In this paper,an emergency decision-making method,based on case-based reasoning and cloud model,is proposed to solve the risk decision-making problem in emergency response.Casebased reasoning,by allowing the decision-...In this paper,an emergency decision-making method,based on case-based reasoning and cloud model,is proposed to solve the risk decision-making problem in emergency response.Casebased reasoning,by allowing the decision-maker to referring to past decisions,introduces a short-cut to formulate feasible emergency alternatives.Cloud model is used to evaluate and optimise the emergency response alternatives.To evaluate emergency response alternatives,the decision criterion must be determined according to the aim and characteristics of emergency rescue in disasters or accidents.Then,the weight cloud and evaluation cloud of the decision criterion are determined by the Delphi method combined with backward cloud generator,and the synthesised cloud of each alternative is calculated through arithmetic rules of cloud.Finally,a ranking of all response alternatives can be determined,and the best alternative is selected.Case study shows that the method makes the conversion between qualitative description and quantitative indication more effective.展开更多
目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月...目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月就诊于首都医科大学附属北京天坛医院行机械取栓的422例AIS患者进行回顾性分析,其中全身麻醉组(general anesthesia,GA)203例、非全身麻醉组(non-general anesthesia,non-GA)173例,EC-GA组46例。主要观察指标为患者术后90 d神经功能良好预后比例,即90 d改良Rankin量表(Modified Rankin Scale,mRS)评分≤2的患者比例(mRS分0~2表示神经功能预后良好,mRS分3~6预后不良)。次要观察指标为时间指标[发病-入室时间(T1),入室-动脉穿刺时间(T2),动脉穿刺-血流再痛时间(T3)],改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)的良好比例(mTICI:0~2a再通不良;2b~3再通良好),病死率(出院病死率和90 d病死率),术后并发症(肺炎发生率和颅内出血发生率)及EC-GA的危险因素。结果 46例患者进行EC-GA,总体转化率为21.0%,其中前循环转化率约为19.0%,后循环转换率约为28.9%。3组患者在神经功能预后评分(90 d mRS)及良好预后比例(90 d mRS≤2)差异无统计学意义(P>0.05);EC-GA未显著增加不良预后风险:与non-GA组比较,OR=1.538(95%CI:0.792~2.984);与GA组比较,OR=1.315(95%CI:0.684~2.528)。多因素回归分析显示:入室美国国立卫生研究院脑卒中量表(National Institute of Health Stroke Scale,NIHSS)评分>15分时,术中EC-GA的风险显著增加,调整比值比(adjusted odds ratio,aOR)=2.005(95%CI:1.035~3.881)。结论 急性脑卒中患者行机械取栓治疗中,紧急全身麻醉转化未显著增加不良预后风险;入室NIHSS评分大于15分,与术中紧急全身麻醉转化风险相关。展开更多
基金This work was supported by National Social Science Fund of China[grant number 18BGL232].
文摘In this paper,an emergency decision-making method,based on case-based reasoning and cloud model,is proposed to solve the risk decision-making problem in emergency response.Casebased reasoning,by allowing the decision-maker to referring to past decisions,introduces a short-cut to formulate feasible emergency alternatives.Cloud model is used to evaluate and optimise the emergency response alternatives.To evaluate emergency response alternatives,the decision criterion must be determined according to the aim and characteristics of emergency rescue in disasters or accidents.Then,the weight cloud and evaluation cloud of the decision criterion are determined by the Delphi method combined with backward cloud generator,and the synthesised cloud of each alternative is calculated through arithmetic rules of cloud.Finally,a ranking of all response alternatives can be determined,and the best alternative is selected.Case study shows that the method makes the conversion between qualitative description and quantitative indication more effective.
文摘目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术时,紧急全身麻醉转化(emergency conversion to general anesthesia,EC-GA)对术后神经功能预后的影响及术中EC-GA的预测因素。方法 本研究对2017年11月至2021年5月就诊于首都医科大学附属北京天坛医院行机械取栓的422例AIS患者进行回顾性分析,其中全身麻醉组(general anesthesia,GA)203例、非全身麻醉组(non-general anesthesia,non-GA)173例,EC-GA组46例。主要观察指标为患者术后90 d神经功能良好预后比例,即90 d改良Rankin量表(Modified Rankin Scale,mRS)评分≤2的患者比例(mRS分0~2表示神经功能预后良好,mRS分3~6预后不良)。次要观察指标为时间指标[发病-入室时间(T1),入室-动脉穿刺时间(T2),动脉穿刺-血流再痛时间(T3)],改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)的良好比例(mTICI:0~2a再通不良;2b~3再通良好),病死率(出院病死率和90 d病死率),术后并发症(肺炎发生率和颅内出血发生率)及EC-GA的危险因素。结果 46例患者进行EC-GA,总体转化率为21.0%,其中前循环转化率约为19.0%,后循环转换率约为28.9%。3组患者在神经功能预后评分(90 d mRS)及良好预后比例(90 d mRS≤2)差异无统计学意义(P>0.05);EC-GA未显著增加不良预后风险:与non-GA组比较,OR=1.538(95%CI:0.792~2.984);与GA组比较,OR=1.315(95%CI:0.684~2.528)。多因素回归分析显示:入室美国国立卫生研究院脑卒中量表(National Institute of Health Stroke Scale,NIHSS)评分>15分时,术中EC-GA的风险显著增加,调整比值比(adjusted odds ratio,aOR)=2.005(95%CI:1.035~3.881)。结论 急性脑卒中患者行机械取栓治疗中,紧急全身麻醉转化未显著增加不良预后风险;入室NIHSS评分大于15分,与术中紧急全身麻醉转化风险相关。