外二科（急救外科）

The Second Department of Surgery (Emergency Surgery) of the First Affiliated Hospital of Tianjin University of Chinese Medicine is divided into the Emergency Department of the South Hospital and the Emergency Department of the North Hospital. The Emergency Department of South Hospital The construction of the Emergency Department of South Hospital started early and has developed steadily. For many years, the Emergency Department of South Hospital has always regarded "the urgent needs of patients and the needs of patients" as its treatment philosophy. The discipline takes the treatment of clinical critical illness with traditional Chinese medicine as the main research idea. Establish a clinical emergency, critical and severe treatment system with traditional Chinese medicine as the main treatment method. It is a discipline that integrates medical care, teaching and scientific research covering pre-hospital first aid, emergency treatment, and critical illness treatment. The main research directions are the protective effect of acupuncture on the heart and brain, the treatment of syncope and wind-warm lung-heat syndrome with traditional Chinese medicine, and the therapeutic effect of traditional Chinese medicine on multiple organ dysfunction syndrome. Highlight the clinical guiding ideology of traditional Chinese medicine to prevent disease before it becomes a disease, that is, to prevent disease from developing. The specialty insists on extensive research in the field of Chinese medicine first aid, which effectively promotes the academic development and progress of the specialty. Create a three-in-one emergency medical model of "combination of Chinese and Western medicine, combination of acupuncture and medicine, and combination of internal and external medicine". While using advanced modern medical treatment methods, we actively apply traditional Chinese medicine and acupuncture therapy to the treatment of emergency and critical illness. TCM syndrome differentiation and treatment for critically ill patients do not lose the essence of TCM, and active treatment with Western medicine is in line with evidence-based medicine.Pay attention to basic and clinical research, and strengthen basic research on clinical emergencies based on specialty characteristics to provide a basis for improving clinical efficacy. The main research idea of ​​specialty construction is to treat clinical critical illness with traditional Chinese medicine. The main research directions are the diagnosis and treatment of sepsis using integrated traditional Chinese and Western medicine; the diagnosis and treatment of syncope syndrome using integrated traditional Chinese and Western medicine; and the diagnosis and treatment of wind-warm and lung-heat syndrome using integrated traditional Chinese and Western medicine. Highlight the clinical guiding ideology of traditional Chinese medicine to prevent the disease before it becomes a disease, and to improve the effectiveness of emergency diagnosis and treatment of traditional Chinese medicine. The construction of junior colleges implements the subject leader responsibility system, implements standardized and scientific construction and management, formulates discipline construction plans, and encourages innovation and exchanges. For example, innovative management systems such as subject-based management have been implemented, operation management systems and procedures have been established and improved, and standard operating procedures (SOPs) have been established for a number of technologies to ensure the healthy development of the discipline. The specialist is responsible for critical emergency rescue and hospital-wide rescue consultation work. It has the ability to handle emergency emergencies and can skillfully use emergency operation skills. It has carried out a series of emergency rescue work integrating traditional Chinese and Western medicine, including the treatment of acute myocardial infarction, abdominal septic shock, cerebral hemorrhage, and gastrointestinal bleeding with traditional Chinese and Western medicine;Combining traditional Chinese medicine and Western medicine to treat diseases such as multiple organ dysfunction, sepsis, heart failure, respiratory failure, renal failure, brain resuscitation after cardiopulmonary resuscitation, and febrile convulsions in children. Carry out continuous blood purification treatment for critically ill patients and achieve good results. Department Honors The Emergency Department of South Hospital was approved by the State Administration of Traditional Chinese Medicine as a national TCM emergency clinical center in 1996. It obtained the right to confer master's degrees in 2003. In 2006, it was selected into the first batch of TCM clinical emergency base construction project units by the State Administration of TCM. In 2007, it was rated as a TCM emergency clinical base construction unit by the State Administration of Traditional Chinese Medicine. In 2021, it took the lead in establishing the national TCM emergency medical team and was responsible for the daily management and training of the medical team. Currently, it is the National Administration of Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine emergency clinical training base, a key specialty of the State Administration of Traditional Chinese Medicine, a vice-chairman unit of the China Traditional Chinese Medicine Emergency Specialty Medical Association, a chairman unit of Tianjin City, a vice-chairman unit of the National Traditional Chinese Medicine Emergency Rescue Base Alliance, a collaborative unit of the National Traditional Chinese Medicine Emergency and Critical Care Medicine Regional Diagnosis and Treatment Center, a national emergency medical team and a base for epidemic prevention and emergency medical rescue. The focus of clinical work is on heart, lung and cerebrovascular diseases.Three special technologies with traditional Chinese medicine characteristics are carried out, including acupuncture for brain resuscitation treatment after cardiac arrest, integrated traditional Chinese and Western medicine for post-acute myocardial infarction complications, and integrated traditional Chinese and Western medicine for the treatment of multiple organ failure syndrome. Establish and improve the "Public Health Emergency Reporting Management System" and "Infectious Disease Epidemic Reporting Management System", and formulate the "Public Health Emergency Emergency Plan", "Emergency Plan for Food Poisoning Incidents in Groups Treated by the Emergency Department", and "Disinfection and Isolation Measures for Infectious Public Health Incidents" systems. During the SARS period, he was awarded the title of "Advanced Group for Meritorious Service during the Tenth Five-Year Plan". An emergency cooperation group has been formed with 32 TCM emergency departments across the country. It has formed a TCM Stroke Heartache Collaboration Group with 5 units including Zhejiang Traditional Chinese Medicine Hospital and Xinjiang Traditional Chinese Medicine Hospital and serves as the deputy group leader. Formed a TCM Sepsis Collaboration Group with 6 units including Beijing University of Chinese Medicine Dongzhimen Hospital. Organize and optimize clinical diagnosis and treatment plans. The "Tianjin Traditional Chinese Medicine Emergency Clinical Training Plan" was also formulated to be used as standardized training content for clinical residents. At present, the Emergency Department has trained 22 master's students, who have become the backbone of the unit. There are currently 12 master's students studying there, and about 4-6 master's students are currently recruited every year.Future Construction Direction: This discipline has earlier put forward the academic point of view of the protective effect of acupuncture on the heart and brain, and has a high academic status among similar disciplines. It also features the protective effect of acupuncture on the heart and brain, the therapeutic effect of traditional Chinese medicine on heart failure, and the therapeutic effect of traditional Chinese medicine on multiple organ dysfunction syndrome. The Emergency Department of South Hospital will continue to focus on heart, lung, and cerebrovascular diseases as its clinical focus in the future. Excavate, organize and summarize the emergency clinical diagnosis and treatment methods of traditional Chinese medicine and integrated traditional Chinese and Western medicine, inherit the emergency academic thoughts and clinical experience of famous traditional Chinese medicine experts, and formulate diagnosis and treatment standards. It emphasizes highlighting the characteristics of traditional Chinese medicine in emergency medicine, and actively applies traditional Chinese medicine and acupuncture therapy to the treatment of emergency and critical illness while using advanced modern medical treatment methods. Improve the emergency treatment model with the characteristics of "three combinations", that is, "combination of Chinese and Western medicine, combination of acupuncture and medicine, and combination of internal and external medicine". TCM syndrome differentiation and treatment for critically ill patients do not lose the essence of TCM, and active treatment with Western medicine is in line with evidence-based medicine. Pay attention to basic and clinical research, and strengthen basic research on clinical emergencies based on subject characteristics to provide a basis for improving clinical efficacy. Current basic research focuses on common clinical cardiovascular and cerebrovascular diseases to explore the mechanisms of action of traditional Chinese medicine and acupuncture in acute clinical settings.Acupuncture and medicine pay equal attention to exert multiple mechanisms to improve the curative effect. Systematically explore, summarize, promote, and apply acupuncture, traditional Chinese medicine, and other characteristic traditional Chinese medicine emergency diagnosis and treatment technologies to improve the level of emergency diagnosis and treatment of traditional Chinese medicine. Features of Specialized Treatment (1) Integrated Traditional Chinese and Western Medicine in the Treatment of Multiple Organ Dysfunction Syndrome (MODS) For Multiple Organ Dysfunction Syndrome (MODS), we use traditional Chinese medicine methods such as clearing away heat and detoxifying, tonifying the body, activating blood circulation and removing blood stasis, combined with intensive western medicine treatment to effectively reduce the mortality rate of MODS. Modern medicine believes that MODS is a clinical syndrome in which two or more organ failures occur simultaneously or sequentially after severe infection, trauma, major surgery, pathological obstetrics, etc. It is a disease with high clinical mortality. Its pathogenesis is related to endotoxin, inflammatory mesons, oxygen supply and oxygen consumption, immune system abnormalities, etc., but it is not fully understood yet. Combining our many years of clinical experience and the basic theories of traditional Chinese medicine, we propose that deficiency of both qi and yin and depletion of yin and yang are the root causes of MODS; blood stasis, toxins, phlegm, and turbidity are the root causes of MODS; collateral blockage is an important pathogenesis of MODS; strengthening the body and eliminating evil are the fundamental principles for preventing and treating MODS.Under the guidance of traditional Chinese medicine theory, we propose that the key to early stage treatment is to replenish qi and nourish yin, detoxify and activate blood circulation, and activate collaterals and resolve phlegm. The middle stage is to warm yang and activate blood circulation, detoxify and nourish yin, activate collaterals and resolve phlegm. The later stage lies in the methods of restoring Yang, strengthening the body, and activating blood circulation and dredging collaterals. Collaborative treatments such as Xuebijing Injection, Shengmai Injection, Shenfu Injection, Danhong Injection, and traditional Chinese medicine decoction were used at different stages of the disease to relieve the systemic inflammatory response and thereby reduce the mortality rate of MODS. (2) Integrated traditional Chinese and Western medicine to treat complications of myocardial infarction Myocardial infarction is caused by acute coronary artery occlusion, interruption of blood flow, and local necrosis of the myocardium due to severe and long-lasting ischemia. At present, early intravenous thrombolysis has become a routine treatment in the emergency department of our hospital, and percutaneous coronary angioplasty (PTCA) is also gradually carried out. Along with emergency reperfusion and vascular reconstruction treatment, traditional Chinese medicine is used to replenish qi and activate blood circulation, replenish qi, nourish yin, activate blood circulation, activate blood circulation and remove blood stasis, resolve phlegm and reduce turbidity, etc. to prevent and treat the occurrence of severe heart failure, cardiogenic shock, and arrhythmia after myocardial infarction, and reduce the mortality rate of acute myocardial infarction to less than 8%. Cardiogenic shock occurs during the recovery period of acute myocardial infarction, and traditional Chinese medicine treatment mainly focuses on restoring yang to relieve stress and activating blood circulation to stabilize the condition.Choose our hospital's intravenous preparation Huayu Tongmai Liquid for intravenous injection, and take our hospital's preparation Shenfu Mixture. Thus, on the whole, by improving microcirculatory blood supply, enhancing myocardial nutrition, and trying to reduce the necrotic area caused by embolism, it also overcomes the disadvantage of increased myocardial oxygen consumption caused by western medicine in treating shock. Heart failure occurs during the recovery period of acute myocardial infarction. Traditional Chinese medicine treatment is based on the principles of replenishing heart qi, nourishing the heart and calming the mind. The hospital's preparations Shenmai Mixture and Tongmai Mixture are used for treatment. Arrhythmias during the recovery period of acute myocardial infarction may include paroxysmal premature ventricular or atrioventricular block. Due to obvious symptoms, the patient is often emotionally nervous and affects recovery. Traditional Chinese medicine treatment is based on the principles of warming and nourishing the heart yang, calming the nerves and calming palpitations. The hospital's preparation 651 pills is used for oral treatment. In short, TCM syndrome differentiation is used to treat the acute and recovery stages of myocardial infarction. Through comprehensive therapy, it can replenish heart qi, activate blood circulation, remove blood stasis, and unblock meridians, improve coronary blood circulation, promote angiogenesis, and form collateral circulation, which can limit the scope of embolism, protect ischemic myocardium, prevent the occurrence and development of complications, and improve the efficacy.(3) Acupuncture for brain resuscitation in patients after cardiac arrest (CA). With prompt cardiopulmonary resuscitation (CPR) after cardiac arrest (CA), about 50% of patients can achieve recovery of spontaneous circulation, but there are still many short-term survivors who eventually die in a coma, and about 10%-30% of long-term survivors may have varying degrees of permanent brain damage (such as partial paralysis, aphasia, mental disorder, cognitive impairment, etc.). Therefore, since the early 1960s, cardiopulmonary and cerebral resuscitation (CPCR) systems have been formed at home and abroad. It includes three interconnected treatment stages: basic life support (BLS), advanced life support (ALS), and long-term life support (PLS). The recovery of brain function is the ultimate goal of resuscitation. This treatment includes basic life support and advanced life support at the same time. After the heart beats and the autonomic circulation is restored, the treatment focuses on "opening and closing, resuscitating, and adjusting yin and yang" to resuscitate the patient's brain, that is, acupuncture in the ditch is performed to perform the sparrow pecking method; Baihui is performed to twist and tonify; and bilateral Neiguan acupoints are lifted and inserted to purge. After applying acupuncture at each acupoint for 1 minute, leave the needle in place for 30 minutes. For the first 24 hours, acupuncture is given every 6 hours. Thereafter, acupuncture was performed every 12 hours. Treatment lasts for 7 days.This therapy shortens the recovery time of neurological function and mechanical ventilation time of cardiopulmonary resuscitation patients, improves the prognosis of neurological function and reduces medical costs. The Emergency Department of North Hospital The Emergency Department of North Hospital is characterized by integrated traditional Chinese and Western medicine treatment, and mainly treats difficult, critical, and diverse and complex patients. The department has rich experience in the diagnosis and treatment of difficult febrile diseases, various infectious diseases, cardiovascular system, nervous system, digestive system, urinary system, blood system, rheumatic diseases, common emergency diseases, and various difficult diseases. It adopts the treatment and nursing technology of integrated traditional Chinese and Western medicine to achieve the best therapeutic effect for patients. Over the years, the medical staff of the department have been studying technology, taking root in clinical practice, and serving patients in a down-to-earth manner. It has successfully diagnosed the first case of type B insulin resistance in Tianjin, successfully diagnosed and treated a case of atypical adult Still's disease, successfully cured a case of hypophysitis and type 1 diabetes caused by a PD-1 inhibitor, successfully diagnosed and treated a case of atypical POMES syndrome, etc. There are countless such cases of successful diagnosis and cure of patients. It has established a good reputation among patients and their families, and patients come here in droves.The Emergency Department of the North Hospital is a department with great love. Under the leadership of department director Wang Qingquan, all medical staff work hard and contribute silently. They have repeatedly helped patients and their families in difficulty solve practical problems, such as advance hospitalization fees and return tickets. Their sincere dedication and love for patients have become the daily work of all the medical staff in the Emergency Department of the North Hospital, and they have gained the recognition and trust of patients. In the fight against the epidemic, all medical staff in the Emergency Department of the North Hospital actively responded to the call and supported Shanghai, Hainan and designated hospitals. With the adjustment of epidemic prevention and control policies and measures, the focus of work has shifted from infection prevention and control to medical treatment. The number of patients admitted and admitted has increased sharply in a short period of time. The medical staff in the department are facing more arduous tests. In the face of difficulties, they have not flinched and persisted day and night. The department gives full play to the characteristics and advantages of traditional Chinese medicine, scientifically provides medical treatment, strives to improve critical illness rescue capabilities, and uses the sincere love of emergency responders to interpret the benevolence and loyalty of doctors with practical actions.