新冠肺炎疫情下定点医院联合指挥管理体系的建立及实践

西安市人民医院航天城院区被指定为西安市新冠肺炎定点救治医院期间,通过建立联合指挥管理体系,快速完成“平战转换”。通过构建由综合协调组、联合医务部、联合护理部、联合感控部等管理小组组成的指挥系统,保障医疗同质化,提高救治效率,针对性提出人员分工、规范收治流程等对策,为突发公共卫生事件管理提供参考。     

基于信息化平台的临床路径管理探索

医院信息化平台建设为电子化临床路径管理提供了支持.阐述了以DRGs为依据遴选病种,做好路径数据准备,结合医院实际构建适宜的电子临床路径管理系统,分析了以信息化为基础的临床路径实施效果及存在问题.     

PDCA循环应用于临床路径管理的实践

分析了PDCA循环应用于临床路径管理的可行性。结合医院实践,从计划准备阶段(P)、具体实施阶段(D)、检查监控阶段(C)以及反馈处理、持续改进阶段(A)等4个环节,就PDCA循环如何应用于临床路径管理进行了说明。指出PDCA循环与临床路径管理有机结合,对促进临床路径管理的有序开展具有十分重要的意义。     

克山病患者抗氧化能力测定

Objective To explore the relationship between myocardial damage and antioxidant capacity in vivo of Keshan disease patients and to analyze the possible pathogenesis. Methods In the period from 2005 to 2006, 41 chronic and latent Keshan disease cases were chosen as the case group from such serious endemic areas as Yongjin Village, Xinfa Village of Fuyu County, Fuan Village of Shangzhi County, Xinghuo Village of Wudalianchi County, 61 healthy people from the same area as internal controls, 48 healthy people from Xianglansan Village of Wangkui County, an un-endemic area, as external control. Fasting peripheral venous blood was collected from all the people. And blood selenium, glutathione peroxidase(GSH-Px) and suporoxide dismutase.(T-SOD) activities, malondialdehyde (MDA) levels were examined. Results Blood selenium level of the patient group [(34.80±13.30) μg/L], GSH-Px[(104.10±34.19)U/L]and T-SOD[(92.16±17.98)×103 U/L]actives were significantly lower than the internal control group [(41.24±13.57)μg/L, (118.57±25.49)U/L, (104.82±13.56)×103 U/L]and the external control group [(48.33±16.51)μg/L, (155.00±24.01)U/L, (108.48±12.73)×103 U/L], respectively, with a statistically significant difference(all P < 0.05). MDA level of the patient group[(7.12± 1.37)μmol/L]was higher than that in the internal control group[(5.36±1.18)μmol/L]and the external control group[(5.22±0.83)μmol/L]with a statistically significant differences(both P < 0.05). The blood selenium level, GSH-Px activity of internal control group was resoectively lower than that in the external control group, the differences being statistically significant(beth P < 0.05). Conclusions Selenium deficiency may lead to reduced antioxidant capacity and enhanced oxidative damage in Keshan disease patients in vivo. There may be a certain relationship between oxidative stress disorder and myocardial damage of Keshan disease.     

Orthofix带锁髓内钉治疗胫骨开放骨折

目的　探讨 Orthofix不扩髓胫骨带锁髓内钉治疗胫骨开放骨折的临床疗效。方法　对 34例胫骨开放骨折的治疗进行回顾性分析 ,2 0例胫骨开放骨折清创后应用 Orthofix带锁髓内钉治疗 ,并对同期使用钢板固定的 14例胫骨开放骨折进行比较。结果　带锁髓内钉治疗组随访病例优 14例 ,良 2例 ,无髓内钉及锁钉断裂等情况出现。钢板组优 6例 ,良 5例 ,差 3例。其中 3例出现皮肤坏死感染 ,1例经治疗后愈合 ,另 2例发展成胫骨骨髓炎。结论　Orthofix带锁髓内钉治疗胫骨开放骨折疗效肯定 ,值得在临床推广应用。     

黑龙江省克山病病区内外环境硒水平及人群柯萨奇B组病毒感染现况调查

目的 了解黑龙江省克山病病区内外环境硒水平及柯萨奇B组病毒(CVB)人群感染情况,为采取有针对性的防治措施提供依据.方法 在克山病病区设立病区病例组和病区对照组,在非病区设立非病区对照组,采集血液样品用于检测血硒及CVB IgM抗体,同时采集病区和非病区土壤、粮食用于硒测定;硒的测定采用氢化物发生原子荧光光度法.CVB IgM抗体采用酶联免疫吸附法(ELISA)检测.结果 病区土壤、玉米、小麦、大豆含硒量[(0.092±0.011)、(0.003±0.001)、(0.005±0.003)、(0.006±0.001)mg/kg]均低于非病区[(0.198±0.016)、(0.012±0.004)、(0.037±0.007)、(0.037±0.008)mg/kg],二者比较差异均有统计学意义(t值分别为17.007、8.551、15.842、12.109,P<0.01).病区病例组血硒[(34.803±13.302)μg/L]低于病区对照组[(41.235 ±13.571)μg/L],二者比较差异有统计学意义(P<0.05);病区病例组、病区对照组、非病区对照组的CVB感染阳性率分别为90.0%(36/40)、68.3%(41/46)、45.8%(22/48),病区和非病区CVB感染的比值比(OR)为3.957,95%可信区间为1.898～8.246;病区病例组和病区对照组CVB感染的OR值为4.171,95%可信区间为1.298～13.404;CVB感染组与未感染组血硒水平比较,差异无统计学意义(t=1.179,P>0.05).结论 黑龙江省克山病病区仍存在低硒及CVB感染情况.     

低硒与低营养复合因素致大鼠心肌损伤的实验研究

目的 探讨长期低硒与低营养复合因素膳食对大鼠心肌损伤的作用。方法 将Wistar大鼠40只随机分成2组，实验组用低硒、低蛋白、低维生素E饲料喂养，对照组用常硒、常蛋白、常维生素E饲料喂养，至第26周处死大鼠。测定全血谷胱甘肽过氧化物酶（GSH-Px）活性，血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）水平和心脏质量与体质量比值。光镜、电镜下观察心肌结构改变。结果 实验组大鼠全血GSH墩活性水平显著低于对照组（t=58．79，P〈0．01）；实验组与对照组大鼠血清CK分别为（1．456±0．291）、（1．057±0．251）kU／L，CK—MB分别为（1．138±0．215）、（0．722±0．130）kU／L，LDH分别为（864．96±137．57）、（404．65±72．49）U／L，组间比较差异有统计学意义（t=4．71、7．46、13.42，P〈0．01）。大鼠心脏质量与体质量比值，实验组[（3．608±0．166）g／kg]显著高于对照组[（3．140±0．114）g／kg]，组间比较差异有统计学意义（t=10．62，P〈0．01）。光镜下实验组大鼠心肌出现散在小灶状坏死，检出率为66．67％，两组心肌病变检出率差异有统计学意义（χ^2=7．25，P〈0．01）。电镜下实验组大鼠部分心肌细胞线粒体嵴断裂，基质密度下降，细胞核固缩，早期凋亡形成，肌丝走行紊乱甚至溶解；对照组大鼠心肌细胞膜结构完好，线粒体嵴清晰，基质密度适中。结论 长期低硒、低营养复合因素膳食可引起大鼠心肌组织出现损伤。     

克山病患者抗氧化能力测定

Objective To explore the relationship between myocardial damage and antioxidant capacity in vivo of Keshan disease patients and to analyze the possible pathogenesis. Methods In the period from 2005 to 2006, 41 chronic and latent Keshan disease cases were chosen as the case group from such serious endemic areas as Yongjin Village, Xinfa Village of Fuyu County, Fuan Village of Shangzhi County, Xinghuo Village of Wudalianchi County, 61 healthy people from the same area as internal controls, 48 healthy people from Xianglansan Village of Wangkui County, an un-endemic area, as external control. Fasting peripheral venous blood was collected from all the people. And blood selenium, glutathione peroxidase(GSH-Px) and suporoxide dismutase.(T-SOD) activities, malondialdehyde (MDA) levels were examined. Results Blood selenium level of the patient group [(34.80±13.30) μg/L], GSH-Px[(104.10±34.19)U/L]and T-SOD[(92.16±17.98)×103 U/L]actives were significantly lower than the internal control group [(41.24±13.57)μg/L, (118.57±25.49)U/L, (104.82±13.56)×103 U/L]and the external control group [(48.33±16.51)μg/L, (155.00±24.01)U/L, (108.48±12.73)×103 U/L], respectively, with a statistically significant difference(all P < 0.05). MDA level of the patient group[(7.12± 1.37)μmol/L]was higher than that in the internal control group[(5.36±1.18)μmol/L]and the external control group[(5.22±0.83)μmol/L]with a statistically significant differences(both P < 0.05). The blood selenium level, GSH-Px activity of internal control group was resoectively lower than that in the external control group, the differences being statistically significant(beth P < 0.05). Conclusions Selenium deficiency may lead to reduced antioxidant capacity and enhanced oxidative damage in Keshan disease patients in vivo. There may be a certain relationship between oxidative stress disorder and myocardial damage of Keshan disease.     

克山病患者抗氧化能力测定

Objective To explore the relationship between myocardial damage and antioxidant capacity in vivo of Keshan disease patients and to analyze the possible pathogenesis. Methods In the period from 2005 to 2006, 41 chronic and latent Keshan disease cases were chosen as the case group from such serious endemic areas as Yongjin Village, Xinfa Village of Fuyu County, Fuan Village of Shangzhi County, Xinghuo Village of Wudalianchi County, 61 healthy people from the same area as internal controls, 48 healthy people from Xianglansan Village of Wangkui County, an un-endemic area, as external control. Fasting peripheral venous blood was collected from all the people. And blood selenium, glutathione peroxidase(GSH-Px) and suporoxide dismutase.(T-SOD) activities, malondialdehyde (MDA) levels were examined. Results Blood selenium level of the patient group [(34.80±13.30) μg/L], GSH-Px[(104.10±34.19)U/L]and T-SOD[(92.16±17.98)×103 U/L]actives were significantly lower than the internal control group [(41.24±13.57)μg/L, (118.57±25.49)U/L, (104.82±13.56)×103 U/L]and the external control group [(48.33±16.51)μg/L, (155.00±24.01)U/L, (108.48±12.73)×103 U/L], respectively, with a statistically significant difference(all P < 0.05). MDA level of the patient group[(7.12± 1.37)μmol/L]was higher than that in the internal control group[(5.36±1.18)μmol/L]and the external control group[(5.22±0.83)μmol/L]with a statistically significant differences(both P < 0.05). The blood selenium level, GSH-Px activity of internal control group was resoectively lower than that in the external control group, the differences being statistically significant(beth P < 0.05). Conclusions Selenium deficiency may lead to reduced antioxidant capacity and enhanced oxidative damage in Keshan disease patients in vivo. There may be a certain relationship between oxidative stress disorder and myocardial damage of Keshan disease.     

克山病病区普通人群心电图结果分析

克山病是一种地方性心肌病。自有记载以来已有70多年历史。20世纪50年代克山病多以急型、亚急型发病为主要表现,而目前克山病患者以潜在型或慢型多见,临床表现多不典型。但病区内