Objective To explore the variations in category of internal diseases in order to plan out strategies to deal with during pre-hospital period in Chongqing urban area.Methods The category of internal diseases of pre-hospital emergency service in Chongqing urban area from January 2004 to December 2013 was studied and the data were analyzed retrospectively.Results Firstly,the number of patients in pre-hospital emergency service continued to mount up year by year,from 6031 patients in 2004 to 12 264 patients in 2013.The ration of male to femal was 1.24∶1 to 1.68∶ 1,and the cases of female increased year after year,from 2246 to 5486.Secondly,cardiovascular disease was the leading illness in the wide varieties of internal disease (15.35％-19.36％).The number of cerebrovascular accident (9.72％-13.11％),respiratory diseases (7.48％-10.20％) and digestive diseases (8.36％-10.58％) were escalating.However,the acute poisoning cases (2.36％-6.18％) showed a tendency of decline.The peak time of the pre-hospital emergency service was stable in past ten years.Thirdly,there were seasonal variation in incidence of cardiovascular,cerebrovascular and respiratory disease,more cases occurred in January and December than in other months.Alcoholism commonly peaked before Spring Festival.Fourthly,the peak time of internal disease occurred in the past 10 years was stable,peaked during 20:00-24:00,and the trough time was during 0:00-4:00,the ratio of trough to peak ranged from 30.7％ to 43.5％.Conclusion The variation of the internal disease category was associated more or less with seasonal rotation,the improved living standards,and stress of modern life,and the incidence of emergency illness were escalating year by year,thus the corresponding measures should be instituted to deal with those major changes.Improving pre-hospital emergency response capacity and efficacy of treatment is of great significance.Strengthening the prophylaxis and healthcare,and establishing a professional capability for triage classification of diseases during emergency service are great essential for promoting the swiftness of prehospital emergency response.

Objective To explore the feasibility, safety and effectiveness of mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries so as to further improve success rate of treatment of severe thoracic trauma. Methods A retrospective study was done on the clinical data of 72 patients with severe thoracic injuries (AIS≥3) treated by surgeons from Chongqing Emergency Medical Center (CEMC) from April 1998 to August 2008. The patients were divided into pre-hospital group (n = 36) and in-hospital group (n = 36) according to the time that the definite surgery performed. Results (1) There was no significant statistical difference upon arrival time from scene to primary hospital between two groups (P > 0.05). For patients in pre-hospital group, the time to receive definite surgery was (3.9±4.1) hours, which was significant shorter than (9.6±8.2) hours in in-hospital group (P < 0.05). (2) There were no statistical significant differences upon blood loss volume and blood transfusion volume between two groups (P > 0.05). (3) There was no significant statistical difference upon ISS value between two groups (P > 0.05), but the RTS value of pre-hospital group was significantly lower than that of in-hospital group (P < 0.05). The incidence rate of shock in pre-hospital group was 86.1%, which was significantly higher than 41.7% in in-hospital group (P < 0.05). (4) The percentage of patients who received thoracic close drainage in pre-hospital group was 16.7%, which was significantly higher than 5.6% in in-hospital group. There was no significant statistical difference upon thoracic close drainage plus thoracotomy, thoracic close drainage plus laparotomy and thoracic close drainage plus other operations between two groups. However, the operative rate of thoracic close drainage plus thoracotomy for penetrating injury was 4.8 times higher than that for blunt injury in pre-hospital group, and 1.9 times higher than that for blunt injury in-hospitai group. The operative rate of thoracic close drainage plus laparotomy for blunt injury was 5 times higher than that for penetrating injury in prehospital group, and 4.5 times higher than that for penetrating injury in in-hospital group. The overall survival rate was 95.8% (69/72). Five of eight moribund patients were saved in pre-hospital group, the prevented death rate accounted for 13.9% (5/36) in this group. Conclusions It is flexible, safe and effective to implement mobile intensive care and definite lifesaving surgical interventions for patients with severe thoracic injuries in primary hospitals. After the condition of the patient is stabilized, a quick transportation of the patients to a higher level trauma centers (hospitals) for further treatment may reduce the pre-hospital death rate.

Objective:To investigate the effects of dexmedetomidine and urapidil on postoperative extubation stress response, postoperative shivering, and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage.Methods:A total of 120 patients with hypertensive intracerebral hemorrhage admitted to the Seventh People′s Hospital of Hebei Province from January 2021 to December 2022 were selected as the research subjects. They were randomly divided into an observation group (60 cases) and a control group (60 cases) according to the random number table method. All patients underwent intracranial hematoma removal surgery under general anesthesia combined with bone flap decompression surgery for treatment. The observation group patients received sedation and analgesia with dexmedetomidine and urapidil after surgery, while the control group patients received sedation and analgesia with dexmedetomidine after surgery. The differences in vital signs, stress indicators, cerebral oxygen and cerebral glucose metabolism, and adverse reactions between two groups of patients were compared.Results:There was no statistically significant difference in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and bispectral index (BIS) between the two groups after entering the room (T 0) and before anesthesia medication (T 1) (all P>0.05). The HR, SBP, DBP, and BIS of the observation group were significantly lower than those of the control group at extubation (T 2), immediately after extubation (T 3), 1 minute after extubation (T 4), and 3 minutes after extubation (T 5), and the differences were statistically significant (all P<0.05). There was no statistically significant difference in various stress indicators between the two groups of patients at T 0 (all P>0.05), while the stress indicators of the observation group were significantly lower than those of the control group at T 5 (all P<0.05). There was no statistically significant difference in the cerebral oxygen uptake rate (CERO 2) and cerebral arteriovenous blood glucose difference (AVDG) between the two groups of patients at T 0 (all P>0.05), while the CERO 2 and AVDG in the observation group at T 5 were significantly higher than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of hypoxemia, hypotension, and bradycardia between the two groups of patients after surgery (all P>0.05). The incidence of postoperative shivering in the observation group was lower than that in the control group ( P<0.05). The Glasgow Coma Index of both groups of patients after surgery was higher than that before surgery (all P<0.05), and there was no statistically significant difference in Glasgow Coma Index between the two groups before and after surgery (all P>0.05). Conclusions:Dexmedetomidine and Urapidil have significant improvement effects on postoperative extubation stress response, postoperative shivering, and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage. It is recommended to promote them clinically.