Forthcoming Articles http://cnemergency.org.cn EN-US http://cnemergency.org.cn/EN/current.shtml http://cnemergency.org.cn 5 　Objective　To investigate the extent and distribution of symptom—to—repeffusion delay in pafients with acute ST-segment elevation myocardial infarction(STEMI)treated with primary PCI．Methods　We had prospectively enroHed 127 patients of STEMl within 24 hours of symptom onset who underwent primary PCI(PPCI)in Peking University Third Hospital from July 2013 to July 2014． The data of time delay were collected．Results　The median pre—hospital delay(PHD)and door—to— balloon time(DTB)of STEMl were 154．5 minutes and 104 minutes respectively．The DTB was divided into several intervals and median times were recorded as follows：door—to—first ECG was 2 minutes： first ECG—to—decision of PPCI WaS 12 minutes：decision—to—informed consent of PPCI was 5 minutes；consent of PCI—to—outdoor of Emergency Department(ED)Was 32 minutes(mainly used to activate catheter team)；outdoor of ED-to-balloon time Was 35 minutes．The percentage of patients with door—to—first ECG less than 10 minutes，first ECG—to—decision of PPCI less than 10 minutes， DTB less than 90 minutes was 91.6％．43.9％and 39.8％respectively．Conclusion　PHD is still a major part of treatment delay in patients with STEMI underwent PPCI，pre-hospital activation of catheter team may be effective to reduce DTB according to its distribution．]]> Objective　To investigate the efficiency of the high flow oxygen therapy on mechanical ventilation patients with artificial airway during the weaning process in ICU. Methods　105 patients weaning from mechanical ventilation due to respiratory failure and not yet extubated were investigated. The patients were randomly divided into two groups by computer generated random numbers table. The patients in the study group received the high flow oxygen therapy through trachea cannula, while using artificial nose combined with Venturi air oxygen mixing valve for conventional oxygen therapy in the control group. The respiratory rate, pH, PaO2, PaO2/FiO2, PaCO2 at different times (6, 12, 24 h after weaning), airway humidification and times of sputum aspiration by the fiberoptic bronchoscopy were compared between the two groups. The rate of mechanical ventilation reuse after weaning, the rate of noninvasive ventilator use after extubation, re-intubation rate within 72 h after extubation and ICU duration were also compared between the two groups. Results　Compared with the control group, the respiratory rate at different times (6, 12, 24 h after oxygen therapy) was lower in the study group (P＜0.01) and PaO2, PaO2/FiO2 was higher in the study group (P＜0.01). No difference showed in pH, PaCO2 between two groups (P＞0.05). The effect of airway humidification was better in the study group (P＜0.01), and less of times of sputum aspiration showed in the study group (2.1±1.3 vs. 3.0±1.3, P＜0.01); The rate of mechanical ventilation reuse after weaning was lower in the study group (11.8% vs. 29.6%, P＜0.05). But no statistically difference showed in the rate of noninvasive ventilator use after extubation (17.6% vs. 31.5%, P＞0.05), re-intubation rate within 72 h after extubation (7.8% vs. 18.5%，P＞0.05) and ICU duration (14.3±3.0 vs. 14.3±3.3, P＞0.05). Conclusion　For the patients weaning from mechanical ventilation in the ICU, high flow oxygen therapy can decrease the respiratory rate after weaning, improve the oxygenation and airway humidification effect, reduce the times of sputum aspiration by the fiberoptic bronchoscopy and the rate of mechanical ventilation reuse after weaning, compared to the conventional oxygen therapy. But there is no statistically difference in the rate of noninvasive ventilation after extubation, re-intubation rate within 72 h after extubation and ICU duration.]]> Objective To investigate the clinical effect of early goal directed therapy（EGDT）guided by plasma colloid osmotic pressure in patients with septic shock. Methods Forty cases of patients with septic shock were selected from March 2014 to February 2016 in the emergency department of Guizhou People's Hospital, the patients were divided into EGDT group（20 cases）and plasma colloid osmotic pressure（PCOP）group（20 cases）according to the random number table method. The EGDT group was given routine septic shock bundle treatment program for fluid resuscitation, the blood sampling was selected to monitor PCOP value in PCOP group in addition to conventional EGDT treatment,and according to the PCOP value to guide the fluid recovery, always stabling the PCOP values in the normal ranges（19～25 mm Hg）. The following indicators were detected in two groups in the diagnosis of in⁃
fection shock 0, 6, 24, 72 h time point including acute physiology science and chronic health evaluationⅡ（APACHEⅡ）score, and number of application cases of vasoactive drugs, the oxygen index（PaO2/FiO2）, serum procalcitionin（PCT）level, central venous pressure（CVP）, mean arterial pressure（MAP）,blood lactic acid, and calculating the time of mechanical ventilation and living intensive care unit（ICU）time as well as 14 days fatality rate. Results The APACHEⅡ score and the number of application cases of vasoactive drugs were decreased gradually comparing with before treatment, the above indicates in the PCOP group were significantly lower than that of traditional liquid group in the treatment 72 h［APACHEⅡ score（sub）:（13.2±6.3）vs. （17.21±6.5）, use of vasoactive drugs cases: 4 vs. 9, P＜0.05］. After treatment, the oxygenation index of the two groups increased, the PCOP group was significantly higher than that of the traditional EGDT group in the treatment 72 h［PaO2/FiO2:（157.5±21.2）mm Hg vs.（112±20.2）mm Hg］. The PCT levels were gradually decreased after treatment and significantly lower than those before treatment at the 72 h hours point（all P＜0.05）, but there was no significant difference between the two groups at each time point. The lactate clearance rate increased gradually in two groups,but the lactic acid clearance rate in the PCOP group at each time point were significantly higher than those of conventional liquid resuscitation group［6 h:（18.7±8.1）% vs.（15.4±7.1）%, t＝-6.033, P＝0.001; 24 h:（21.3±7.3）% vs.（11.4±7.1）%, t＝-4.516, P＝0.001; 48 h:（28.6±5.9）% vs.（19.2±9.4）%, t＝-6.836, P＝0.001］. The volume of fluid resuscitation of PCOP group within 6 hours were significantly higher than that of EGDT group［（3912±892）mL vs.（2796±795）mL, t＝-3.781, P＝0.031）; the volume of fluid resuscitation after the 24 h and 72 h were decreased significantly comparing with the traditional cluster group; it was the lowest after the 72 h［（1023±452）mL vs.（1845±420）mL,t＝5.908, P＝0.033）. The mechanical ventilation time and the length of ICU stay were significantly shorter than the traditional EGDT, the mechanical ventilation time［（93.4±21.3）h vs.（12.53±29.6）h,t＝9.753, P＝0.001］, length of ICU stay［（7.3±2.9）d vs.（9.8±3.6）d, t＝2.993, P＝0.004）, but 14 days fatality rate was slightly lower than that of traditional EGDT［27.27%（6/22）than 33.33%（7/21）,t＝0.433, P＝0.752］. Conclusion The early goal-directed therapy guided by the plasma colloid osmotic pressure can reduce the severity of the patients with septic shock, guide fluid resuscitation more accurately and reduce lung water to improve oxygenation, and shorten the time of mechanical ventilation and ICU stay, so it has great clinical significance.]]> Objective To summarize the clinical features and analyze the serologic test results of latent syphilis. Methods The clinical data of 601 patients with latent syphilis who were treated in the sexually transmitted disease centre of Peking Union Medical College Hospital between January 2001 and November 2007 were retrospectively analyzed. Results Of the 601 cases of latent syphilis,there were 174 cases of early latent syphilis(EL),170 cases of late latent syphilis(LL),and 257 cases of unknown latent syphilis. Male to female ratio was 0.74:1（256 males and 345 females,respectively). Patients aged 20-39 years accounted for the largest proportion. Non-marital sexual intercourse was the main route of infection. Forty-six patients (7.65%) were co-infected with other sexually transmitted diseases. A total of 251 cases of latent syphilis (41.76%) were confirmed when the patients were receiving tests for other sexually transmitted diseases or suspected sexually transmitted diseases. Of the 601 patients with EL,LL and unknown latency,the proportion of serum rapid plasma reagin(RPR) titers higher than or equal to 8 were 72.99% (127/174),52.94% (90/170),and 60.31%(155/257),respectively. Compared with the early syphilis,serological negative conversion rate was significantly lower after treatment for l2 months in the early latent syphilis patients (P=0.044). Conclusion Education and awareness raising on syphilis should be strengthened to lower the prevalence of latent syphilis.]]>