新时期军队医院卫生人力资源管理初探

通过对军队医院卫生人力资源管理现状的分析,提出新时期军队医院卫生人力资源管理的应对策略:树立正确的用人观念;引入竞争的用人机制;建立有机的学习型医院;树立长效的激励机制;进行科学的绩效评估;做好员工职业生涯的规划。从而为军队医院卫生人力资源管理提供有力保障。     

肝外门静脉高压12例诊治体会

目的 探讨肝外门脉高压的诊断和外科治疗经验.方法 回顾性分析12例肝外门脉高压患者的临床资料.全部病人行彩超或磁共振血管造影(MRA)、螺旋CT血管造影(CTA)检查,9例行间接门静脉造影或下腔静脉造影.10例行手术治疗,2例行保守治疗.结果 手术顺利,无手术并发症和死亡.术后病人腹水消退,脾亢消失,未再发生上消化道出血.结论 彩超、MRA、CTA、间接门静脉造影及下腔静脉造影是诊断肝外门脉高压的主要手段,分流手术安全有效.     

巨细胞病毒在慢性乙型肝炎患者肝组织中的表达

目的探讨巨细胞病毒(CMV)在慢性乙型肝炎(CHB)患者肝组织中表达意义。方法采用免疫组化以抗-CMV单克隆抗体对76例CHB患者肝组织进行检测,然后用抗-HBcAg多克隆抗体和抗-CMV单克隆抗体双标记技术在CHB患者同一张肝组织切片上显示两种病毒分布特点。结果轻度和重度慢性肝炎患者CMV检出率无显著差异(P=0.444),而重度CHB患者中CMV表达阳性细胞明显多于轻度患者(P=0.012)。双标记染色显示CMVAg和HBcAg多数表达于肝小叶内同一区域肝细胞甚至同一肝细胞内,也可见于肝小叶中不同部位。结论CHB患者更易重叠CMV感染,并且其感染程度与肝组织的活动性病变密切相关。     

怎样做一名优秀的内镜医生

怎样做一名优秀的妇科内镜医生？我想主要有五个方面的问题。第一个是妇科内镜，作为一个微创外科，是二十一世纪外科医生和妇产科医生必备的技术。无论是在县级医院，还是在省级医院，这是一项基本技术。第二个是如何选择手术的适应证。就像我们做任何手术一样，要选择一个最适合的手术方式。实际上就是要选择什么样的病人适合做腹腔镜手术。第三个就是用这样一个手术方式来诊断治疗病人，要掌握这个病诊断治疗的基本原则。第四个就是要掌握一些基本的要领来预防或者避免并发症的发生。最后一个就是讲怎样培训自己成为一个合格的、优秀的妇科内镜医生。     

不同部位和不同生长年限白芍中的芍药苷含量测定

目的采用高效液相色谱法检测不同部位和不同生长年限白芍中的芍药苷含量。方法以C18化学键合硅胶柱分离芍药苷,甲醇-0.05mol/L磷酸二氢钾溶液-醋酸-异丙醇(67∶173∶4∶4)为流动相,UV检测波长为230nm进行测定。结果不同部位和不同生长年限白芍中的芍药苷含量差异较大。结论生长年限越长其芍药苷含量相对较高,根茎中的芍药苷含量比根相对高。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

产褥期上矢状窦及脑静脉血栓形成的CT诊断

目的 探讨CT对产褥期脑静脉血栓（CVT)的诊断价值。方法 对13例临床怀疑或随诊CVT的患者行CT检查。患者23～25岁，产后3～17天发病，主要临床表现为头痛、呕吐、视乳头水肿等高颅压症状，局灶性神经功能缺损，偏瘫、失语、抽搐发作及意识障碍等。结果 CVT在CT上表现为脑水肿低密度区内小片状高密度出血灶，特征性变化为平扫时可见硬膜窦内异常高密度及脑实质静脉增高即“条索征”，强化后硬膜窦内呈“空三角征”。结论 CT可准确地显示CVT的图像学改变，与MRI、MRV、DSA技术相结合，是诊断脑静脉病变可靠、有效和快捷的检查方法。x     

一起食用狗肝引起食物中毒的调查

2004年1月9日14时，吉林省航道管理局18名职工在共同进餐后出现发烧、头痛、恶心、呕吐等症状，送至医院住院治疗。接到报告后吉林市卫生局卫生监督所迅速组织卫生监督员进行现场调查和采样取证，通过流行病学方法对调查资料分析判断，同时依据实验室检验结果，认为是一起因食用狗肝引起的急性维生素A中毒事件，同时围绕该起食物中毒的发生过程及原因展开了一系列的调查与分析。     

慢性乙型肝炎治疗过程血清转氨酶变化水平与HBeAg转换的关系

目的探讨慢性乙型肝炎治疗过程中血清转氨酶变化水平与HBeAg转换的关系。方法选择经过专科治疗的HBeAg阳性慢性乙型肝炎患者136例，按转氨酶水平分为升高型、降低型、稳定型三类，观察治疗后血清转氨酶变化水平与HBeAg转换的关系。结果血清HBeAg转换率高低随血清转氨酶变化水平不同而显现有差异，升高型53．73％、降低型33．33％、稳定型12．12％。其中，升高型、稳定型与降低型相比，均有显著性差异（P〈O．05）；稳定型与升高型相比有非常显著性差异（P〈O．005）。结论治疗HBeAg阳性的慢性乙型肝炎时，应将血清转氨酶变化水平与血HBeAg转换这一主体疗效因素进行有机联系。当血清转氨酶呈现升高型变化时，可能预示着会出现血清HBeAg转换的最佳治疗应答效果。     

股骨头坏死治疗仪对股骨头坏死患者骨结构修复及髋关节功能的影响

目的:探讨股骨头坏死治疗仪对股骨头坏死患者髋关节功能及骨结构修复的影响。方法:2000-01/2002-12随机抽取股骨头坏死患者90例,治疗组60例采用股骨头坏死治疗仪配合口服中药治疗,对照组30例单纯口服中药治疗。评估两组患者治疗前后的髋关节疼痛评分、生活能力评分,髋关节活动度评分,行走距离评分。结果:髋关节疼痛评分治疗前治疗组为(15.47±3.25)分,治疗后为(26.80±6.56)分,对照组治疗前为(15.20±4.38)分,治疗后为(28.00±6.21)分,两组治疗前后差异均有显著性意义(t=12.30,8.35,P<0.01)。生活能力评分治疗组治疗前为(11.75±2.73)分,治疗后为(18.17±3.44)分,对照组治疗前为(10.00±4.38)分,治疗后为(28.00±6.21)分,两组治疗前后比较差异均有显著性意义(t=25.17,8.35,P<0.01)。髋关节活动度评分治疗组治疗前为(9.67±2.88)分,治疗后为(13.87±3.57)分,对照组治疗前为(8.80±3.04)分,治疗后为(12.13±3.23)分,两组治疗前后比较,差异有显著性意义(t=24.24,5.76,P<0.01)。行走距离评分治疗组治疗前为(6.80±1.73)分,治疗后为(10.25±1.66)分,对照组治疗前为(5.10±1.79)分,治疗后为(8.90±2.78)分,两组治疗前后比较差异有显著性意义(t=32.91,6.67,P<0.01)。结论:“股骨头坏死治疗仪”对股骨头坏死患者的髋关节疼痛、髋关节活动度、行走距离均有切实的改善作用。