PDCA循环法在ICU微量注射泵安全给药中的应用

目的探讨PDCA循环法在ICU微量注射泵安全给药中的应用效果。方法运用计划（Plan）、实施（Do）、检查（Check）、处理（Action）循环法,对在ICU微量注射泵安全给药中存在的护理缺陷和不安全隐患进行质量控制。结果实施控制半年后床头交接班制度完善率由实施前的80%上升至100%,微泵给药准确率由实施前的90%达100%,微泵给药药物配伍禁忌发生率由实施前的10%下降至0%,完全达到了预期目标。结论 PDCA循环法保证了ICU微量注射泵用药安全,提升了护理质量,保证了患者用药安全,它是一种确保护理质量不断保持高水准的先进方法,值得大力推行。     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.     

心电图正常的急性心肌梗死1例

患者男性,45岁.因反复胸痛半月,加重9h入院.患者近半月来轻度体力活动后即感胸痛,休息数分钟缓解,9h前突发胸骨后剧烈疼痛、压榨感,持续不缓解,伴恶心、呕吐、出汗,无黑矇、晕厥,无呼吸困难.     

心脏瓣膜病患者围手术期血浆脑钠肽的变化及其临床意义

目的 观察心脏瓣膜病患者血浆脑钠肽(Brain natriuretic peptide,BNP)在围手术期的变化,并探讨其临床意义.方法 36例心脏瓣膜病患者根据美国纽约心脏病协会(NYHA)分级,评估术前心功能,经胸超声心动图测量左室射血分数(LVEF),并在术前1d、术后1d、术后7d测定血浆BNP浓度.分析围手术期血浆BNP的变化,结合心功能分级和LVEF结果,探讨其临床意义.结果 36例患者住院期间无死亡病例,1例术后出现心包填塞,行二次开胸止血术,术后平均呼吸机辅助时间为(22.40±8.65)h,术后ICU平均治疗时间为(5.10±2.45)d.患者术后1d血浆BNP较术前1d明显升高(P＜0.05),术后7d血浆BNP较术后1d明显下降(P＜0.05),略高于术前1d水平(P＞0.05).患者心功能NYHA分级与术前1d血浆BNP浓度水平呈正相关(r=0.814,P＜0.05).患者术前1d血浆BNP与术前LVEF呈明显负相关(r=-0.614,P＜0.05);术后7d血浆BNP与术后LVEF呈明显负相关(r=-0.672,P＜0.05).对于术后LVEF＜50％和≥50％的患者,术前1d血浆BNP浓度的平均值分别为(912.42±110.75) pg/ml和(561.27±127.79) pg/ml (P＜0.05).对于术后呼吸机辅助时间＜24h和≥24 h的患者,术前1d血浆BNP浓度的平均值分别为(644.83±138.93) pg/ml和(778.78±157.82) pg/ml (P＞0.05).结论 心脏瓣膜病患者围手术期血浆BNP浓度检测方便,能正确反映心功能状态.     

冠心病肿瘤坏死因子和可溶性肿瘤坏死因子受体活性

本研究旨在通过测定冠心病患者血清肿瘤坏死因子（ＴＮＦα）和可溶性肿瘤坏死因子受体（ＳＴＮＦＲⅡ）以探讨其在冠心病发病中的意义。１对象和方法冠心病患者３０例,男性２４例,女性６例,平均年龄５９．８±１４．０岁;正常对照者３０例,男性２４例,女性６例...     

定量分析碘染后色变数据诊断早期食管癌的初探

目的 初步探讨计算机定量分析食管黏膜碘染色后的色变数据诊断早期食管癌的价值.方法 应用Lugol碘液对58例患者食管的可疑病灶进行染色,采集图像,进行病理活检,应用计算机的颜色定量分析软件对黏膜颜色变化进行定量分析,并与病理结果进行比较.结果 58例患者共发现62个异常染色灶,其中黏膜组织慢性炎症19个,低级别上皮内瘤变13个,高级别上皮内瘤变11个,鳞状细胞癌19个.颜色分量参数R/R'(红色)及H/II'(色调)在上述4组不同的病理改变间有统计学意义(P＜0.05).结论 计算机定量分析食管黏膜碘染色后的色变数据,能较好地反映病灶的病理性质,帮助提高活检的准确性并有望提高食管早期癌的诊断率.