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Objective:To put forward possible improvement measures through analyzing characteristics of pre-hospital first aid in Ali region and the problems confronted.Methods:The relevant data of pre-hospital first aid in the Emergency Department of Ali People's Hospital of Tibet from September 2015 to August 2019 were collected, and the epidemiological statistics were made. In addition, the number and cycle rule of pre-hospital first aid and the proportion of traffic injuries in pre-hospital first aid in different time periods were analyzed. The isochronous maps were drawn, and the residential areas, tourist attractions and main roads covered by the ground emergency medical service (GEMS) and helicopter emergency medical services (HEMS) at different periods were compared.Results:The epidemiology of pre-hospital first aid was mainly in middle-aged and young patients, accounting for 80.35%. Trauma patients were the most common in both non-native population (45.72%) and local residents, of which traffic injuries accounted for 66.43% of total trauma. Neurological emergency was the second most common among local residents (24.65%), and high altitude reaction was the second most common among non-native population (19.14%). From April to December every year, the amont of emergency treatment in Ali region increased periodically, and reached the peak from July to September. After eliminating the periodic influencing factors, the amount of pre-hospital first aid in Ali region showed a gradual increase over time. The regression equation was Y=15.7+0.27 X, F=36.809, P<0.05, R2=0.444. From April to December every year, the amount of pre-hospital first aid caused by traffic injuries increased significantly ( χ2= 10.819, P< 0.05). Within 15 min, GEMS could cover all the towns in Ali region, as well as the area where the first aid point was located and some villages that were pretty close to the first aid point, with a total of 49 villages (residences); Compared with 15 min, the pre-hospital resources could cover 75 villages (residences) and 4 tourist attractions within 1 h ( χ2 = 10.813, P < 0.05), and the main roads could cover about 788 km. If combined GEMS and HEMS, compared with the coverage of only one hour of ground emergency, the pre-hospital resources could cover 116 villages (residences) and 5 tourist attractions ( χ2 = 19.447, P < 0.05), and the main roads could cover about 1 234 km ( χ2 = 349.532, P < 0.05). Conclusions:HEMS combined with GEMS might fundamentally solve problem of comparatively small coverage of the emergency network in Ali region at present.
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Objective To investigate the efficacy of microsurgery and predictors of outcome for poor -grade aneurysmal subarachnoid hemorrhage(aSAH).Methods Clinical data of 43 patients of poor -grade aSAH who per-formed microsurgery were retrospectively analyzed.There were 30 patients with Hunt -Hess grade IV and 1 3 patients with grade V.24 patients received emergency operation(within 6hours after onset),1 6 patients received ultra -early operation(within first 24hours after onset).Outcome was assessed by Glascow Outcome Scale(GOS).Results Of 43 patients who received microsurgery,favorable outcome was achieved by 1 9 cases of 43 cases (44.2%),poor outcome was achieved by 1 6 cases of 43 cases (37.2%),the overall outcome of patients with Hunt -Hess grade IV was better than that with grade V(Z =-2.486,P =0.01 6).1 8 patients with intracerebral hematoma received ultra -early or emergency operation,effective surgical intervention(GOS≥3)achieved in 1 2 patients,there was no signifi-cant difference in prognosis between the patients and the others who without intracerebral hematomas(χ2 =0.1 03,P =1 .000).Conclusion The ultra -early or emergency surgery could avoid the risk of aneurysmal re -rupture,relieve malignant intracranial hypertension as soon as possible and decrease the mortality of poor -grade aSAH patients.
ABSTRACT
Objective To investigate the outcome of microsurgical treatment and its influencing factors in patients with aneurysmal subarachnoid hemorrhage.Methods The consecutive patients with aneurysmal subarachnoid hemorrhage treated with the early or ultra-early microsurgery were enrolled retrospectively.The Glasgow outcome scale (GOS) was used to assess the outcomes of patients at discharge.GOS 4-5 was defined as good outcome,and GOS 1-3 was defined as poor outcome.Results A total of 147 patients with aneurysmal subaraclnoid hemorrhage were enrolled.One hundred and twelve patients (76.2％) had good outcomes.There were significant differences in the proportions of preoperative Glasgow Coma Scale (GCS) scores (12.8 ± 2.8 vs.7.5 ± 3.8;t =7.525,P ＜0.001),low Hunt-Hess grade (83.0％ vs.31.4％;x2 =34.318,P ＜ 0.001),size of aneurysm (x2 =9.531,P =0.009),preoperative rebleeding (6.3％ vs.25.7％;x2 =8.506,P =0.003),preoperative brain herniation (4.5％ vs.40.0％;x2 =26.846,P ＜ 0.001),initial CT scan showing intracerebral hemorrhage (19.6％ vs.48.6％;x2 =11.449,P =0.002),and intraventricular hemorrhage (8.9％ vs.40.0％;x2 =18.846,P ＜0.001) between the good outcome group and the poor outcome group.Multivariate logistic regression analysis showed that the larger aneurysm (odds ratio [OR] 3.194,95％ confidence interval [CI] 1.458-6.999;P =0.004),older age (OR 1.054,95％ CI 1.013-1.097;P=0.010),lower preoperative GCS score (OR 0.539,95％ CI 0.410-0.724;P ＜ 0.001),and preoperative brain herniation (OR 3.633,95％ CI 1.039-12.700;P =0.043) were the independent risk factors for poor outcomes.Conclusions After active surgical treatment,most of the patients with aneurysmal subarachnoid hemorrhage have good outcomes,however,patients with older age,larger aneurysms,lower preoperative GCS scores,and preoperative brain herniation usually have poor outcomes.