目标管理在医疗设备维修管理中的应用与效果分析

分析目标管理在医疗设备维修管理中的应用效果,选取2019年1月至2020年12月医疗设备维修数据,对比分析实施目标管理前后的设备整体平均维修时长、维修关单良好率、基础性设备(病床、监护仪及泵类)平均维修时长和工程师维修关单良好率,为医院维修管理精细化实践提供参考。     

尿毒症血透患者血浆瘦素与胰岛素水平的关系

应用放免法测定尿毒症血透患者及健康人 (各 3 0例 )血浆中瘦素、C肽及胰岛素水平。结果 :血透组血浆瘦素及C肽质量浓度明显高于对照组 (P <0 .0 1 ) ;瘦素质量浓度与体质量指数 (BMI)、C肽及胰岛素呈正相关 (P <0 .0 5 )。提示 :尿毒症维持性血透患者血浆瘦素及C肽质量浓度明显升高 ,瘦素与BMI、C肽及胰岛素水平呈正相关     

终末期肾衰维持性血透死亡70例临床分析

目的 探讨终末期肾衰（ESRF）在维持性血液透析（MHD）中的死因及离治对策。方法 对70例在MHD中死亡的ESRF者主要并发症及死因作回顾性分析。结果 近13年来MHD的ESRF患者死亡70例,平均 透析54.7周,93.8次。原发病以慢性肾小球肾炎为主（71.4%)。MHD之前已有高血压,且每次血透前、后伴发高血压次数超过其血透总次数的30%者47例。死因：脑出血27例,心衰23例,心率失常6例,消化道大出血4例,心肌梗死3例,肺结核1例。其中多囊肾中3例（3／4）、痛风性肾病3例（3／3）、高血压肾病中2例（2／3）均死于脑出血。结论 ESRF在MHD中主要死因是脑出血和心衰,高血压是主要危险因素应予良好控制。多囊肾和痛风引起的ESRF在MHD中易因脑出血而死亡。     

血浆内皮素和心钠素与维持性血液透析患者高血压关系的研究

目的：探讨血浆瓦皮素（ET）和心钠素（ANP）在维持性血液透析患者高血压中的作用。方法：尿毒症患者分为维持性血液透析不使用促红细胞生成素（EPO）组、维持性血液透析使用EPO组及尿毒辣症非透析组,以上3组各自分为高血压组和高血压正常组,另设健康对照组。应用放射免疫法检测血浆ET－1和ANP水平。结果：所有尿毒症患者血浆ET－1和ANP水平均高于健康对照组,维持血液透析使用EPO组血浆ET－1和ANP水平高于维持特性血液透不使用EPO组（P＜0．05）;各组中高血压亚组的血压ET－1水平及ET－1／ANP比值均高于其相应的患者的高血压同 浆ET－1水平井高升以及ET－1和ANP比值的增大有密切关系。     

Iron,coronary artery calcification,and mortality in patients undergoing hemodialysis

ObjectiveA high coronary artery calcification score (CACS) may be associated with high mortality in patients undergoing hemodialysis (HD). Recently, effects of iron on vascular smooth muscle cell calcification have been described. We aimed to investigate the relationships between iron, CACS, and mortality in HD patients.MethodsWe studied 173 consecutive patients who were undergoing maintenance HD. Laboratory data and Agatston’s CACS were obtained at baseline for two groups of patients: those with CACS ≥400 (n = 109) and those with CACS <400 (n = 64). Logistic regression analyses for CACS ≥400 and Cox proportional hazard analyses for mortality were conducted.ResultsThe median (interquartile range) age and duration of dialysis of the participants were 67 (60–75) years and 73 (37–138) months, respectively. Serum iron (Fe) and transferrin saturation (TSAT) levels were significantly lower in participants with CACS ≥400 than in those with CACS <400, although the serum ferritin concentration did not differ between the groups. TSAT ≥21% was significantly associated with CACS ≥400 (odds ratio 0.46, p<0.05). TSAT ≥17%, Fe ≥63 µg/dL, and ferritin ≥200 ng/mL appear to protect against 5-year all-cause mortality in HD patients, independent of conventional risk factors of all-cause mortality (p < 0.05).ConclusionWe have identified associations between iron, CACS, and mortality in HD patients. Lower TSAT was found to be an independent predictor of CACS ≥400, and iron deficiency (low TSAT, iron, or ferritin) was a significant predictor of 5-year all-cause mortality in HD patients.     

Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Background There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries.Methods In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR.Results The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality.Conclusions In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.     

Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis

PurposeThis study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis.MethodsThis was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017.ResultsParticipants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster.ConclusionsA different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster.