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Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.
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The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.
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The heart locates in the chest. When the cardiac arrest is caused by various internal and external factors, it is necessary to establish an artificial circulation for the heart, including external compression. But when the integrity of the chest is destroyed, the "home" of the chest cannot effectively carry out high-quality cardiopulmonary resuscitation (CPR). The abdomen not only possesses 1/4 body blood volume, but also is the abdominal respiratory basis mainly through diaphragm. Through the "abdominal pump" mechanism, intrathoracic pressure is changed by moving the diaphragm up and down, and then exert the effect of indirect "chest pump", "heart pump" and "lung pump". So by using abdomen as the second "home", the purpose of establishing artificial circulation and respiration can be successfully achieved.
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Objective To study the effectiveness and safety of abdominal lifting and compression method in patients sufferred from cardiac arrest (CA).Methods According to the inclusion and exclusion criteria,72 patients from Hainan People's Hospital and Zhengzhou People's Hospital were enrolled for study of abdominal lifting and compression (ALC) method from January 2014 to June 2015.The markers of respiratory and circulatory performance of all patients were recorded,and re-collected after CPR with ALC.In addition,the data of demographics and clinical signs of patients were collected.The rates of restoration of spontaneous circulation (ROSC) and successful resuscitation were calculated.Differential analysis of singlegroup design univariate quantitative and qualitative data was carried out.Results A total of 72 patients were included finally.The ROSC rate was 15.3％ (11/72) after using ALC equipment,and there was no statistically significant difference in rate of ROSC (P =0.566) between ALC and pre-test (13.0％).However,compared with NT group resuscitated without using ALC method or with using chest compression method,the rate of ROSC was significantly improved in the ALC group (15.3％ vs.O.1％,P ＜ 0.01).Conclusions Abdominal lifting and compression CPR equipment is stable,portable and safe in practice.Abdominal lifting and compression CPR method has its prominent role in saving patients from respiratory and cardiac arrest,and it is sufficient to overcome the disadvantages of conventional CPR method.
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Objective To explore the regularity of incidence of agonal respiration (AR) and agonal respiration frequency rate (ARFR) during untreated cardiac arrest (CA) after ventricular fibrillation (VF) in a swine model.Methods Ten healthy male domestic pigs weighing (25.0± 3.0) kg were employed in this experiment.VF was induced by intraventricular shock with alternating current without treatment for 8 minutes.The incidence of AR and ARFR per minute were recorded for 8 minutes.Statistical analysis was performed using SPSS 19.0 system software.Results AR occurred in all animals after VF induced CA within 8 minutes.There was 1 animal showed AR at the first minute with ARFR (0.2±0.1) times/min,4 animals showed AR at the second minute with ARFR (1.2 ± 1.0) times/min,7 animals showed AR at the third minute with ARFR (2.7 ± 1.4) times/min,all animals showed AR at the fourth to fifth minute with ARFR (3.7 ± 1.6) times/min and (3.2 ± 1.9) times/min,7 animals showed AR at the sixth minute with ARFR (1.3 ± 1.0) times/min,no animal showed AR at the seventh minute,and 1 animal showed AR at the eighth minute with ARFR (0.2±0.1) times/min.The first and the last AR were observed at (2.02±0.84) minutes and (5.21 ± 1.12) minutes respectively.Occurrence of AR reached its peak at the fourth to fifth minute,and it was absent at the seventh minute.ARFR after CA showed a crescendo-decrescendo pattern,which increased from (0.2±0.1) times/min to (3.7±1.6) times/min followed by a fall to (0.2±0.1) times/min.Conclusions AR is one of the symbolic signs after CA.AR occurred in all animals during untreated VF,and it reaches its peak at the fomrth to fifth minute,with a crescendo-decrescendo pattern of ARFR.Effective identification and treatment in victim with AR timely can help to improve the success rate of cardiopulmonary resuscitation and survival rate.
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ObjectiveTo investigate the effect of anisodamine on the expression of connexin 43 (Cx43) in swine ventricular myocardium after resuscitation from cardiac arrest.Methods The experiment was conducted on healthy pigs, and they were randomly divided into three groups, namely sham group, epinephrine group (control group) and anisodamine group (experimental group, animals were resuscitated combined with injection of 0.4 mg/kg of anisodamine), with 5 pigs in each group. Model of ventricular fibrillation was reproduced by alternating current challenge, and cardiopulmonary resuscitation (CPR) was performed 8 minutes after cardiac arrest. Left ventricular myocardium was harvested at 24 hours after restoration of spontaneous circulation. The expression and distribution of Cx43 were observed by immunofluorescence, Cx43 mRNA expression was assessed with reverse transcription-polymerase chain reaction (RT-PCR), and the protein expressions of Cx43 and phosphorylation of Cx43 (p-Cx43) were analyzed by Western Blot.Results The positive expression of Cx43 in ventricular muscle was distributed uniformly, mostly at the end-to-end linkage of myocardial cells, with a few side-to-side linkage in sham group. The positive expression of Cx43 in control group was significantly weaker than that in the sham group, and the signal intensity was significantly declined (4.35±2.10 vs. 10.02±3.66,P 0.05). The p-Cx43 protein expression of control group was significantly lower than that of the sham group (A value: 0.22±0.03 vs. 0.37±0.06,P 0.05). No significant difference in p-Cx43/Cx43 was found among sham, control, and experiment groups (0.57±0.09, 0.51±0.05, 0.58±0.06, all P> 0.05).ConclusionAnisodamine can improve the abnormal expression of Cx43 in ventricular muscle of pigs with cardiac arrest, which may be related to the protection effect of anisodamine on cardiac conduction.
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Objective To explore the effect of the interrupted abdominal aorta compression after cardiopulmonary resuscitation (IAAC-CPR)on cardiopulmonary cerebral resuscitation in a rabbit model of cardiac arrest (CA). Methods According to the random number table,10 New Zealand rabbits of both genders were equally divided into the chest compression-cardiopulmonary resuscitation (CC-CPR) group or IAAC-CPR group ,with 5 rabbits in each group. CA model was reproduced by injection of iced-potassium chloride into the jugular vein and obstruction of trachea to produce asphyxia. CA was maintained for 3 minutes before cardiopulmonary resuscitation (CPR). CC-CPR was performed with assisted ventilation+chest compression,while IAAC-CPR was performed by the way of assisted ventilation + chest compressions + compressions on abdominal aorta. The hemodynamics and cerebral cortex blood flow were observed during resuscitation. Time of return of spontaneous circulation (ROSC),24-hour survival rates,and scores of neurological function,and situation of abdominal organs were recorded. Results At 30, 60,90 and 120 seconds after CPR,the cerebral blood flow (CBF,PU value)and mean arterial pressure(MAP, mmHg,1 mmHg=0.133 kPa)of IAAC-CPR group were significantly higher than those of CC-CPR group(CBF 30 seconds:16.1±6.0 vs. 7.8±2.2,60 seconds:91.6±11.8 vs. 57.3±23.2,90 seconds:259.9±74.9 vs. 163.6± 50.3,120 seconds:301.5 ±60.5 vs. 208.4 ±23.8;MAP 30 seconds:46.4 ±9.4 vs. 31.4 ±8.7,60 seconds:55.8 ± 13.8 vs. 34.0±11.5,90 seconds:61.2±11.5 vs. 38.2±10.1,120 seconds:63.6±11.8 vs. 40.2±10.2,all P<0.05). Compared with CC-CPR group,in IAAC - CPR group,the time necessary for ROSC was obviously shortened (seconds:182.0 ±59.0 vs. 312.6 ±86.6,t=2.787,P=0.024),24-hour nerve function score was significantly lowered(2.4±1.7 vs. 4.6±0.6,t=2.974,P=0.023). The successful recovery rate(80.0%vs. 60.0%,χ2=0.000, P =1.000)and 24-hour survival rate (80.0% vs. 40.0%,χ2=0.417,P =0.519)were significantly increased,but without statistical significance. No liver damage was found at 24 hours after ROSC. Conclusion In the early recovery of CA in rabbit,IAAC-CPR can result in better cerebral blood flow perfusion as compared with CC-CPR,and it significantly reduced damage to the nervous system function without producing abdominal organ damage.
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Background and purpose:Reasonable proportion with blood less than half of the surgical system, cancer patients during surgery prone to acute massive blood loss, this study aimed to investigate blood transfusion in the patients who diagnosed with cancer during operation in the Afifliated Tumor Hospital of Xinjiang Medical University, and in order to improve the intraoperative blood transfusion and make it more scientiifc and more reasonable.Methods:The patients who were taken selective operations and heterogenous blood transfusions in the Afifliated Tumor Hospital of Xinjiang Medical University from Oct. 2012 to Dec. 2013 were enrolled, and the clinical data were retrospectively surveyed and investigated.The intraoperative use of blood components and reasonableness in each department were analyzed.Results:The medical records of 299 blood transfusion receipts proportions of reasonable transfusion of RBC from department of gastrointestinal surgery, gynecology, orthopedics, hepatobiliary surgery, neurosurgery, urological surgery and thoracic surgery were 88.9%, 91.8%, 94.3%, 96.3%, 91.6%, 100%, 81.3%,respectively. And the proportions of reasonable transfusion of plasma were 86.2%, 71.8%, 96.4%, 78.4%, 100%, 100%, 87.5%, respectively. The proportions of low-volume blood transfusion and the combined transfusion of RBC and plasma were 62.5% and 43.2% in unreasonable blood transfusion.Conclusion:Except for the unreasonableness in very few departments, the intraoperative blood component transfusion is carried on fairly well. The medical staff still should be further trained in the appropriate use of blood and strengthened the knowledge on blood transfusion.
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Objective To investigate the effects of sustained abdominal aorta compression (SAAC) method combined with sim-plex chest compression (SCC) on partial pressure of end-tidal CO2 (PETCO2 ) ,return of spontaneous circulation(ROSC) ,resuscita-tion success rate and 24 h survival rate of the cardiac arrest model in domestic swines .Methods 20 healthy domestic swines were randomly divided into two groups ;the standard cadiopulmonary resuscitation group (S-CPR) by adopting SCC and the SAAC-CPR group by adopting SCC combined with SAAC during the resuscitation process .The cardiac arrest model was established by the ven-tricular fibrillation induced through the right atrium electrode alternating current stimulation .After 9 min of untreated interval ,CPR was performed .The two groups were firstly given SCC ,after 30 s ,the SAAC-CPR group was added with SAAC .PETCO2 ,coronary perfusion pressure(CPP) ,ROSC rate ,resuscitation success rates ,and 24 h survival rate were compared between the two groups .Re-sults PETCO2 in the SAAC-CPR group was higher than that during the SCC period in the SAAC-CPR group and in the S-CPR group during CPR[(22 .50 ± 3 .17 )mm Hg vs .(11 .80 ± 2 .57) mm Hg ,(13 .40 ± 3 .53) mm Hg ,P<0 .01)] .CPP in the SAAC-CPR group was also higher than that during SCC in the SAAC-CPR group and the S-CPR group[(50 .30 ± 6 .49) mm Hg vs .(14 . 12 ± 3 .01)mm Hg ,(14 .62 ± 2 .59)mm Hg ,P<0 .01)] .3 cases in the S-CPR group and 9 cases in the SAAC-CPR group restored ROSC within 3 times defibrillation ,succeeded in resuscitation after 20 min ROSC and underwent 24 h survival .The ROSC rate ,the resuscitation success rate and the 24 h survival rate in the SAAC-CPR group were significantly higher than those in the S-CPR group(P<0 .05) .No abdominal viscera damage was found in post mortem examinations of all the swines subjects .Conclusion SAAC combined with SCC can elevate PETCO2 ,CPP ,ROSC ,resuscitation success rate and 24 h survival rate ,which is conducive to CPR ,safe and easy to operate .
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Objective To investigate the effect of rocuronium on spectral entropy during induction of general anesthesia in patients of Uygur nstionality. Methods Forty ASA Ⅰ or Ⅱ patients (Uygur nationality) of both sexes, aged 20-50 yr, weighing 45-70 kg, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n = 20 each): normal saline (NS) group and rocuronium group (group R). Anesthesia was induced with target-controlled infusion of propofol. The initial target plasma concentration wan net at 2 μg/ml. The concentration wan then increased by 0.5 μg/ml every 4 min until response entropy (RE) was decreased to 45 and maintained for 4 min. When the plasma concentration was equal to the effect-site concentration, iv rocuronium 0.6 mg/kg was injected in group R, while group NS received the equal volume of NS instead. Fentanyl 3 μg/kg was injected intravenously at 3 min after recuronium administration. The patients were tracheal intubated and mechanically ventilated. State entropy (SE) and RE were recorded immediately before induction (baseline, To), before rocuronium administration (T1), 2 main after rocuronium administration (T2) and at 0, 1, 2 and 3 min after intubation (T3-6). The difference between RE and SE wan calculated. Results The RE value at T3 and T4 and the difference between RE and SE at T2.5 were significantly lower in group R than in group NS ( P ＜ 0.05). Conclusion Rocuronium can decrease the RE value and degree of increase in the difference between RE and SE during induction of general anesthesia in patients of Uygur nationality, which may affect the accuracy of spectral entropy in monitoring the depth of anesthesia.
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OBJECTIVE To analyze the etiological distribution and drug resistance characteristics of patients with respiratory failure and lung infection in EICU.METHODS The types of respiratory failure,the incidence condition of ventilator-associated pneumonia(VAP),the mortality rate,and the drug sensitivity of 129 pathogen strains which were isolated and cultured from the 110 cases with respiratory failure and pneumonia between Jan 2006 to Aug 2008 in EICU were analyzed.RESULTS Among the 110 patients,48 cases were died(the mortality rate of 43.6%).There were 28 cases(58.3%) of Ⅱ type respiratory failure,20 cases(41.7%) of Ⅰ type respiratory failure.Of 129 pathogens strains,there were 29 Gram-positive bacteria(22.5%) and 100 Gram-negative bacteria(77.5%).The major Gram-negative bacteria were Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella pneumoniae,and they showed generally higher multidrug resistance.Except minocycline,A.baumannii appeared strong multidrug resistance to the other 16 kinds of common antibiotics.The main Gram-positive bacteria were Staphyococcus haemolyticus,S.aureus and coagulase-negative staphylococci(CNS),and no evidence showed they resisted to vancomycin.CONCLUSIONS There are high mortality rate of patients with respiratory failure and lung infection if they suffered from compound infection.The main pathogens of the lung infection are Gram-negative bactiera,such as P.aeruginosa,A.baumanniiand K.pneumoniae in order,with high multidrug resistance.The main Gram-positive bacteria show no evidence resist to vancomycin.
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Objective To investigate the injury of members nation earthquake emergency relief team(NERT) in Wenchuan earthquake, and to explore right measures to protect themselves in emergency relief.Method The injury of 187 members of rescue team,who took emergency relief of"5·12" Wenchuan earthquake from 12 May to 29 May 2008, was registered according to International classification of Diseases (ICD). Results Medical staff have treated the members for 268 times, dennatogic and subcutaneous tissue disease accounted for 35.4%, masele,skeleton and connective tissue disease accounted for 26.9% ,disease of respiratory system ac-counted for 13.4% .More members responsible for search injured fixed medical aid post,the treatment times were 224,accounting for 91.0% times (91.0%). Conclusions Sufficient medical preparation,fixed medical aid post,psychological quide are very important for members of relief team.
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Objective To approach the validity of the fast aid and medical organization of earthquake.Method China International Search and Rescue Team (CISAR) fast arrived Wenehuan earthquake area.The problems of medical organization and emergency treatment on spot were rethospectively analyzed.Twenty-two members from different departments,including department of emergency medicine,department of cardiology and orthopaedics,etc,took 280 species of medicine,consumable material,equipment and device,totally more than 1000 kinds.When finding survivors,the members of medical team gave both medical rescue and psychological inter venfion to them.Results After members of CISAR searched 9 hours,they found and treated 49 survivals,including 21 males and 28 females in collapse field of Wonchuan ease.Survivals were 7～61 years old,30 cases<18 yearn old,8 cases 18～39 years old,8 cases 40～59 years old,3 cases>60 yearn old.And 39 cases were found and treated within 72 hours,10 eases over 72 hours.Eight cases had head injuries,12 eases chest injuries,15 cases abdominal injuries,3 eases spinal injury,5 cases pelvic injury,48 eases limb injury,and all eases had medium or severe dehydrate.Forty-nine survivals were rescued with fluid infusion,oxygen inhahtion,bandaging,fixation and transported to hospitals,and none d the 49 cases died.conclusions The effective medical organization and first aid on spot can avoid the rescue chaos on emergency treatment,and reduce the rate of disability and case fatality in disaster.
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<p><b>OBJECTIVE</b>To investigate the effect of NG-nitro-L-arginine (L-NNA), a nitric oxide synthase (NOS) inhibitor, on the testis cell apoptosis in morphine-dependent rats induced by naloxone and the involved mechanisms.</p><p><b>METHODS</b>Forty-eight Wistar rats were randomly divided into a control group, withdrawal group and a therapeutic group. Morphine-dependent rats were given gradually increasing doses of morphine to produce morphine-dependent models, the abstinent syndrome precipitated by naloxone. The inhibiting effect of L-NNA on the abstinent syndrome, and the testis apoptosis, NOS positive cells, calmodulin (CaM) contents, superoxide dismutase (SOD) activity, and glutathione super oxidase (GSHPx) activity of the morphine-dependent rats induced by naloxone were observed and recorded by radioimmunoassay, atomic absorption spectrometry, in situ nick translation (ISNT) and NADPH-d histochemical technique.</p><p><b>RESULTS</b>Compared with the control rats, the function of the somesthetic motor nerves and autonomic nerves was excessive, the apoptosis and NOS positive cells in the testis were significantly increased (P < 0.05 or P < 0.01), the content of CaM and the activity of SOD and GSHPx were obviously decreased in the morphine-dependent rats induced by naloxone. But L-NNA could significantly inhibit the abstinent syndrome, decrease NOS positive cells and apoptosis, and increase CaM content and the activity of SOD and GSHPx in the testis.</p><p><b>CONCLUSION</b>Morphine dependence can induce testis cell apoptosis, an increase in testis NOS positive cells, a decrease in CaM content and the activity of SOD and GSHPx in the testis. L-NNA has the curative effect on the morphine abstinent syndrome, protects testis cells against apoptosis and improves their involved biochemical indexes.</p>
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Animales , Masculino , Ratas , Apoptosis , Calmodulina , Modelos Animales de Enfermedad , Dependencia de Morfina , Patología , Óxido Nítrico Sintasa , Nitroarginina , Farmacología , Distribución Aleatoria , Ratas Wistar , Espermatozoides , Testículo , PatologíaRESUMEN
Objective: To study the effect of taurine to resist the impact of lead on learning and memory. Methods: ABC immunohistochemistry method was used to study the quantity change of nNOS positive neuron in hippocampus of the rats which were fed with distinct dosage of lead acetate in drinking water (0.02, 0.2 g/L) and distinct dosage of taurine (5,10 g/kg) in feed. Rusults: Taurine could increase nNOS positive neuron quantity obviously in hippocampus of rats induced by lead lesion. Conclusion: Taurine could resist impact of lead on learning and memory obviously.