PCT水平、APACHE III及MODS评分对SIRS患者预后预测性的临床比较

目的比较PCT(前降钙素)水平、APACHEIII评分和MODS评分对SIRS(系统性炎症反应综合征)患者预后的预测能力。方法将1998年11月～2004年11月间入住我院ICU,满足SIRS标准的95例患者纳入此次研究。PCT在动脉血样本中检测,记录患者入院第1个24h后APACHEIII和MODS评分,连续2周每天记录1次或直到患者出院或死亡。将患者按预后分成两组,生存者(n=71)和非生存者(n=24)。按照PCT水平的变化结果又分为3组下降组、升高组、无变化组。结果在整个研究期间APACHEIII和MODS评分在生存者和非生存者之间都有显著区别,但是PCT在生存者和非生存者之间区别仅表现在第1到第7天,入院当天按PCT的水平所分的三组中生存者和非生存者PCT的值无显著性区别。PCT、APACHEIII评分和MODS评分第1天预测死亡率的ROC曲线下面积分别为0.690,0.915,0.913。结论PCT可以作为SIRS患者死亡率的预测因子,但是可靠性低于APACHEIII和MODS评分。     

青少年痛经及相关因素分析

目的:调查痛经及其相关因素对青少年的影响,以便有效开展青春期保健教育。方法:采取整群抽样方法对江门市区以及乡镇中学部和大专院校女生进行问卷调查,对有效样本782份采用SPS10.0数据统计分析。结果:痛经发生率为54.2%,初潮年龄、月经周期、经期暴饮暴食及抽烟喝酒与痛经无直接关系,P值>0.05。月经期参加不适宜运动、经期冷水淋浴、经期不良情绪、吃生冷食物与痛经有直接关系。经χ2检验,P值依次为χ2=13.350,P<0.001,χ2=4.054,P<0.05,χ2=28.935,P<0.001,χ2=4.356,P<0.005。结论:应加强青少年重视月经生理的宣传教育,消除她们的恐惧、焦虑及精神负担,加强经期卫生,避免剧烈运动、过度劳累和防止受寒,做好经期卫生保健,是预防妇女疾病的重要环节之一,有利于青少年健康成长。     

Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?

OBJECTIVE—Several methods exist for estimating the risk of perioperative mortality based on preoperative risk factors; graphical methods such as the variable life adjusted display (VLAD) can be used to examine how an individual surgeon's performance for a series of operations fares against what would be expected, given the case mix. This study aimed to devise a method for assessing the natural variation in outcome in order to assist with making judgements about individual performance, in particular whether seemingly poor performance could have occurred by chance.
METHOD—The risk scoring system has been derived and validated locally for cardiac surgery. A method is described for calculating the probability that an observed number of deaths occurs within a sequence of operations if perioperative mortality is regarded as a chance event with an expected value derived from the risk score. To illustrate this method, nested prediction intervals are superimposed onto VLAD plots for a series of 393 isolated coronary artery bypass and isolated valve operations performed by a single surgeon.
RESULTS—Using the locally derived risk score, the VLAD plot for the individual surgeon shows a net life gain of about 6 over the predicted number of survivors, which is observed to be within the 90% prediction interval. If the Parsonnet scoring system is used instead of the locally derived risk score, the net life gain is considerably overestimated.
CONCLUSIONS—The nested prediction intervals are straightforward to generate and can be integrated into a visually informative display. As an indication of the inherent variability in outcome, they have a valuable role in the monitoring of surgical performance.


Keywords: perioperative mortality; variable life adjusted display; locally derived risk score; Parsonnet score     

Application of revised trauma evaluation program in emergency treatment of multiple injuries

Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.     

当归油对痛经小鼠子宫组织中一氧化氮和钙离子的影响

目的探讨当归油治疗原发性痛经的作用机理。方法通过测定痛经模型小鼠子宫重量、子宫组织中一氧化氮和钙离子水平,研究当归油对子宫的作用。结果与阴性组比较,当归油能够减少催产素所致痛经小鼠的扭体次数(P<0.01),对痛经模型小鼠子宫重量无明显影响(P>0.05);给药组小鼠子宫组织中一氧化氮的含量显著升高(P<0.05);而钙离子含量显著降低(P<0 01)。结论当归油对催产素所致痛经小鼠扭体有显著抑制作用,并可升高子宫组织中一氧化氮水平,同时降低钙离子水平。这些作用可能是当归油治疗原发性痛经的部分机制。     

全麻下超快速脱毒复合洛菲西定治疗海洛因依赖

目的探讨全麻下超快速脱毒(UROD)复合洛菲西定治疗海洛因依赖的效果。方法选择60例海洛因依赖者,随机分成两组。对照组行常规UROD,试验组在此基础上,术前晚口服洛菲西定0.4mg,术中再给予1.6mg。对两组病人围术期腹泻,丙泊酚用量及戒断症状评分进行评估。结果与对照组相比,试验组的丙泊酚用量(P<0.001),术后24h内腹泻的发生率(P<0.01),术后24h时主观戒断症状的评分(P<0.001)和客观戒断症状评分(P<0.05)的差异均有显著性。结论UROD复合洛菲西定用于海洛因依赖者脱毒,可以明显减轻戒断症状并降低费用,值得推广。     

355例晚期非小细胞肺癌预后因素分析

目的 回顾分析355例晚期非小细胞肺癌（NSCLC）的预后因素，为探索个体化治疗提供参考依据。方法 1988年3月至2000年10月35例经组织学或细胞学确诊的、未经治疗的晚期NSCLC患者（Ⅲ期134例，37.75%；Ⅳ期221例，62.25%），至少接受2周期化疗。观察疗效和生存期，分析预后因素。结果 全组无CR病例，PR101例，SD147例，有效率为28.45%，肿瘤控制率为69.86%，中位生存期为16月。1、2、3和5年生存率分别为58.41%、29.35%、14.60%和8.60%。Ⅳ期患者只闰生存期为14月，1、2、3和5年生存率分别为54.62%、25.59%、12.70%和6.73%。COX比例风险模型分析显示治疗后ECOG评分改善＋稳定（P＝0.0440)和二线化疗失败后原方案加用γ－IFN或TAM及原发灶放疗等可能有利于生存期的改善。     

Pediatric risk of mortality (PRISM) score in meningococcal disease

To assess the pediatric risk of mortality (PRISM) score as a prognostic scoring system in severe meningococcal disease, the files of 53 consecutive patients admitted to a tertiary pediatric intensive care with a clinical diagnosis of meningococcal disease and positive cultures from blood and/or cerebrospinal fluid were analysed. PRISM-score-based expected mortality was compared with observed mortality. Expected mortality in the whole study population was 29% while observed mortality was 19% (P < 0.05). The highest expected and observed mortality was found in septicaemic patients without (documented) meningitis, while meningitis patients without septicaemia had the lowest mortality. All patients with a mortality risk below 18.3% (n = 29) survived whereas all those with a mortality risk of 65% or higher (n = 7) died. Of the 17 patients with a mortality risk between 18.3% and 63.9%, 14 survived and 3 died. The area under the receiver-operating characteristic (ROC) curve was 0.94, which is at least comparable with the best-performing meningococcal-disease-specific scoring systems. Conclusion The PRISM score is a useful generic measure of severity of illness in meningococcal disease and can be used to determine the effectiveness of different treatment strategies. Received: 5 May 1999 / Accepted: 11 January 2000     

羊水性状及脐动脉S/D与新生儿Apgar评分关系的探讨

目的分析羊水指数、脐动脉S/D和新生儿Apgar评分资料,探讨其相互关系。方法37周以上、在分娩前3d内接受了超声检查的孕妇263例为研究对象。年龄（30.37±3.27）岁,孕龄（39.24±1.25）周;排除胎儿畸形、中度以上妊娠高血压综合征、严重孕妇疾病等异常情况。四象限法测量羊水指数,根据内部回声情况对羊水性状进行评价;频谱多普勒超声测量脐带动脉SV、DV和S/D;胎儿出生后进行Apgar 1min评分。统计学相关分析。结果羊水指数和羊水性状与胎儿脐带动脉S/D显示了一致的变化;以胎儿脐带动脉S/D≥3.0,Apgar 1 min评分≤7有22例,二者呈显著相关（R=0.667,P=0.000）;羊水指数和羊水性状与新生儿Apgar 1 min评分也显示了良好的相关性（R分别为0.667,0.513和0.765,P=0.000）。结论羊水指数和羊水性状与胎儿脐带动脉S/D对评价新生儿缺氧有相同的意义。     

平衡计分卡在医院分配制度改革中的应用实践

介绍了平衡计分卡（BSC）在我院分配制度改革中的应用实践和经验以及显著成效。极大激发了医院员工的工作热情，医、教、研工作得到全面发展，医院综合发力得到了提高。医院业务收入以每年2位数的速度增长，同时管理费用等支出逐年减少，医院发展呈现出前所未有的生机和活力，同时也取得了较好的社会效益和经济效益。