医学装备物资溯源管理系统持续评估与改进的效果分析

目的:研究医学装备物资溯源管理系统持续评估与改进的效果。方法:选取医院151名设备使用管理相关人员,按照医学装备管理方法的不同将其分为观察组(74名)和对照组(77名),观察组采用医学装备物资溯源管理系统的管理模式,对照组采用传统设备管理模式。采用自制满意度调查问卷的方法,调查两组对医学装备管理的满意度,对比分析两组对医学装备管理的中长期效果评价、运营绩效和管理满意度。结果:观察组医学装备管理的中期优良率为91.89%,长期优良率为94.59%,明显高于对照组的79.22%和81.82%,差异有统计学意义(x~2=6.495,x~2=7.837;P<0.05);观察组医学装备管理的满意度为95.95%,明显高于对照组的83.12%,差异有统计学意义(x~2=8.784,P<0.05);观察组平均操作时间、无关操作时间和差错流程数均低于对照组,差异有统计学意义(t=16.620,t=31.638,t=15.745;P<0.05)。结论:医学装备物资溯源管理系统对医学装备管理的中长期效果显著,能够缩短管理操作时间、减少差错流程、提高管理水平和保护患者权益,可实现医学装备全生命周期的信息化管理。     

无创高频振荡通气在极低出生体重早产儿呼吸窘迫综合征初始呼吸支持治疗中的应用

目的探讨经鼻无创高频振荡通气(NHFOV),在呼吸窘迫综合征(RDS)极低出生体重早产儿初始呼吸支持治疗的临床疗效。 方法选择2018年2月至2020年4月,于徐州市中心医院新生儿重症监护病房(NICU)治疗的92例RDS极低出生体重早产儿为研究对象。采用随机数字表法,将其分为NHFOV组(n＝48,采取NHFOV治疗)及经鼻持续气道正压通气(NCPAP)组(n＝44,采取NCPAP治疗)。对2组RDS极低出生体重早产儿一般临床资料,无创通气治疗前、后动脉血气分析指标,疗效,呼吸支持治疗相关并发症发生率及患儿死亡率,采用成组t检验、χ²检验及Mann-Whitney U检验进行统计学比较。本研究经徐州市中心医院医学伦理委员会审核批准(审批文号：XZXY-LJ-20170328-006),并且与患儿监护人均签署临床研究知情同意书。 结果①一般临床资料比较：2组RDS极低出生体重早产儿的性别、出生胎龄与体重及生后1、5 min Apgar评分,入院日龄及分娩前24 h母亲糖皮质激素使用率等一般临床资料比较,差异均无统计学意义(P>0.05)。② 2组RDS极低出生体重早产儿动脉血气分析指标组间比较：NHFOV组RDS极低出生体重早产儿无创通气治疗后1 h、24 h动脉血二氧化碳分压(PaCO₂)分别为(45.8±6.5) mmHg(1 mmHg＝0.133 kPa)及(40.8±4.7) mmHg,均显著低于NCPAP组的(49.3±5.7) mmHg及(44.2±5.2) mmHg;治疗后1 h、24 h动脉血氧分压(PaO₂)与吸入氧浓度分数(FiO₂)比值(P/F)分别为(198.8±30.5) mmHg及(215.1±32.1) mmHg,均显著高于NCPAP组的(176.4±28.1) mmHg及(190.0±29.7) mmHg,并且上述差异均有统计学意义(t＝2.809、3.301、3.663、3.881,P＝0.003、<0.001、<0.001、<0.001)。③2组动脉血气分析指标分别进行组内比较均为：无创通气治疗后24 h的pH值及治疗后1、24 h的PaCO₂水平,均较治疗前改善,而且治疗后24 h的P/F值高于治疗后1 h,并且差异均有统计学意义(P<0.05)。④无创通气疗效比较：NHFOV组RDS极低出生体重早产儿无创通气治疗后,肺表面活性剂(PS)使用率及有创机械通气率(22.9%、6.3%),均显著低于NCPAP组(45.5%、20.5%),并且差异均有统计学意义(χ²＝5.219、4.084,P＝0.022、0.043)。2组RDS极低出生体重早产儿无创通气时间、柠檬酸咖啡因使用率、频繁呼吸暂停发生率及总用氧时间比较,差异均无统计学意义(P>0.05)。⑤2组RDS极低出生体重早产儿鼻损伤、肺气漏、新生儿坏死性小肠结肠炎(NEC)、Ⅲ~Ⅳ级脑室内出血(IVH)、早产儿视网膜病(ROP)(≥Ⅱ期)及支气管肺发育不良(BPD)发生率,以及患儿死亡率比较,差异均无统计学意义(P>0.05)。 结论与NCPAP比较,NHFOV用于RDS极低出生体重早产儿初始呼吸支持治疗,能改善氧合、减少二氧化碳(CO₂)潴留、减少有创机械通气及PS使用,同时不增加呼吸支持治疗相关并发症发生。     

连续性肾脏替代治疗22例危重病例疗效分析

目的总结分析连续性肾脏替代疗法(CRRT)对各类重症疾病的治疗效果,以使CRRT技术能得到更合理的应用,从而提高疗效.方法CRRT治疗的22例重症患者按病因分类,并分别分析了各类疾病CRRT前后神志、肾功能、电解质及生命体征的变化.结果7例肝衰竭及4例多脏器衰竭者经CRRT治疗,2例肝昏迷者神志恢复,4例肾功改善,治疗中生命体征稳定,低血压者血压逐渐平稳,但成活率低.3例因脑卒中所致的高钠血症者在行CRRT治疗4～12 h后血钠恢复正常,1例蛛网膜下腔出血者成活.3例肾移植后急性肾功能衰竭患者行CRRT治疗后6～12 h肾功能恢复正常.结论①对肝衰竭、肝性脑病、肝肾综合征患者,CRRT可改善神志及肾功能,延缓死亡时间,为行肝移植起过渡作用,但不能降低死亡率.②CRRT对脑卒中所致的高钠血症治疗效果好,可为病人康复创造有利的条件.③肾移植后急性肾功能衰竭患者经CRRT治疗后肾功能恢复时间明显缩短,优于常规透析.④对肝衰、多器官功能障碍患者越早行CRRT,治疗效果越好.     

双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎的临床疗效

目的探讨双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎(INP)的临床疗效。方法采用回顾性描述性研究方法。收集2016年4月至2019年7月陆军军医大学大坪医院收治的20例INP病人的临床资料;男11例,女9例;年龄为(42±9)岁。20例病人均行双入路小切口坏死组织清除术,联合术后脓腔持续灌注引流。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊及电话方式进行随访,了解病人发热、腹痛、腹胀、腹泻等临床表现及胰腺周围残余组织感染和生存情况。随访时间截至2020年1月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:20例病人均顺利完成手术,其中14例手术入路为腹上区+左侧腹膜后入路,1例为腹上区+右侧腹膜后入路,5例为腹上区+双侧腹膜后入路。20例病人中,14例行附加手术,其中10例行空肠造瘘术、2例行胃造瘘及空肠造瘘术、1例行腹腔镜胆囊切除及空肠造瘘术、1例行胆囊造瘘术。20例病人手术时间为(228±41)min,术中出血量为100 mL(50~700 mL)。(2)术后情况:20例病人术后开始行0.9%氯化钠溶液脓腔持续灌注引流时间为2 d(1~14 d)。20例病人中,6例发生术后并发症,其中1例为术后胃瘘合并腹腔出血(于术后13 d行剖腹探查止血+胃造瘘术)、1例为术后十二指肠瘘(于术后111 d行胃肠吻合+空肠造瘘术)、1例为术后腹膜后残余组织坏死感染(于术后11 d再次行胰腺周围坏死组织清除引流术)、1例为术后胆囊瘘(于术后71 d行胆囊切除术)、2例为术后胰瘘(经保守治疗后痊愈)。20例病人第1次手术后住院时间为42 d(20~178 d)。(3)随访情况:20例病人均获得术后随访,随访时间为6.0~45.0个月,中位随访时间为14.5个月。随访期间,1例病人继发糖尿病;无病人出现发热、腹痛、腹胀、腹泻等临床表现。20例病人胰腺周围残余组织吸收良好,无病人死亡。结论双入路小切口坏死组织清除术联合持续灌注引流治疗INP安全、可行。     

Quality assurance management methods applied to a local-level primary health care system in rural Nigeria

Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system. Methods. PHC supervisors from Bama Local Government Area were trained for 3 days in the use of QA methods and tools. The supervisors targeted the supervisory system and the health information system (HIS) for improvement. Health worker performance in diarrhoea case management was assessed, using a simulated case, to measure the impact of supervision. A HIS audit assessed data collection forms used by 17 PHC facilities. Gaps in quality were monitored over a 2-month study period and flaws in work processes were modified. Results. PHC supervisors introduced a checklist during monthly visits to facilities to monitor how workers managed cases of diarrhoea. Performance in history-taking, physical examination, disease classification, treatment and counselling improved over the evaluation period. The HIS audit found that a variety of reporting forms were used at PHC facilities. After HIS reporting was standardized, the number of health facilities using a daily disease registry significantly improved during the study period. Conclusions. QA management methods were used by PHC supervisors in Nigeria to improve supervision and the HIS. QA management methods are appropriate for improving the quality of the PHC in Nigeria and in other less developed countries where at least a minimal PHC infrastructure exists.     

Bolusvs. continuous hepatic arterial infusion of cisplatin plus intravenous 5-fluorouracil chemotherapy for unresectable colorectal metastases

A multicenter, randomized Phase 2 study that compared patients, affected by colorectal liver metastases, who received intrahepatic arterial infusion with two different schedules of cisplatin, bolusvs. continuous infusion, and systemic 5-fluorouracil. PURPOSE: The aim of this study was to validate results of a previous Phase 2 trial on bolus cisplatin intrahepatic arterial infusion, which reported a 47 percent response rate and a 32 percent 4-year survival rate for Gennari's Stage 2 patients, with a high rate of neurologic, gastrointestinal, and hematologic toxicity. METHODS: One hundred nine patients were randomized in a Phase 2 study to receive cisplatin intrahepatic arterial infusion (24 mg/m²/day, 15, bolusvs. continuous infusion) and systemic intravenous 5-fluorouracil (250, 375, or 500 mg/m²/day, 15; escalating doses, respectively, at cycles I, II, III, and VI). To avoid neurotoxicity a maximum of six cycles was administered. RESULTS: Preliminary results for the 78 evaluable patients are similar to those of the previous study: response rate 46 percent and at a median follow-up of 16.5 months, the overall survival was 16.5 months, with 45 percent of the patients who received more than 3 cycles alive at 3 years. Toxicity, evaluable in 99 patients, showed a decreased incidence of neurotoxicity and a tolerable gastrointestinal and hematologic toxicity, lower in the cisplatin continuous infusion arm. CONCLUSION: This study clearly shows that cisplatin intrahepatic arterial infusion is able to provide a good palliative effect with a tolerable toxicity.This study was supported in part by Pharmacia-Deltec, Italy.     

Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X)

Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740–925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (55% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1%±6.7% in patients with syndrome X, 61.9%±6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (–3.1±9.5% vs 14.7%±7.4%, P <0.001). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3%±8.3% vs 26.4%±7.3%, P <0.001) with the time to EF overshoot longer (114±43 s vs 74±43 s, P<0.05) in patients with syndrome X. Thus, in patients with syndrome X, left ventricular dysfunction was frequently observed during exercise in spite of normal epicardial coronary arteries. Correspondence to: J. Taki     

Devices for the treatment of diabetes: today

Although single or multiple daily subcutaneous injections of insulin with syringes are the mainstay of insulin delivery techniques for the treatment of diabetes mellitus, several other methods are now available. The present paper will review the main problems occurring with the classical subcutaneous insulin therapy and the possible solutions given by the use of new devices, including more particularly insulin jet injectors, pens, and portable pumps. This review has to be considered as an introduction to the presentations of this symposium devoted to implantable pumps, glucose sensors, and artificial pancreas, respectively.