＜0.05）；在误吸方面，A组与B、C组之间差异有统计学意义（P＜0.05），B、C组之间差异无统计学意义（P＞0.05）。3组患者在留置胃管时间上差异无统计学意义（P＞0.05）。在洗胃时间上，3组两两比较差异均有统计学意义（P＜0.05）。 结论 气管导管固定器固定胃管的方法在洗胃不良反应方面优于一次性口垫固定法及注射器固定法，并可以缩短洗胃时间。